Strong supply chains save lives. Strong malaria supply chains help ensure crucial access to diagnostics and life-saving medicines; if treatment is delayed, more severe complications of malaria can occur. A significant contributor to the decline in malaria has been the rollout of rapid diagnostic tests, which confirm the presence of the parasite, enabling health care providers to improve the quality of diagnosis, and ensuring that only those with malaria are prescribed ACTs. In malaria elimination settings, there must be a zero tolerance for stockouts – supply chains need both to ensure availability of products for routine use and to rapidly respond to outbreaks. As stated in the World Health Organization (WHO)’s 2017 Framework for Elimination “expiration of unused medicines is the price to pay for ensuring that the health system is prepared for an unexpected outbreak of malaria.”
Significant progress has been made in achieving the global targets of reducing malaria-related morbidity and mortality. The WHO’s 2016 World Malaria Report describes major declines in malaria incidence (down 41% from 2000 to 2015) and mortality (down 62% between 2000 and 2015). This progress would not have been possible without the strengthening of the supply chains that manage and move malaria products, improving product availability which supports improvements in malaria case management and outcomes.
Through the USAID | DELIVER PROJECT, JSI helped countries to improve the visibility and use of data on malaria product availability and malaria case management. Analyses of these data demonstrate the link between product availability and malaria case management, such as:
In Burkina Faso, the percentage of health facilities with ACTs available improved from 15% to 85% between 2012 and 2015. During the same time period, the malaria mortality rate in children under 5 decreased by 50%. Facilities stocked out of RDTs decreased from >90% to less than 5%.
In Ghana, in 2010 only 15% of the malaria cases were diagnosed with an RDT or microscopy. By mid-2016, this had improved to almost 90%. During this time, the percent of facilities stocked out of RDTs declined by 50%.
In Malawi, in 2011 around 50% of facilities were stocked out of ACTs; by 2016, less than 10% of facilities were stocked out of ACTs. From 2010 to 2015, the percent of children under 5 that received an ACT increased by 42%.
Also in Malawi, analysis of survey data and supply chain data showed that the peak of stockouts of sulfadoxine-pyrimethamine (SP) resulted in the lowest percentage of eligible pregnant women who received any SP, a critical intervention to preventing malaria in pregnancy.
In Zambia, the decline in stockout rates over the last five years, from more than 30% to less than 5% has been accompanied by significant increases in the percent of children under 5 that received an ACT (more than a 50% increase).
Despite these positive country examples, there are still an estimated 212 million cases of malaria worldwide. WHO has developed the Global Technical Strategy for Malaria 2016–2030 (GTS), outlining ambitious goals for 2030: reducing malaria incidence and mortality rates by 90% compared to 2015 levels, and to eliminate malaria from at least 35 countries.
To reach these goals, continued investments are needed. Funding has grown significantly for malaria control and elimination, from US$0.06 billion in 2010 to US$2.9 billion in 2015, though still a long way from the GTS 2020 target of US$6.4 billion. Funding can help support the increase in the coverage of the tools we have that are known to be effective, including LLINs, SP for IPTp, RDTs, and ACTs.
At the same time, funding can support the development of new tools for vector control, diagnostics, and effective medicines, which we need to sustain the gains made so far. The development of an effective malaria vaccine could be game-changing. We need stronger surveillance systems to better predict and respond to malaria outbreaks. Artemisinin resistance and insecticide resistance has been detected. Both are threats that must be closely monitored.
We need funding and investments in the supply chains that get nets to communities, diagnostics tools to practitioners, entomology supplies to researchers, insecticides and equipment to spray programs, and medicines to clients, wherever and whenever they are needed. As the global malaria community strives for the goals set out in the GTS, it is important to recognize that investments in supply chain strengthening contribute to greater product availability, to preventing, diagnosing, and treating malaria, and ultimately in malaria case outcomes. Supply chain strengthening remains a critical component of the global malaria agenda.