Monitoring the Market for Quality Malaria Treatments in the Democratic Republic of the Congo
Defeat Malaria Project
The Defeat Malaria Project, funded by DFID, seeks to provide long-term access to affordable, quality-assured artemisinin-based combination therapies (QAACTs) in the DRC. QAACTs are ACTs that have passed the WHO’s pre-qualification process and are the most effective treatment for uncomplicated P. falciparum malaria.
The private sector is responsible for over 90% of antimalarials sold and distributed in Kinshasa, but the private antimalarial market is currently dominated by inefficient monotherapies and a wide range of ACTs of questionable quality. When QAACTs are available, they are often too expensive for the average family to afford. Responding to these market challenges, the Defeat Malaria project is introducing subsidized QAACT products carrying the project’s “Green Leaf” branding to the private market in Kinshasa, including formal and informal pharmacies.
The expectation is that these low-cost quality-assured products will increase accessibility of affordable, quality antimalarials to the population and, over time, crowd out and replace less effective malaria treatments.
A New Approach to Market Monitoring
Prior to developing the mystery shopper approach, projects typically relied on stand-alone annual research surveys to collect market information. While valuable information is collected during such studies, it can easily take more than a month to complete data entry, analyze results, and report survey findings. Such a lag means vital market data are often available to program managers too late to
permit them to respond to market trends and address challenges in an efficient manner.
Providing decision makers with routine and high quality data about the availability, price, and promotion of our health products and services will enable project managers to quickly correct problems as they arise.
Mystery Shoppers Survey: Objectives and Methods
The primary objective of the mystery shopper survey is to increase the frequency with which actionable price and availability data on Green Leaf ACTs is available to the project team. The survey also provides a means to monitor providers’ recommended malaria treatments in an unprompted way, providing a more valid method for collecting this information than through a retail survey.
The longitudinal study is conducted at 200 informal pharmacies located across Kinshasa in 50 clusters
of 4 pharmacies. Cluster locations were purposefully selected by considering the following 3 programmatically-relevant criteria:
- • Geographic location within the city, favouring peripheral areas and poorer neighbourhoods;
- • Local population density, reflecting the potential market served by the pharmacies;
- • Level of local commercial activity.
Every quarter, a team of trained mystery shoppers visits each pharmacy and collects three types of data: the availability of any Green Leaf brand QAACT and other antimalarials, their price, and which malaria treatment providers initially recommend.
Responses are recorded immediately after the visit, using a mobile app connected to PSI’s DHIS2 system (Fig. 1).
After three rounds of the mystery shoppers survey conducted in March, June and
September 2016, the Defeat Malaria team is seeing positive trends in terms of availability and provider recommendation of Green Leaf QAACTs, barely six months following the introduction of the product to the Kinshasa market.
- • The availability of Green Leaf, measured as the proportion of informal pharmacies that have the product in stock at the time of visit, increased from less than 2% to 68% between the 1st and 3rd rounds of the survey (Fig. 2). These results suggest that there has been a rapid uptake of the branded QAACTs in Kinshasa’s private sector. Maps depicting the location of our sample of pharmacies confirm that with the exception of some peripheral clusters of outlets, the product is available in most parts of the city.
- • Another encouraging finding is that providers are increasingly recommending a Green Leaf branded product as the preferred malaria treatment to their customers, demonstrating that the marketing campaigns and medical detailing activities conducted under Defeat Malaria are effectively promoting the product. By September 2016, a third of all providers were recommending Green Leaf.
- • The proportion of retailers selling above 1,500 FC (which is above the recommended retail price) grew between the first two periods but dropped between the second and third (Fig. 3). This survey has provided early indicators to project management to investigate the reasons behind this change such as fluctuating exchange rates, minimum required profit margins, and consumer willingness to pay.
Data to decision-making
The Defeat Malaria project team is actively using this data to more efficiently plan their program interventions.
of providers recommending the products is increasing. This is an indication to the management that the medical detailing, supervision and training strategies have made a positive impact.
The project management team has also incorporated these survey results into routine reporting and regular communication with the donor to discuss program progress based on evidence, rather than waiting for annual survey results to be available.
Thus far, the results have been encouraging and have demonstrated that the mystery shoppers approach is an effective way to routinely gain key insights about the introduction of a new brand or product.
To find out more, including how you can adapt these methods for your program, contact your