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IMPACT 2: Evaluating policies in Tanzania to improve malaria diagnosis and treatment

Start date: 1 Oct 2008

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[Project summary in Français / Português]

Scientific title: IMPACT 2: Monitoring Interventions to Improve ACT Access and Targeting 

Latest on this research

[Français / Português]

Scroll down for a list of publications about the findings of this study, and a policy brief.


What did we know before this research?

It is generally agreed that artemisinin-based combination therapies (ACT) are the best treatment for malaria, but it is less clear how it should be deployed by national programmes. Some countries have started to improve this process, on the one hand, by making ACTs more accessible to patients and, on the other hand, by targeting ACTs more effectively to patients who have malaria.

The government of Tanzania has addressed both ACT access and targeting on a national scale. Poor access has been be tackled by the Affordable Medicines Facility-malaria (AMFm), an initiative which distributed subsidised ACTs through public and private facilities and retail drug shops. Targeting has been addressed through introducing rapid diagnostic tests (RDT) in public health facilities.

What does this study add?

This research has evaluated both AMFm and the roll-out of RDTs in three rural Tanzanian regions, comparing the situation “before and after” the interventions were implemented.  We have used surveys of public health facilities, private antimalarial outlets and households. Through these we have assessed the impact on availability, affordability and quality of treatment, as well as coverage at a community level.

In addition, we conducted a cluster randomised controlled trial to assess how effective sending SMS messages to drug shop staff was in improving the way patients took their ACT medication (known as patient adherence).

Finally, we have used qualitative methods to explore the socio-cultural context and other factors that influence the implementation and outcome of the two interventions.

The research team

Principal Investigators:

  • Catherine Goodman, London School of Hygiene & Tropical Medicine (
  • S. Patrick Kachur, Malaria Branch, US Centers for Disease Control and Prevention
  • Salim Abdulla, Ifakara Health Institute, Tanzania

Other Investigators:

Ifakara Health Institute:

  • Admirabilis Kalolella
  • Charles Festo
  • Boniface Johanes
  • Happy Nchimbi
  • Clarence Mkoba

London School of Hygiene & Tropical Medicine

  • Katia Bruxvoort
  • Rebecca Thomson
  • Matthew Cairns

US Centers for Disease Control and Prevention

  • Denise Allen
  • Melissa Briggs

Research Themes

Related Publications

Getting antimalarials on target: impact of national roll-out of malaria rapid diagnostic tests on health facility treatment in three regions of Tanzania

Katia Bruxvoort, Admirabilis Kalolella, Happy Nchimbi, Charles Festo, Mark Taylor, Rebecca Thomson, Matthew Cairns, Julie Thwing, Immo Kleinschmidt, Catherine Goodman and S. Patrick Kachur  |  Published
Tropical Medicine and International Health

Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data

Sarah Tougher, the ACTwatch Group, Yazoume Ye, John H Amuasi, Idrissa A Kourgueni, Rebecca Thomson, Catherine Goodman, Andrea G Mann, Ruilin Ren, Barbara A Willey, Catherine A Adegoke, Abdinasir Amin, Daniel Ansong, Katia Bruxvoort, Diadier A Diallo, Grac  |  Published

How patients take Malaria treatment: A systematic review of the literature on adherence to antimalarial drugs

Katia Bruxvoort, Catherine Goodman, S. Patrick Kachur, David Schellenberg  |  Published
Plos One

Prevalence of Malaria parasitemia and purchase of artemisinin-based combination therapies (ACTs) among drug shop clients in two regions in Tanzania with ACT subsidies

Melissa A. Briggs, Admirabilis Kalolella, Katia Bruxvoort, Ryan Wiegand, Gerard Lopez, Charles Festo, Pierre Lyaruu, Mitya Kenani, Salim Abdulla, Catherine Goodman, S. Patrick Kachur  |  Published

Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the affordable medicines facility -Malaria

Rebecca Thomson, Charles Festo, Boniface Johanes, Admirabilis Kalolella, Katia Bruxvoort, Happy Nchimbi, Sarah Tougher, Matthew Cairns, Mark Taylor, Immo Kleinschmidt, Yazoume Ye, Andrea Mann, Ruilin Ren, Barbara Willey, Fred Arnold, Kara  |  Published

