Understanding the anti-malarial market Carrying out the survey: Lessons learnt

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1 Understanding the anti-malarial market Carrying out the survey: Lessons learnt Survey team: Area Supervisors, Data Collectors and Data entrants Aziz Maija, Survey manager

2 Collection of relevant information Demographic data from UBOS Random sampling of the parishes Identification of facilities in the Public, mission and Private sector using data from NDA,PSU and MoH Letters of introduction for the DDHs and Outlet facilities were collected from MoH

3 Survey team 3 teams per districts for intensive study and one team per district in non intensive area Each team had a pharmacist and a social scientist working together Each district had a supervisor who was the Pharmacist in the regional hospital Invitation were sent out to the survey team for one weeks training in Jinja

4 Survey process One weeks training of data collectors in Jinja Pre-testing of the data collection tools in Jinja Survey process flagged off for last week of May and first week of June 2007 First contact in the district was the DDHS who would identify the District guide Data collection took 13 days including travel to the districts Data entry lasted upto 3 weeks

5 Locating and accessing all the outlets It was difficult to differentiate the geographical mapping and the actual physical location of the parishes sampled due to new districts being created Poor road network made access hard in some areas especially in the rural setting Timing was an issue as some of the facilities would be closed at the time of data collection in the morning It was challenging to identify the informal sector esp the retail stores and market vendors selling antimalarial medicines. Some facilities would close when you arrive esp unlicenced fearing for NDA The local leaders were not very willing to help identify the outlets esp the unlicensed since it was their duty to close the unlicensed outlets. Community distributors were difficult to come by. They were mobile. Classifying outlets by sector was quite easy except for a few clinics which were also acting as drug shops Except the traditional healers, all sectors were clearly represented and the major problem was accessing these facilities. RECOMMENDATION: Use of district local guides improves identification and location of outlets

6 The less formal sector

7 Quality of medicines (presentation & storage) In some outlets particularly the informal sector, storage of medicines was very poor. In some cases medicines were stored in basins under the bed. In some D/Shops medicines had been removed from their original containers and repacked into transparent polythene The outlet facilities were in poor physical condition Individual tabs were manipulated with bare hands. Mini-doses were given out by the outlets e.g. Quinine syrup was sold in mls according to purchasing power e.g. 5mls. However the operators were eager to learn about best practices in handling medicines. They requested for training in this area.. RECOMMENDATION: Training of the operators in use of medicines and less use of aggressive power by the authorities

8 Building assurances and ensuring the information collected is accurate and the prices stated are the actual prices? There was re-assurance of the outlet facility operators and they opened up. The major fear of the facility operators was NDA and URA. There was also use of LCs to re-assure them Prices were compared across facilities in each study area to ensure that figures provided by the outlets were not falsified. Area supervisors collected data from 10% of the outlets covered by the data collectors and compared the data to ensure prices were matching. RECOMMENDATION: Sensitization of the operators before data collection & re-assurance with the help of LCs

9 Observations on the choices the community has where to buy and what to get/buy? The community asked for medicines by name and also by fever but cost was a major hindrance for access to medicines The community bought medicines from the nearest facility The outlet operators stocked medicines according to the demand Some of the outlet operators had no knowledge about ACTs. Some operators still think C/Q + SP are the first line medicines Outlet operators reported that some of the patients perceived Coartem as ineffective RECOMMENDATION: Increase awareness of the community about the ACTs

10 The main challenges in processing data: The form was very long and it took a long time to fill especially in facilities that had a lot of the medicines (Pharmacies) Calculation of unit prices by the data collectors was an issue esp for suspensions. It was challenging dealing with a large number of workbooks to enter the data. 164 medicines were surveyed yet each workbook could accommodate 50 medicines Large number of work books and the large volume of the data collection tool made data entry time consuming. RECOMMENDATION: Use of PDA programmed to calculate the unit price as well will improve the data collection process. Designing the workbooks in a different application that can handle all the medicines

11 Thank You