Global Market Solutions Improve Antimalarial Availability for Children

A child receives SPAQ in Cameroon. Photo credit: Alemnkia Agendia/GHSC-PSM.

Topics:

Governance

Workforce Development

Malaria

Projects:

Date

May 28, 2020

Seasonal malaria chemoprevention (SMC) campaigns are a key tool for many developing countries to prevent malaria in children under 5 years of age. SMC relies on four monthly doses of sulfadoxine/pyrimethamine and amodiaquine (SPAQ) for young children in preparation for rainy seasons in areas of high disease transmission in the Sahel sub-region of sub-Saharan Africa. In this region, 31 million children under age 5 were in SMC-eligible areas as of 2018, and 12 countries have scaled up SMC in collaboration with various global donors. The annual demand for SPAQ reached 120 million treatments in 2018, and is expected to increase in the future.

However, SMC campaigns are only effective if the supply of SPAQ is readily available and distributed prior to the period of greatest risk. Treatments need to be delivered during a tight 4-month window, adding further constraints to a process that is already constrained by a single WHO-prequalified supplier and their production limitation, given the number of orders across global donors.

As a result, SPAQ supply has been squeezed, causing competition among countries for the treatment. With demand soaring, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project began looking for creative ways to secure treatment availability.

SMC 2019: PMI Countries that Received SPAQ in Time for Campaigns

GHSC-PSM, funded by the U.S. President’s Malaria Initiative (PMI), introduced a new strategy to mitigate supply challenges in 2018. By addressing global market as well as country-level constraints, as of 2019 the project ensured that several PMI countries in Africa received the SPAQ quantities they needed in time for their campaigns (see box), potentially protecting up to 6 million children.

At the global market level, the project streamlined procurement procedures by shifting orders from wholesalers to the manufacturer. GHSC-PSM worked with countries to place orders a full year before they were needed and prepositioned inventory at a regional distribution center in Belgium, introducing flexibility and responsiveness for last-minute quantity changes and delivery requirements from Europe to the Sahel sub-region.

The project also negotiated a lower fixed price, built processes to optimize shelf life and stabilize inventory fluctuations, and tested products before shipping.

Market-level improvements like these allowed country governments and global partners to shift their attention from global supply risks to the business of coordinating and delivering medicine to patients.

In Cameroon, for example, confidence in global supply, coupled with new geographic information system (GIS) tracking capabilities, strong coordination among national and district-level stakeholders, and a well-planned distribution strategy ensured that every one of the country’s 487 health facilities received supplies they needed well in advance of their 2019 SMC campaign; prior campaigns had reached fewer than 50 facilities. The campaign ultimately reached 6.7 million children from 3-59 months old in the country’s North and Far North regions. In total, 7.7 million treatments were successfully dispatched within 16 days, covering a surface area of 100,363 km².

“With GHSC-PSM, we have no worries about the availability of medicines for the campaign,” said Dr. Djele Sali, Coordinator of the Regional Technical Group for the Fight Against Malaria in the North. “I wish other partners would follow their example to ensure that all other material is available for a hitch-free campaign.”

In 2019, GHSC-PSM also subcontracted SPAQ warehousing and packaging to Cameroon's regional medical stores (RMS), which then worked with private distribution companies. This was the first time the RMS played a prominent role in a large-scale SMC campaign and in such a short amount of time. The success of RMS’ efforts is a strong sign of growing capacity and self-reliance in Cameroon. Other PMI countries achieved similar results, responding quickly to transportation and other sudden constraints.

A child in Ghana has her finger marked with black ink to indicate that she received her dose of SPAQ.

A child in Ghana has her finger marked with black ink to indicate that she received her dose of SPAQ. Photo credit: GHSC-PSM

In Niger, the two PMI-supported regions, Dosso and Tahoua, received their commodities well ahead of the 2019 SMC campaign. In accordance with the distribution strategy, commodities were pre-positioned at 17 district stores servicing 273 integrated health facilities, targeting 1.3 million children between the ages of 3-59 months. More than 4.8 million treatments donated by PMI, the World Bank, and Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) were successfully dispatched within 5 days, in collaboration with the central medical store transportation fleet (ONPPC), covering a surface area of 147,215 km².

Ghana’s 2019 campaign ran from July to October, with all SPAQ commodities delivered to the country level in May 2019. The PMI-supported Northern region received 2.5 million treatments, targeting over 670,000 children between 3-59 months old. Treatments were sorted and dispatched to 615 health facilities in the Northern region in four waves. Each delivery took place over seven days prior to each of the four dosing cycles, covering over 70,000 km².

In Mali, the entire seasonal supply of SPAQ was delivered to the central level in April 2019, with distribution occurring from July to October. Distribution strategies varied widely by region due to geography and security considerations. In the Mopti region, for example, the Pharmacie Populaire du Mali (PPM) used their own vehicles as well as a variety of other modes of transportation including pinnaces (small fishing boats) and public transport. At the district level, further methods including trucks, carts, and motorcycles were used to bring supplies to community health facilities. In each case, supply chain managers made transport decisions close to the date of distribution so that they could respond to the latest security context. Overall, 3 million SPAQ treatments were delivered to seven regions (Kayes, Koulikoro, Sikasso, Segou, Mopti, Gao and Kidal), enough to protect more than 750,000 children between 3-59 months old.

GHSC-PSM continues to collaborate with global partners and manufacturers to further ensure secure, reliable supply for SPAQ and other antimalarial products worldwide. The project is collaborating with global partners and manufacturers to diversify the supply of SPAQ and ensure SPAQ is available in time for 2020 SMC campaigns and beyond. GHSC-PSM is also working with national government and local counterparts to sustain reliable supply in future seasonal malaria campaigns.

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