The Private Sector and Access to Malaria Diagnostics and Treatment in Uganda

Malaria, a disease that has caused so much loss of human life, has also greatly exemplified goodwill for collaboration in Uganda. The Ugandan government with support from donor communities, research and academia has worked to increase coverage of life-saving interventions to impact upon the burden of malaria; there is improved malaria case management, and more pregnant mothers have access to long lasting insecticidal mosquito nets. However, surmountable challenges still exist as we come closer to reaching the MDG (Millennium Development Goal) target of 2015.

The public sector, as the biggest player in delivery of malaria services, continues to lack the capacity to address all the needs of the number one killer disease of both children and adults in Uganda.  An estimated 110,000 malaria related deaths are reported annually affecting mostly children and pregnant women.  The sector’s challenges are also reflected in the suboptimal community response to fevers, whereby nearly half of caretakers and adult patients opt for self-medication, with only a quarter of caretakers seeking treatment at a health facility. This is further compounded by poor access to malaria diagnosis, which still remains poor in Uganda; over 80% of malaria treatments are applied without parasitological testing. As a result, presumptive treatment is very common and treatment decisions are often irrational; emphasizing the need to use of RDTs prior to treatment to improve cost-effectiveness especially when prescribing the preferred efficacious and expensive malaria ACTs.

Before the institution of the Affordable Medicines Facility-malaria (AMFm), the role of the private sector was not well emphasized and promoted. This was big oversight; given 50% of all malaria treatments distributed to patients in Uganda are accessed through drug shops and clinics, especially amongst lower income groups.

JLM Pharmaceuticals Ltd, a for-profit start-up company, being aware of the urgent gap to increase access to malaria diagnostic and treatment, launched a concerted effort to gain better understanding of the current need that can be filled through the private sector. JLM has partnered with Zagaya and WDI institute at the University of Michigan to conceptualize a delivery system for a single bundled malaria product targeting the private sector, through private wholesalers, and drug shops at community level. The bundled product would contain both an RDT together with ACT malaria treatment. We have a lot of optimism for the impact this product will have on malaria service delivery in Uganda, especially incentivizing use of malaria RDTs to inform treatment decisions which will improve patient’s outcomes; improve tracking of product consumption to address issues of drug wastage, and improve access to affordable and quality medicines.

A recent survey conducted by JLM in Rakai, Kampala, and Masaka districts reported 75% of drug shops and clinics having to leave their businesses for 1-2 days to pick malaria diagnostics and treatment from neighboring private wholesaler. This embedded transportation barrier was highlighted by most drug shops and clinics as a major challenge to the viability of their businesses. To address the service gap at community level, JLM serving as the main supplier of the single bundled malaria product, partners with private wholesalers as middle-level distributors for small drug shops and clinics at community level. This model applies to areas where the private wholesalers have a good clientele record, and the geographical location allows for use of existing system. However, for very remote and hard to reach rural communities, JLM will deliver the supplies to the door-steps of drug shops and clinic to improve access and availability to these commodities.

JLM is working on delivery model that will utilize micro financing and business management training under a franchise to build sustainability at service outlets level, and for the overall supply chain. The survey findings reported that supplies were purchased on credit by all private wholesalers, and majority of drug shops and clinics which also gave debt for drugs and diagnostics to a sizeable number of patients.  This resulted in small profit margins for these businesses, greatly affecting the viability, and continuity of these small businesses. It is a very interesting and very optimistic season for us to be able to reach and plug a gap that will impact the livelihood of people suffering from malaria and their affected families. We are optimistic that the multiplex of delivery options highlighted above will in the long term converge into a concrete and rewarding contribution towards elimination of malaria.

Agnes Nabasirye is CEO of JLM Pharmaceuticals Ltd.