Title: Understanding private sector demand for malaria medications in developing countries
Funder: Economic and Social Research Council

Abstract: In 2010, there were more than 200 million malaria infections around the world and it was estimated that less than half of these cases received the type of treatment recommended by both the World Health Organization and the governments in countries where malaria is a major health problem, called artemisinin-based combination therapy (ACT). Malaria infections that are not properly treated can lead to serious health consequences, including permanent disability and even death, with young children in developing countries particularly at risk. Part of the reason why so many individuals do not get optimally treated with ACTs is because that due to problems of access, availability of drugs, convenience and cost in the public sector, patients in malaria-endemic countries often turn to private clinics, hospitals and even retail shops in order to obtain treatment. And although ACTs are available on the market, these patients are unlikely to receive them as treatment and instead are likely to be treated with an older, less effective medicine. The aim of this study is to help to answer the questions of why malaria patients who turn to the private sector for treatment are less likely to receive an ACT drug, and what factors act as facilitators and barriers to receiving an ACT. There will be a particular focus on the responsiveness of demand for ACTs to price, and the potential effects of interventions to reduce the price of antimalarial medicines. It is hoped that by generating better understanding of these factors, this new knowledge will help all of those working to ensure that malaria infections are optimally treated to design more successful interventions and better predict the impact of these interventions. To do this, we propose to analyse data collected in Benin, Madagascar, Uganda and Zambia during surveys of households that experienced a recent malaria infection and complementary surveys of all sources of antimalarial medicines in the vicinity of these households, including private retailers, clinics and hospitals. During the first stage of the analysis, we will investigate patterns of treatment seeking behaviour by describing whether or not treatment for the malaria episode was sought, where treatment was sought, what antimalarial was received and in what quantity, whether an ACT was received, the price paid for the medicines, and total costs of treatment. We will also investigate if these patterns differ across selected groupings, such as age and income groups, household size/composition, and by urban and rural locations. The second stage of the analysis will use statistical models to ascertain which factors are important facilitators and barriers to patients receiving an ACT to treat malaria, and we may also investigate how these factors affect the quantity of medicines purchased. Because of the complexity of both the behaviour we are attempting to analyse and the data we are using to do so, there are a number of issues that must be considered to ensure these analyses are conducted in a valid way. For example, the decision-making processes that lead to the final event of acquiring an ACT could involve a number of choices: one is the decision of whether or not to seek treatment; another involves choosing where to procure the treatment; while another decision involves whether or not an antimalarial is obtained, the choice of antimalarial, and in what quantity. Models must allow for these decisions to be made simultaneously, separately, or sequentially (with subsequent choices being dependent on previous ones). Finally, using these models, we will attempt to predict how changes in the price of ACTs, household income, and distance to outlets, among others, might affect the number of patients treated with ACTs and quantity of ACTs consumed.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION