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Medicine Sellers and Malaria Treatment in Sub-Saharan Africa: What Do They Do and How Can Their Practice Be Improved?

Medicine sellers are widely used for fever and malaria treatment in sub-Saharan Africa, but concerns surround the appropriateness of drugs and information provided. Because there is increasing interest in improving their services, we reviewed the literature on their characteristics and interventions to improve their malaria-related practices. Sixteen interventions were identified, involving a mixture of training/capacity building, demand generation, quality assurance, and creating an enabling environment. Although evidence is insufficient to prove which approaches are superior, tentative conclusions were possible. Interventions increased rates of appropriate treatment, and medicine sellers were willing to participate. Features of successful interventions included a comprehensive situation analysis of the legal and market environment; buy-in from medicine sellers, community members and government; use of a combination of approaches; and maintenance of training and supervision. Interventions must be adapted to include artemisinin-based combination therapies, and their sustainability and potential to operate at a national level should be further explored.

Received December 26, 2006. Accepted for publication September 21, 2007.

Acknowledgments: The review on interventions was commissioned by the Private Provider Task Force of the RBM Sub-group for Communication and Training within the Malaria Case Management Working Group. We thank Larry Barat for comments on an earlier draft of this report.

Financial support: This study was supported by the U.S. Agency for International Development– funded Basic Support for Institutionalizing Child Support and Africa’s Health in 2010 projects. Catherine Goodman is a member of the Consortium for Research on Equitable Health Systems, which is supported by the United Kingdom Department for International Development.

^* Address correspondence to Catherine Goodman, KEMRI/ Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya. E-mail: catherine.goodman{at}lshtm.ac.uk

Authors’ addresses: Catherine Goodman, Health Economics and Policy, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: catherine.goodman{at}lshtm.ac.uk; and Kenya Medical Research Institute/Wellcome Trust Collaborative Programme PO Box 43640, Nairobi, Kenya. Telephone: 254-20-272-0163, Fax: 254-20-271-1673. William Brieger, Health Systems Program, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, 615 North Wolfe Street, Room E8141, Baltimore, MD 21205. Telephone: 443-787-4042, Fax: 443-787-0217, E-mail: bbbrieger{at}yahoo.com or bbrieger{at}jhsph.edu. Alasdair Unwin, Plan International, International Headquarters, Chobham House, Christchurch Way, Woking, Surrey, GU21 6JG, UK. Telephone: 44-1483-73-3338, Fax: 44-1483-75-6505, E-mail: alasdair.unwin{at}plan-international.org. Anne Mills, Department for Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Telephone: 44-207-927-2354, Fax: 44-207-436-3611, E-mail: Anne.mills{at}lshtm.ac.uk. Sylvia Meek, Malaria Consortium, Development House, 56– 64 Leonard Street, London EC2A 4LT, UK. Telephone: 44-20-7549-0214, Fax: 44-20-7549-0211, E-mail: s.meek{at}malariaconsortium.org. George Greer, Child Survival and Infectious Diseases Bureau for Africa, Health Team, U.S. Agency for International Development, 1300 Pennsylvania Avenue, NW, Washington, DC 20523-4600. Telephone: 202-712-0504, Fax: 202-216-3373, E-mail: ggreer{at}usaid.gov

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