Malaria Policy Change for Better Health Outcomes

2. Malaria Track

3. Overarching reality: POLICY CHANGE

4. Themes: • Complexity of systems and change • Need • Better/deeper knowledge • Standards • Scale • Importance of cost information • Policy change

5. What we know • Have evidence of problems, but how bad undefined (poor-quality drugs, adherence) and findings hard to generalize • Some interventions can be effective in some settings; not sure about how to generalize/do at scale/apply • Educational and feedback interventions • CBHW • Media • Policy change • Costly, complex, takes time • Need systems approach

6. Clear recommendations • Develop frameworks (including considerations of appropriate response) and increase support for drug quality testing, pharmacovigilance • Encourage information-sharing (?networks) among countries about drug quality, implementation experiences etc. • Use pre-packed drugs, patient and provider aids • Learn from private-sector approaches to influence providers and consumers • Urge GF and others to clarify commitment for sustainability of financing new treatment • Take a health systems approach

7. Need for information • Need to compile/review information: policy change, CBHW • More info about interventions with attention to scalability

8. Standards • Measuring resistance • Need to communicate standards (drug quality and appropriate dosing are accounted for) • Need to get people to follow existing standards • Quality assurance (of drugs, RDTs) • Sampling • Classifications: “failed”, “fake”, “counterfeit” • Measure stability under actual conditions

9. Research standards • Interventions • Scale • Sample size • Generalizable to at-scale interventions • Context • Test in range of settings (multi-site) • Private providers crucial (methods: beyond mystery patients) • Analysis • Need guidelines about design and (statistical) analysis of interventions to improve provider behavior

10. Research standards (cont’d) • Publication • Clear and full descriptions of interventions • (?Checklist of dimensions) • Panel to consider pros and cons of identification of brands/sources of failed drugs

11. Develop Tools • To drive/support policy • Develop “options appraisal” techniques for policy decisions • To support implementation • Better methods for drug quality monitoring, including validating simple methods that can be applied at the community level • Better biologic diagnostic techniques, including improving implementation and utilization

12. Improve understanding and develop interventions • Links between drug quality, use and development of resistance • Regulation/enforcement • How to improve effectiveness • Commercial market • How to influence • Private sector providers/dual providers • How to influence • CBHWs • Strategies to improve training, retention, motivation & remuneration

13. Cost information • Better C/E models of malaria treatment policy change (including costs of maintaining status quo) • Costs of interventions (incl policy chg) • Cost of intervention • Cost of implementing intervention • Projected costs of at-scale implementation

14. Plan research about policy change • To understand effects and test interventions to improve, e.g.: • Adherence • Treatment seeking (shift pub-pvt) • Health outcomes