Our Methods
ACTwatch measures which antimalarials are available, where they are available, at what price and by whom they are used. These indicators are measured over time and across countries through three study components: outlet surveys, supply chain studies and household surveys. Nationally representative outlet surveys examine the market share of different antimalarials passing through both public facilities and private retail outlets. Supply chain research provides a picture of the supply chain serving these outlets and measures mark-ups at each level of the supply chain. On the demand side, nationally representative household surveys capture treatment seeking patterns and utilization of anti-malarial drugs, as well as respondent knowledge of antimalarials in the seven countries.
The collection and processing of these data provides sound evidence for country-specific policy recommendations. The use of standardized indicators allow for broad trends to be identified and global policy recommendations to be made as well. The implementation of these recommendations into policy and action by study countries will constitute success for the ACTwatch project.
Study Components
ACTwatch has three main components:
Outlet Survey (PSI): Monitor trends in the availability, volumes and prices of antimalarials in the public and private sectors, which includes the informal sector. The survey is nationally representative and encompasses all outlet types with the potential to sell antimalarials (from hospitals to private pharmacies to street hawkers). The survey is conducted periodically over the life of the project.
Household Survey (PSI): Examine trends in the levels of household use of different antimalarials and their source. It also identifies the determinants of use (health seeking behaviour) of antimalarials. The survey is nationally representative, and is conducted at baseline and during year four.
Supply Chain Research (LSHTM): Identify the determinants of the price and availability of antimalarials at different levels of the supply chain, including markups at each level. The study collects nationally representative information along the supply chain from importer/manufacturer to retailer using a systematic sampling approach, and a structured survey alongside qualitative research methods.
Key indicators
| Category |
Indicator |
Research component |
| Availability |
Proportion of outlets that:
- Have in stock any antimalarial, specific antimalarial categories
- Reported no disruption in stock of antimalarials in the last three months
- Have either rapid diagnostic test or microscopic blood testing facilities
|
Outlet
Supply chain
|
| Price |
- Median price of a full adult course by antimalarial category
- Household price of fever episode treated with an antimalarial
|
Outlet
Supply chain
Household
|
| Market Share |
- Total volume of an antimalarial category, sold or distributed in the last week as a proporation of the total voluame of all antimalarials sold or distributed in the last week
|
Outlet
Supply chain
|
| Provider / wholesaler knowledge and behaviour |
Proportion of providers that:
- Correctly state the recommended first-line treatment, the correct dosing regimen
- Can list at least one danger sign in a child that requires referral to a public health facility
|
Outlet
Supply chain
|
| Use |
Proportion of children under five with fever in the past two weeks that:
- Received antimalarial treatment, by antimalarial category and source, the same or next day after fever onset, by socio-economic quintile
- Received a blood test for malaria the same or next day after fever onset
|
Household |
| Caregiver knowledge / behaviour |
Proportion of caregivers that:
- Sought treatment for fever, by source, and resons(s) for this choice(s)
- Can name the first-line drug. Know a common braind of first-line ACT
- Request a specific antimalarial by category or brand name from providers
- Express their opinion on the most effective malarial treatment for adults, by antimalarial category
|
Household |
| Supply chain structure |
- Minimum and maximum number of steps in the distribution chain
- Proportion of wholesalers that engage in specified business pracices
- Proportion of wholesalers that have specific categories of antimalarials and RDTs in stock
- Median percent and absolute mark-up applied by wholesalers and retailers by antimalarial category
|
Outlet
Supply chain
|
