Public-Private Partnerships: The final frontier in the malaria endgame!
Deepak Batra, Principal (Africa and Middle East) and Tridip Borah, Consultant, Public Health
Blog
May 14, 2019

Introduction: The Malaria Problem

Malaria is on the rise and is currently endemic in 91 countries worldwide. In 2018, at least 219 million people were diagnosed with the disease, and about 435,000 deaths; And the economic implications of Malaria are manifold, for example, in Africa alone, the economic impact of malaria is estimated at $12 billion every year. This figure factors in costs of health care, absenteeism, days lost in education, decreased productivity due to brain damage from cerebral malaria, and loss of investment and tourism.

Reduction and elimination of malaria are contingent on provision and access to quality diagnosis and treatment mechanisms. Correspondingly, early diagnosis and treatment ensure a reduction in both, malaria-related illness and deaths. One of the most popular methods of diagnosis is Rapid Diagnostic Tests (RDTs), a method based on clinical grounds or microscopy. Whereas for treatment of uncomplicated malaria caused by the P. falciparum parasite, the World Health Organisation recommends an Artemisinin-Based Combination Therapy (ACTs). Resistance to antimalarial medicine, however, continues to be a problem.

The Global Antimalarial Market

The global antimalarial drugs market is expected to increase by almost 41 per cent by 2027 (USD 742.5 Million in 2016 to USD 1,049.5 Million). The antimalarial market is majorly driven by three therapies ( 70 per cent share by value, and almost 40 per cent share by volume). The two active pharmaceutical ingredients (API), Hydroxychloroquine, and Atovaquone-Proguanil comprises almost half of the global antimalarials market by value. Although, ACTs are considered to be one of the most efficacious therapy for malaria and holds 11 per cent share by value & 14 per cent share by volumes. In terms of volume, Chloroquine has the highest share (30 per cent) followed by hydroxychloroquine (23 per cent).

Additionally, some of the key drugs which constitute the branded market are Malarone (forms about 45 per cent of total branded sales) followed by Daraprim (which forms almost 13 per cent sales).

Health Service Delivery and Policy Implications

 

In most malaria infested countries standardized malaria treatment is delivered by the public sector through the various National programs across countries, but there is no precise information on the composition and market share of the private sector engagement in malaria testing and treatment, which makes it difficult for the health ministries and the malaria programmes of various countries to tailor adequate policies and interventions at the population level. The total burden in both sectors is equivocal due to specious and varying methods of reporting by the private sector. Therefore, evidence produced by the private sector is inadequate, and the various techniques and approaches of the private sector in different countries has caused a lack of clarity in data management systems.

Additionally, private sector healthcare providers tend to focus on profit and capital gains at the expense of providing quality care. In many cases, the upkeep set by the private sector for protocols and regulations is low or non-existent. Unregulated private providers are an additional factor adding to the burden of missing malaria cases, as they do not regularly report to the national health management information systems (HMIS); This makes it difficult for the national Health Ministries to formulate effective policies and prepare effective program implementation plans to combat Malaria.

Role of Private Sector

pharmacists hands taking medicines from shelf

Owing to the global shift in access to malaria care, most people today are seeking medical attention from private providers or resorting to self-medication. The private sector has a significant role to play in order to provide evidence on the total burden of malaria. Through the collection of malaria drug prescriptions and sales, we can begin to get a clearer picture of the actual prevalence rates and thereby push decision-makers to formulate effective policies, plans, and strategies to combat the spread of malaria. For example, Antimalarials prescriptions are majorly derived from the retail sector which comprises more than 80% of the market across all the global regions.

One method to better identify the burden of malaria on the private sector is through the collection and analysis of drug prescription and sales data in the private sector across various channels and sources. Analyzing this data can help identify malaria endemic geographical areas and prioritization of those areas for more private sector engagement.

Once the total number of patients being treated in the private sector is calculated, the total burden of malaria in both the private and public sectors can be tallied for every level of care (national, sub-national, and pin code level). Malaria hotspots can further be identified in endemic countries, and missing cases of malaria can also be traced. The valuable insight and analyses compiled through this process can be used effectively to provide technical support to health ministries and national malaria programs for enhanced coverage and quality health care services at the population level.

The IQVIA Way

 

An effective approach to fighting malaria requires the cooperation of both the public and private sectors. It is essential to look at the private sector as a vital partner for malaria diagnosis, treatment, and surveillance. And it is crucial to understand and bridge the gap between public and private providers for improved malaria care services. Today, IQVIA works with governments, nonprofit organizations, and healthcare market players to fight malaria around the world. At IQVIA, we help create innovative solutions and identify creative methods to find and eliminate missing malaria cases worldwide.

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