Danielle Garfinkel, FPwatch Communications Fellow, and the

ACTwatch group, PSI

2017 Annual CUGH Global Health Conference, April 8th

Protecting the Quality of AntimalarialsThe market penetration of non-quality assured artemisinin

combination therapies in eight African countries

Background

ACTwatch was a research project implemented by PSI and Ministries of Health in 13 countries

• 50 outlet surveys conducted between 2008-2017

• Outlet types: public and private hospitals/clinics/health centres, pharmacies, drug stores, retail shops, mobile drug sellers, community health workers

• Outlet surveys measure availability, price, and market share

What is Non Quality-Assured ACT?Not approved by 1)WHO Prequalification Programme; 2) European Medicines Agency; or 3) stringent regulatory authority

▪ 49,500+ outlets audited for antimalarials

▪ 78,558 quality-assured ACTs (QAACTs)

▪ 83,130 non quality-assured ACTs (non-QAACT)

Study countries

Descriptive results

▪ Benin, DRC (Kinshasa & Katanga),

Nigeria, Kenya, Tanzania, Uganda,

Madagascar, and Zambia

0%

20%

40%

60%

80%

100%

20

09

20

11

20

14

20

09

20

13

20

15

20

13

20

15

20

09

20

11

20

13

20

15

20

10

20

11

20

14

20

10

20

11

20

14

20

10

20

11

20

13

20

15

20

10

20

11

20

13

/14

20

15

20

09

20

11

20

14

Benin Kinshasa

DRC

Katanga

DRC

Nigeria Kenya Tanzania Uganda Madagascar Zambia

West & Central Africa East Africa Southern Africa

PE

RC

EN

T O

F O

UT

LE

TS

Private sector availability QA ACT Non QA ACT

Notes:

Significant difference in non-QA ACT availability between first and final survey year: * p<0.05 ** p<0.01 *** p<0.001

The whiskers indicate the interquartile range, or 25th and 75th percentile.

*** *** ***

0%

20%

40%

60%

80%

100%

20

09

20

11

20

14

20

09

20

13

20

15

20

13

20

15

20

09

20

11

20

13

20

15

20

10

20

11

20

14

20

10

20

11

20

14

20

10

20

11

20

13

20

15

20

10

20

11

20

13

/14

20

15

20

09

20

11

20

14

Benin Kinshasa

DRC

Katanga

DRC

Nigeria Kenya Tanzania Uganda Madagascar Zambia

West & Central Africa East Africa Southern Africa

PE

RC

EN

T O

F O

UT

LE

TS

Non QA

ACT: 21%

42%

Non QA

ACT: 23%

48%

Non QA ACT:

61% 83%

Private sector market shareQA ACT Non QA ACT

Notes:

Significant difference in non-QA ACT relative market share between first and final survey year: * p<0.05 ** p<0.01 *** p<0.001

Non-artemisinin therapy Artemisinin monotherapy

0%

20%

40%

60%

80%

100%

2009

2014

2009

2013

2015

2013

2015

2009

2011

2013

2015

2010

2011

2014

2010

2011

2014

2010

2011

2013

2015

2010

2011

2013

2015

2009

2011

2014

Benin Kinshasa Katanga Nigeria Kenya Tanzania Uganda Madagascar Zambia

West & Central Africa East Africa Southern Africa

Pe

rce

nt

pri

vate

an

ti-m

alar

ial

shar

e

*** ***

Additional findings

▪ Non-QAACT was typically more expensive than QA ACT

▪ Non-QAACT private market share tended to be highest among pharmacies and drug stores and in urban areas

▪ 180 unique manufacturers of non-QAACT, most in India and China

Opportunities for reducing non-QA product

penetration in the supply chain

ManufacturersNational Registration

SystemsWholesalers/

RetailersConsumers

• Support manufacturers to establish Good Manufacturing Processes

• Align national registration medicine lists to match drugs that meet global quality assurance standards

• Improve regulation

• Strengthen training and supervision

• Identifying logos• Implement

consumer product authentication technologies

Questions?

Comments?

Thank You! Learn more at www.ACTwatch.info