Nigeria outlet report 2013

Recent public and private sector strategies to improve malaria case management in Nigeria have been successful. Readiness for malaria case management has improved among both public and private sector outlets between 2009 and 2013. In 2013, most antimalarial-stocking public and private for-profit health facilities, pharmacies, and PPMVs were stocking quality-assured ACT (QA ACT) and provider knowledge of the first-line treatment has improved over time. The availability of malaria blood testing has increased since 2009, however there is need to further address gaps in availability in order to ensure confirmatory testing prior to antimalarial treatment. Addressing large gaps in availability of malaria blood testing is particularly important among PPMVs who are providing the majority of antimalarial treatments in Nigeria but generally do not have malaria rapid diagnostic tests available.

The distribution of QA ACT relative to other types of antimalarials has increased over time. However, more than half of the antimalarials distributed in Nigeria are still non-artemisinin therapies including SP and chloroquine. These non-artemisinin therapies are distributed primarily by the private sector. The private sector availability of QA ACT has improved over time and the retail price reduced with the introduction of the Global Fund co-payment mechanism. However the median private sector price of QA ACT is still more than 2 times the cost of the most commonly distributed non-artemisinin therapy, SP. The private sector price of QA ACT relative to SP is likely a barrier to achieving higher QA ACT relative market share.

Oral artemisinin monotherapy availability and relative market share have decreased over time. However, despite a ban on production and importation, oral artemisinin monotherapy accounted for 2% of the antimalarial market share in 2013 and was available among one in four antimalarial-stocking PPMVs and the vast majority of antimalarial-stocking pharmacies.

Most of the QA ACTs distributed by PPMVs and other private sector outlets have the ‘green leaf’ logo indicating co-payment by the Global Fund. This finding suggests that the co-payment mechanism known as the AMFm has been important for improving QA ACT market share over time. Nigeria has applied for continuation of the private sector co-payment mechanism through the Global Fund new funding model. ACTwatch outlet surveys will continue to monitor antimalarial availability, price, and market share. The next outlet survey is planned for 2015. 

This country reference document is a detailed presentation of the 2013 national ACTwatch outlet survey (OS) conducted in Nigeria. The 2013 OS follows previous survey rounds conducted by ACTwatch in Nigeria in 2008, 2009 and 2011.

ACTwatch antimalarial market monitoring in Nigeria from 2008 to present has been implemented in the context of strategies designed and implemented to improve coverage of appropriate case management. These include: 

  • Scale up of quality-assured ACTs in the public and private sectors through mechanisms including the Global Fund co-payment mechanism piloted under the Affordable Medicines Facility, malaria (AMFm). The initial AMFm pilot period was 2010-2011 and co-paid ACTs were delivered to first-line buyers in Nigeria from 2010-2013.
  • Scale up of malaria rapid diagnostic tests (RDT) and malaria case management training in the public and private sectors to facilitate confirmatory testing prior to appropriate antimalarial treatment.  

 The 2013 OS was the fourth round of ACTwatch outlet surveys conducted in Nigeria. This report presents trend lines with three data points: 1) the 2009 AMFm baseline survey; 2) the 2011 AMFm pilot endline survey; and 3) the most recent 2013 survey. Another outlet survey round is planned for 2015. These surveys are designed to monitor key antimalarial market indicators at national level and within geopolitical domains (North Central, North East, North West, South East, South South, and South West). ACTwatch outlet survey findings can inform ongoing monitoring, evaluation, and adjustment to policy, strategy, and funding decisions to strengthen malaria case management.