1. MALARIA TRACK SESSION SUMMARIES_ICIUM 2011 TEAM MEMBERS: EVELYN ANSAH, KOJO YEBOAH-ANTWI, CHARLES EZENDUKA, DAVID OFORI-ADJEI

2. OVERVIEW OF SESSIONS  SESSION 1F: SCALING UP ACCESS TO NEW ANTIMALARIALS – CHALLENGES  SESSION 2F: SCALING UP ACCESS TO NEW ANTIMALARIALS – OPPORTUNITIES  SESSION 3F -PRICES AND AFFORDABILITY OF ACTS IN THE PRIVATE SECTOR  SESSION 4F: THE ROLE OF MEDICINE RETAIL OUTLETS IN IMPROVING ACCESS TO MEDICINES  SESSION 5F. MALARIA: RAPID DIAGNOSTIC TESTS AND PATIENT DEMAND FOR ANTIMALARIALS

3. KEY OBSERVATIONS  In scaling up access to ACTs, both the Public and Private sectors (including the retail market) have critical roles to play.  ACTs are currently more accessible in the public sector.  Where ACTs are available in the private sector they tend to be more expensive.

4. KEY OBSERVATIONS 2  In the private sector monotherapies and cheaper ineffective antimalarials are still predominant due to poor and ineffective regulatory systems  Financial barriers continue to limit access to ACTs in the private sector where healthcare financing is still largely out-of-pocket  The capacity of the private sector to manage malaria effectively is also weak.

5. KEY OBSERVATIONS 3  Adherence to treatment guidelines for malaria including diagnostic test results is generally poor among health workers.  Innovative ways of improving this situation are being tried in many places e.g DTC  Use of RDTs in Community Case Management has been found to be feasible, effective and acceptable

6. KEY OBSERVATIONS 4  There is large variability in results from some RDTs, which could lead to overestimation of malaria positive cases and prevalence (i.e. from false positive results)  Home based care without RDTS leads to over-estimation of malaria prevalence and over-usage of ACTs

7. KEY OBSERVATIONS 5  Pharmacovigilance systems for antimalarials are weak.  Despite the growing resistance of Sulphadoxine Pyrimethamine for treatment of uncomplicated malaria, it is still very useful as prophylaxis against malaria in pregnant women. The standard two doses is still adequate

8. Recommendations 1  NMCPs/MOHs must fully engage the private sector to ensure an effective and comprehensive implementation of the antimalarial policy  There is a need for enforcement of regulations to ensure that monotherapies and ineffective antimalarials are not in the market. 

9. Recommendations 2  Strategies to improve on health worker adherence to treatment guidelines should be adopted by countries  Community Case Management of malaria (ACTs plus RDTs) should be scaled up in all countries  Pharmacovigilance systems should be strengthened

10. Recommendations 3  The private sector needs to be supported (training, access to credit facilities etc), regulated and supervised effectively to enable them perform their critical role  Countries should implement sustainable strategies to ensure affordability of ACTs in the private sector

11. Recommendations 4  Data on clients and services must be collected by the Private sector and incorporated into the National Health Management Information Systems for decision making.  Quality assurance systems for RDTs need to be put in place to ensure reliability of test results

12. Research Gaps 1  Studies on options for deploying ACTs effectively in the private sector are needed  Options for Community Case Management of malaria should be explored within the context of countries

13. Research Gaps 2  Studies to test interventions aimed at improving heath worker adherence to treatment guidelines and diagnostic test results need to be carried out  Options aimed at improving access to quality assured ACTs in the private sector