Malaria

Challenge

Malaria is one of the major causes of death and severe illness among sub-Saharan African children under five years of age. Since artemisinin-based combination therapy (ACT)* has been introduced, many countries have not been able to waive user fees for ACT treatment. There is now considerable literature on the impacts of such fees. Their adverse impacts on health service use - especially among the poor - have been well documented.

On the other hand, health facilities depend on revenues from user fees to deliver quality services. While the debate continues, there is no consensus in the international malaria community on whether user fees should be removed or sustained for malaria treatment, especially for children under five.

Approach

Building on existing evidence, Health Systems 20/20 is carrying out a study in Senegal and Mali to further investigate and address a series of user fee related policy questions in order to inform policymakers on the impact of user fees on providing and utilizing ACT treatment, particularly for young children.

Both quantitative and qualitative techniques, including a literature review, a health facility survey, and in-depth key informant interviews, are being used to gather data. Financial gap analysis, user fee operation analysis, user fee impact analysis, and key stakeholders’ attitude analysis will all be carried out. Currently, the study design has been approved, the instruments of data collection have been developed, and the data collection process will soon commence. Results of the work are expected to be ready by the end of the year.

*Artemisinin-based combination therapy (ACT) is used to treat malaria. The World Health Organization strongly recommends switching protocols to include an artemisinin-based combination therapy (ACT). These drug combinations are more effective, allow for shorter treatment courses, and protect against drug resistance.