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Private sector not giving antimalarials to the people they should

16 April 2014

Drug shop in Tanzania

A study in Tanzanian drug shops showed that most malaria patients did not receive an antimalarial and most people who obtained one didn’t in fact have malaria.


Throughout Africa, the private sector is frequently the first source of treatment for malaria or fever. Reasons include the proximity to the home and the good availability of medicines. However, diagnostic tools are usually not available at drug shops.

This study, now published in PLOS ONE  as part of the ACT Consortium, investigated how many drug shop clients had malaria and how many of those who purchased an ACT (artemisinin-based combination therapy, the recommended malaria treatment) did have the infection.

Results showed that only 12% of those going to a drug shop with a complaint of malaria or fever were infected by malaria parasites.

Out of 777 clients from 73 drug shops, more than 70% of ACTs went to clients who did not have malaria, and less than a third of clients who had the disease bought an antimalarial.

Subsidies not well targeted to malaria patients in the private sector

Tanzania was one of the countries that implemented the Affordable Medicines Facility-malaria (AMFm), an initiative that subsidises antimalarials and expands their access in both the public and private sectors.

The country also requires drug shop owners to receive training and have their shops accredited by the government through the Accredited Drug Dispensing Outlet (ADDO) programme.

Dr Melissa Briggs from the US Centers for Disease Control and lead author of the study, said: “RDTs were initially rolled out in the public sector, following the WHO recommendation to look for malaria parasites in patients’ blood before giving antimalarial treatment. However, this was not done in the private sector in Tanzania.  As a result at the time of this study, most drug shop owners did not have access to RDTs.  This research shows how well ACTs are used in the setting of subsidized ACTs when diagnostic tools are not available in drug shops such as these.”

Introduction of diagnostic tools in drug shops proposed

This is currently the only study investigating the targeting of antimalarials in the private sector where ACTs are subsidised and there is no malaria diagnostic testing.

Based on the poor targeting that this study confirms, the Tanzanian government decided to continue subsiding ACTs, and to begin to subsidise rapid diagnostic tests in drug shops in some regions. Many questions remain about where and how private sector diagnostic testing should be implemented, emphasising the need for further research in this area.

“While work to strengthen the public sector should continue, it is important that we continue to investigate ways to ensure that these patients who are presenting to the private sector have access to life-saving medications as well.  Further studies that are now occurring evaluating the use of RDTs in drug shops such as these will go a long way in informing health policy in Tanzania and similar settings,” Dr Briggs said.


Further information

Research Themes

Related Publications