Trends in Access to Antimalarial Treatment in The Private Sector in Uganda: An Assessment of Availability and Affordability of First Line Antimalarials and Diagnostics Between 2007 and 2018

Background Malaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanism aimed to increase availability and affordability of artemisinin-based combination therapies (ACTs). This paper examines the availability and affordability of first line malaria treatment and diagnostics in the private sector in Uganda between 2007 and 2018. MethodsCross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices and affordability of ACTs in private retail outlets. A minimum of 30 outlets were surveyed per year. Availability, patient prices and affordability of malaria rapid diagnostic tests (mRDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the ACTs and mRDTs were calculated in US dollars (USD). Affordability was assessed by computing number of days’ wages the lowest paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria. ResultsAvailability of artemether/lumefantrine (A/L), the first line ACT, increased from 85% to 100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. Affordability of ACTs and mRDTs was below one day’s wages for LPGW.Conclusion Availability of ACTs in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider inclusion of the diagnostic kits in the subsidy program.