Getting antimalarials to those who need them most through implementation research guidance
A new method of treating malaria offers hope for fighting this notoriously difficult parasite. Figuring out how best to implement the programme presents many challenges.
Artemisinin-based combination therapies (ACTs) provide more effective treatment and lessen the chance of the parasite developing resistance against the drug. An innovative financing mechanism set up to give malaria-endemic countries increased access to affordable ACTs is now in place. The approach, dubbed the Affordable Medicines Facility-malaria (AMFm), is hosted and managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, with support from the Roll Back Malaria Partnership. The two-year pilot phase of the financing mechanism is taking place in Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, the United Republic of Tanzania (mainland and Zanzibar) and Uganda.
To make this health intervention work, which will involve the public, for-profit and not-for-profit sectors, the drugs need to be not only affordable, but also get to patients in a sustainable and efficient way. Working out how to establish effective distribution networks in both the public and private sectors is complicated, with new challenges in each country. Currently, many countries have poor links between their national malaria control programmes and researchers in the field; a paucity of support for implementation research; and weak health systems generally, said Dr. Andrew Kitua, leader of TDR’s malaria team. “They are busier doing the actual implementation than thinking about the research that can guide implementation,” he said. But implementing a new approach without studying it to extract lessons learned can be an important opportunity that should not be missed.
The new financing available to subsidize malaria drugs is a welcome advance, but without proper research to guide planning on how to best use and distribute the medicines, those gains may be weakened, said Kitua. The same type of research and planning is necessary to learn how best the drugs can reach people living in rural areas, with limited access to shops or central distributors. There is, for example, the need to understand how best to increase access to appropriate diagnostic methods, and also make sure that ACTs are not over prescribed and only given to the people who need them.
“So how do countries do all of these things? Nobody knows,” said Kitua. Which is why implementation research is key: “There is no clear way to do it. Each country has its own particular situation in terms of structures to provide health services, roads and who provides care in remote rural populations. Each has therefore to develop their own approach.”
In order to bolster their research capacity, WHO and its African regional office, with TDR, have been working with the pilot countries to develop operational and implementation research plans that will help get the drugs where they are needed most. This began in December 2009 with a capacity-building workshop in Accra, Ghana, followed by a qualitative methods workshop hosted by the Multilateral Initiative on Malaria at the Biotechnology Centre of the University of Yaoundé, Cameroon.
TDR is now working to set up regional training centres' in Africa and developing a curriculum that can be used to train national malaria programmes in conducting implementation research.
For more information contact Dr Andrew Kitua, firstname.lastname@example.org