The AFFORD Health Marketing Initiative

Situation:

Scaling-up coverage of life-saving interventions including long lasting insecticide-treated nets (LLINs) and artemisinin based combination therapy (ACTs) requires a multi-pronged approach. The AFFORD project works to increase availability and coverage of these commodities through both a public sector and commericial sector focus.

LLINs

Free or high subsidized nets can target the most vulnerable to ensure rapid scale up of protection in this group, whilst the growth of the commercial sector is supported to ensure LLIN coverage will remain high with families able to purchase nets for themselves, in particular to replace nets they may have received through free, donor dependant systems. To promote sustainable growth of the commercial sector the commercial components of our Mozambique and Uganda programmes aim to support the private sector by allowing them to market their own brands. Support goes directly to net distributors who feed the retail market, with a focus on rural markets and promotion of LLINs.

ACTs

Uganda has recently changed drug policy to an ACT combination, artemether-lumefantrine. The brand CoArtem (include brand mark) is available at health facilities and provided free of charge, yet many families still seek treatment through the private sector in Uganda. Ensuring private providers are aware of the importance of the use of effective drugs and the inadequacy of many commonly prescribed mono-therapies is an important component to working towards the goal of each child being treated with an effective malaria medicine within 24 hours of the on-set of fever. Availability of affordable ACTs on the market is also vital to improve access of these drugs by families through the private sector.

Response:

LLINs:

In Uganda, the AFFORD Health Marketing Initiative (USAID funded, ledby a consortium of partners including the Malaria Consortium and Johns Hopkins University) is distributing over a million long-lasting insecticide treated nets (LLINs) with support from the US President's Malaria Initiative (PMI). The objective is to support Uganda to achieve the national and PMI target of 85% of pregnant women and children under-five sleeping under an ITN by 2010.

The strategy is to rapidly increase coverage and utilization, to target the biologically and economically vulnerable and to sustain these high levels in order to achieve impact on the malaria burden. These plans recommend a variety of different distribution mechanisms, including:

• Distribution of free LLINs through ANC services in order to reach pregnant women
• Community-based distribution of free LLINs through civil society organizations
• Increasing long-term, sustainable access to ITNs (and LLINs in particular) through the commercial sector

Improving access to LLINs through the commercial sector is especially valuable for assuring access to replacement ITNs after they have reached the end of their useful life. Strengthening commercial access directly supports free and subsidized distribution, and vice-versa, toward the longer-term objective of sustained use of LLINs.

AFFORD will distribute around two million LLINs in the next four years using the following mechanisms and approaches:

• LLIN distribution to pregnant women attending ANC services. This element of the strategy will provide free LLINs to a highly vulnerable population - pregnant women in conflict-affected and economically disadvantaged regions of the country. This activity is focusingon the districts in the North affected by conflict, the extremely neglected and econimcally vulnerable North East (Karamoja) and the West Nile region. Outreach ANC services will reach those communities farthest from health facilities.
• LLINs delivered to vulnerable groups and communities through Ugandan community based organizations (CBOs) and faith based organizations (FBOs). This element of the strategy is designed to make the most of the close relationships between these organizations and the communities they support, as a way to ensure rapid scale-up in LLIN ownership with a strong focus on supporting the families ensure the LLINs are used every night. It has the additional benefit of building the capacity of local CSOs in providing malaria services.
• Increasing access to LLINs sold through the commercial market. This element of the strategy serves two purposes. First, it provides a growing and expanding market with replacement nets by building the private commercial LLIN sector. Second, it assists the local commercial LLIN distributors to survive in a market which is currently experiencing high volumes of free nets.

LLIN Communication:

AFFORD will implement LLIN communication activities in tandem with the LLIN distribution program. These activities will use a variety of media and approaches and focus on the three distribution mechanisms highlighted in this proposal. Key messages will include:

• Highlighting the benefits of LLINs compared with conventional nets in terms of longevity of protection, and convenience for users.
• Correct use of LLINs.
• Marketing and branding of selected LLINs and their suppliers.
• Public Relations for the new LLIN facility as well as overall PMI efforts.

ACTs:

Under the AFFORD project the Malaria Consortium, together with the private practitioners association and the Ministry of Health undertook the task of training private practitioners on the new anti-malaria drug policy. The nationwide training complemented the training conducted by the Ministry of Health for the public health workers (pictured). Over 3000 practitioners have been trained so far and provided with Job Aides (pictured) to support their work.

Support to local manufacture and importers of ACT brands for the commercial market has begun with a situation analysis and recommendations made to the interested businesses. Support for technically sound marketing of ACT products has also been provided.

An important role has also been to work with towards community awareness of the new drug policy. Low literacy inserts have been developed with this aim. These will be made available to all local ACT manufacturers and importers in Uganda free of charge

Points to note:

Organised free provision of LLINs, has an important role to ensure malaria protection to those most vulnerable to malaria such as pregnant women, children under five and the very poor rural people. However, improving access to LLINs through the commercial sector is vital to ensure access to replacement nets after they have reached the end of their useful life. There is now global consensus around the WHO Strategic Framework for Scaling-Up ITNs in Africa, which recognizes a multi-sectoral role for both the public sector (targeting vulnerable groups for free distribution to promote equity) and the private sector (for commercial distribution systems). Our programmes also take this approach, integrating ITN delivery with maternal and child health programmes, whilst concurrently working with the private sector in a complementary and supportive manner to ensure that coverage can be maintained is the way forward.

For more info about AFFORD click here

Photo: Sabine Garbysch, William Daniels and Malaria Consortium

Graph: Malaria Consortium