The practice of 'doing' evaluation: lessons learned from nine complex intervention trials in action

Joanna Reynolds, Deborah DiLiberto, Lindsay Mangham-Jefferies, Evelyn K Ansah, Sham Lal, Hilda Mbakilwa, Katia Bruxvoort, Jayne Webster, Lasse S Vestergaard, Shunmay Yeung, Toby Leslie, Eleanor Hutchinson, Hugh Reyburn, David G Lalloo, David Schellenberg, Bonnie Cundill, Sarah G Staedke, Virginia Wiseman, Catherine Goodman & Clare IR Chandler  |  Published
Implementation Science

Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention

Barbara A Willey, Sarah Tougher, Yazoume Ye, The ACTwatchGroup, Andrea G Mann, Rebecca Thomson, Idrissa A Kourgueni, John H Amuasi, Ruilin Ren, Marilyn Wamukoya, Sergio Torres Rueda, Mark Taylor, Moctar Seydou, Samuel Blay Nguah, Salif Ndiaye, Blessing Mb  |  Published
Malaria Journal

Cluster randomized trial of text message reminders to retail staff in Tanzanian drug shops dispensing Artemether-Lumefantrine: Effect on dispenser knowledge and patient adherence

Katia Bruxvoort, Charles Festo, Admirabilis Kalolella, Matthew Cairns, Peter Lyaruu, Mitya Kenani, S. Patrick Kachur, Catherine Goodman, David Schellenberg  |  Published
American Journal of Tropical Medicine and Hygiene

Improving access to Malaria medicine through private-sector subsidies in seven African countries

Sarah Tougher, Andrea G. Mann, ACTwatch Group, Yazoume Ye, Idrissa A. Kourgueni, Rebecca Thomson, John H. Amuasi, Ruilin Ren, Barbara A. Willey, Daniel Ansong, Katia Bruxvoort, Graciela Diap, Charles Festo, Boniface Johanes, Admirabilis Kalolella, Oumarou  |  Published
Health Affairs

Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?

Katia Bruxvoort, Admirabilis Kalolella, Matthew Cairns, Charles Festo, Mitya Kenani, Peter Lyaruu, S Patrick Kachur, David Schellenberg, Catherine Goodman  |  Published
Malaria Journal

Measuring patient adherence to Malaria treatment: A comparison of results from self-report and a customised electronic monitoring device

Katia Bruxvoort, Charles Festo, Matthew Cairns, Admirabilis Kalolella, Frank Mayaya, S. Patrick Kachur, David Schellenberg, Catherine Goodman  |  Published

Availability and price of malaria rapid diagnostic tests in the public and private health sectors in 2011: results from 10 nationally representative cross-sectional retail surveys.

Poyer S, Shewchuk T, Tougher S, Ye Y; ACTwatch Group, Mann AG, Willey BA, Thomson R, Amuasi JH, Ren R, Wamukoya M, Taylor M, Nguah SB, Mberu B, Kalolella A, Juma E, Festo C, Johanes B, Diap G, Bruxvoort K, Ansong D, Hanson K, Arnold F, and Goodman C.  |  Published
Tropical Medicine & International Health

Examining intervention design: lessons from the development of eight related malaria health care intervention studies

Clare I.R. Chandler*, Helen Burchett, Louise Boyle, Olivia Achonduh, Anthony Mbonye, Deborah DiLiberto, Hugh Reyburn, Obinna Onwujekwe, Ane Haaland, Arantxa Roca-Feltrer, Frank Baiden, Wilfred F. Mbacham, Richard Ndyomugyenyi, Florence Nankya, Lindsay Man  |  Published
Health Systems and Reform

An assessment of the malaria-related knowledge and practices of Tanzania’s drug retailers: exploring the impact of drug store accreditation

Rebecca Thomson, Boniface Johanes, Charles Festo, Admirabilis Kalolella, Mark Taylor, Sarah Tougher, Yazoume Ye, Andrea Mann, Ruilin Ren, Katia Bruxvoort, Barbara Willey, Fred Arnold, Kara Hanson & Catherine Goodman  |  Published
BMC Health Services Research

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