Diagnosis of malaria is important to ensure early and effective treatment, to facilitate public health surveillance, and to prevent drug resistance. Rapid diagnostic tests are an important tool in resource-constrained settings, as they do not rely on costly lab equipment or specially trained personnel. In many areas of the world, including in Uganda’s private health care sector, clinics’ and drug shops’ diagnosis of malaria is often presumptive and patients receive neither a rapid diagnostic test nor microscopy.
The effectiveness, or suitability, of rapid diagnostic tests is well understood and documented due to extensive World Health Organization evaluations and guidelines. Further, several studies have focused on the patient perspective, such as willingness to pay and willingness to be tested. However, there is much less understood about the supplier perspective, including willingness to stock.
CITE's research evaluates the preferences and priorities of agents across the malaria rapid diagnostic test supply chain in Uganda on stocking the devices. A multi criteria decision analysis framework was applied and adapted to be relevant and understandable for agents in Uganda so that it was possible to analyze business decisions incorporating attributes such as selling price, purchase cost, sales volume, complexity of regulations, waste management, and training available.
- Retailers identified time per sale and training as the most important criteria in their decision to stock.
- Retailer satisfaction with stocking the technology dropped significantly when time per sale was longer than 10 minutes.
- The highest weighted criterion for retailers was training since they are responsible for administration of the test and interpretation of results.
Recommendation: Malaria rapid diagnostics should be framed as a service, not a product.
- Distributors identified expiration date and sales volume as the most important criteria in their decision to stock.
- Because the shelf life of malaria rapid diagnostics could be just a matter of months, distributors bear most of the expiration risk, while retailers were able to buy small amounts of stock at a time.
First Line Buyers
- First line buyers’ preferences varied due to different business strategies.
- One buyer valued NGO relationships yet was unwilling to invest more than 10 hours per week in managing diagnostics, while the other was more willing to invest time in achieving the financial results they valued most.
Recommendation: Business objectives and risks vary across the supply chain. Design business models and risk sharing contracts that are better aligned with incentives.
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CITE is thrilled to announce our 2015 technology evaluations: malaria rapid diagnostic tests, post-harvest storage technologies, educational technologies, and water test kits!