Bringing Effective Malaria Treatment Closer to the Communities through the Private Sector in Liberia

Access to artemisinin-based combination therapies (ACTs) remains low because their use is limited to public health facilities. Currently, 46 percent of Liberia’s population access malaria medicines through the private sector, where ACTs are more expensive. As a result, the majority of these outlets also stock chloroquine and other monotherapies. To increase Liberians’ access to ACTs through the private sector, the Ministry of Health and Social Welfare ( MoHSW) needs to characterize that market, so it can design an effective distribution and marketing plan. The Strenghtening Pharmaceutical Systems (SPS) program, in collaboration with the MoHSW, conducted a situational analysis of the private sector in Montserrado County, Liberia, to gather the evidence needed to successfully distribute subsidized ACTs through the private sector. Key findings included—

• High availability of unrecommended malaria medicines in the market such as chloroquine, amodiaquine, sulfadoxine-pyrimethamine (SP) and artesunate (AS) tablets
  
• The median price for treating malaria using AS/amodiaquine (the recommended first-line treatment) is 100 Liberian dollars (LRD) or 1.4 US dollars (USD) was over five times more expensive than chloroquine treatment (median LRD 15 or USD 0.21 - exchange rate as of April 2010 USD = 70 LRD)
  
• Most facilities had good storage conditions
  

Following this assessment, 41 stakeholders representing various groups (Ministry of Health MoHSW, academic institutions, professional associations, private sector, nongovernmental organizations, and donors) were briefed on the situation analysis findings and the proposed activities to increase access to subsidized ACTs through private sector in Liberia. Stakeholders came to consensus on the strategies to implement the program. Specifically, the meeting addressed policy, coordination, and regulatory oversight; price and incentives; supply chain strategy; providers training; supervision; monitoring and evaluation; and consumer education. Consequently, SPS and the NMCP developed an implementation plan highlighting key activities and timelines prior to the ACTs distribution which is planned to start in early June 2011.

In collaboration with the NMCP, SPS trained 16 trainers who continue to facilitate training rollout to reach an estimated 1,000 dispensers in the county. Furthermore, SPS has worked with NMCP to select and develop MOU with private sector wholesalers who will distribute subsidized ACTs to nearly 500 private sector retails outlets (pharmacies and medicines stores).

AWith support from US Agency for International Development President’s Malaria Initiative, SPS is building on experience in private sector access initiatives in other countries to help the NMCP implement these activities in Liberia, and has worked closely with the NMCP to implement key activities that would ensure the private sector in Liberia is successfully integrated into the new ACT policy implementation. Activities are phased in approach starting with Montserrado County, which account for 33 percent of Liberia’s population and over 70 percent of retail private pharmacies in the country. Experiences in Montserrado will guide further implementation in the rest of the country.