Large-Scale Malaria Treatment in the Private Sector: A Case Study of the Cambodian Experience
(2010; 28 pages)


Population Services International/Cambodia (PSI/Cambodia) was established in 1993 to address child survival (safe water and diarrhea treatment), HIV/AIDS, malaria, and reproductive health needs among women of child-bearing age, caretakers of children under five, and high-risk groups including commercial sex workers and men who have sex with men. Following a successful pilot in 2002, in 2003 PSI/ Cambodia established an initiative to provide branded malaria treatment through private clinics, pharmacies, and shops across most of rural Cambodia. By 2009 this program provided half of all malaria treatment in the country and 75% of all artesunate and mefloquine (AS/MQ) distributed. Cambodia was the first country to pilot and then scale-up the provision of subsidized ACTs in the private sector. The PSI/Cambodia malaria program sells a branded version of the same ACT supported by Cambodia’s National Malaria Control Program, known as "CNM." PSI/Cambodia imports the ACTs directly into its Phnom Penh warehouse before distributing them to three regional PSI depots. PSI-employed sales representatives make monthly sales calls to 1,737 private outlets. 500 of these are clinician or pharmacy-operated facilities that are also visited once per month by PSI employed medical detailers who provide training, counseling, and support on the appropriate use of ACTs, malaria test kits, and other medicines. Stock outs have been a major problem for the program since inception. The primary causes of stock outs have been changes in the approval status of manufacturers, and long procurement timelines often associated with donor delays which have hindered the arrival of ACTs into Cambodia. Because of PSI/Cambodia’s in-house management of the in-country supply chain, no stock outs have been reported resulting from breakdowns of the supply chain within Cambodia; breaks have all been the result of delays in the procurement of Malarine into Cambodia and affect both the public and private sector’s ability to deliver. ACTs sold through the PSI/Cambodia program are highly subsidized, and are sold to private outlets at an average price of $0.29, with a recommended average price to patients of $0.45. In practice, the price of Malarine to patients has been documented to vary considerably, ranging between $0.82 and $1.18. This price volatility and overcharging appears to be due primarily to fluctuations in the supply of ACTs. The PSI/Cambodia experience shows that large-scale provision of ACTs is possible through private sector channels. Ongoing supply management, greatly dependent on donor flexibility and responsiveness, and regular, focused interactions with retailers are important factors in assuring both price and quality service at the outlet level.

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