Clinton Health Access Initiative
In the past decade, remarkable advances have been made in treating and preventing malaria. Better medicines and long-lasting bed nets have been developed. Donor funding for malaria control has dramatically increased from $153 million in 2000 to over $1 billion in 2010. Indeed, the focus of many countries has recently shifted from malaria control to malaria elimination. Not surprisingly, this rapid infusion of new technology, increased funding, and policy reform has created a new set of challenges for the governments of malaria endemic countries. CHAI works in partnership with governments to address these challenges, creating evidence-based solutions tailor-made to each unique situation.
CHAI’s work on malaria treatment began in Tanzania, which was, like most of Africa, flooded with cheap, ineffective malaria drugs called monotherapies. While government programs were making the switch to effective ACTs (artemisinin-based combination therapies), this treatment remained prohibitively expensive at the pharmacies where most Africans buy their drugs.
Donors and partners questioned whether a subsidy could work, so CHAI launched a proof-of-concept pilot program in Tanzania that provided a co-pay at the top of the supply chain to bring the cost of ACTs in line with monotherapies. Although most pilots take two years, our rapid response produced tangible results in just a few months. Coupled with marketing campaigns to educate consumers, this strategy began to help push the ineffective drugs out of the market.
Just four months after the Tanzania pilot began, the number of patients buying ACTs in private drug stores shot up from 1 percent to 44 percent. This evidence convinced donors to launch the Affordable Medicines Facility-malaria (AMFm). To date, over 150 million doses of subsidized ACTs have been ordered in nine AMFm countries at prices that have been reduced by 80 to 90 percent.
Today, CHAI supports AMFm by providing technical assistance to governments, helping them apply for and implement AMFm, and roll out marketing campaigns that educate people about treatment.
CHAI also works to transform how malaria is diagnosed. Even with the increased availability of effective rapid diagnostic tests in remote villages, malaria’s long and lethal history leads people – including health professionals – to habitually believe that every fever is malaria, when often it is not. CHAI assists governments in training clinicians to make accurate diagnoses and help patients understand their condition and access proper treatment instead of automatically prescribing anti-malarial medicines for every fever.
CHAI is currently working with AMFm countries to expand access to malaria treatment by increasing the market penetration of ACTs to over 50 percent in the next year. This initiative includes helping new ACTs gain market entry and uptake by providing technical assistance, regulatory expertise, and cost-optimization support to the companies that manufacture them.
CHAI is also continuing our work to improve the sustainability and efficiency of malaria financing, including the exploration of novel mechanisms like cash-on-delivery, which pays for progress made toward targets. Additionally, CHAI is helping Swaziland advance toward becoming the first mainland African country to eliminate malaria by ramping up effective surveillance to track down and diagnose every case. Even a few years ago, people thought that eliminating malaria in a sub-Saharan African country was impossible and yet Swaziland is now on the verge of achieving that remarkable feat.