In 2001, the Tanzanian government changed their malaria treatment policy from chloroquine (CQ) to sulfadoxine-pyrimethamine (SP) as the first-line drug. How much did this policy change cost? Researchers from the London School of Hygiene and Tropical Medicine, UK, assess the costs and make recommendations for other countries undertaking treatment policy change.

Cost is a factor in determining whether and when a country should switch malarial drug policy, with most attention falling on the cost of the drugs rather than the policy change process itself. Prior to the switch, the Tanzanian National Malaria Control Programme (NMCP) commissioned a study to estimate its likely costs, effects and cost-effectiveness. They estimated the costs of the policy change process at US$424,200. But how much did the government really spend?

Excluding drug costs and private and community expenses, the researchers found that the costs fell into four broad areas:

• Consultation, consensus and advocacy – total costs were Tanzanian Shillings (Tsh) 141 million. The biggest single activity was the orientation of Regional and District Health Management Teams.
• Development and production of treatment guidelines – costs totalled Tsh 105 million. Drafting and approval of the guidelines involved three separate meetings.
• Training of health workers – this cost Tsh 363 million. Training involved a cascade approach aiming to reach all staff involved in the care of malaria patients.
• Communication and publicity – total costs were Tsh 187 million. This covered development, pre-testing and production of radio, television and press adverts, plus printed materials.

Total costs were Tsh 795 million (US$813,743), which is about US$0.02 per capita. This total is equivalent to about four percent of annual government and donor expenditure on malaria and to about one percent of overall public expenditure on health. The majority of the funds were provided by the government of Tanzania, followed by the World Health Organization. A number of planned activities were not implemented. Including these would have brought the total cost to Tsh 880 million (US$896,130). This is more than twice the amount predicted by the NMCP, suggesting that the costs of policy change are often underestimated.

Many countries in sub-Saharan Africa are in the process of changing policy on first-line anti-malarial treatment. Tanzania is among several facing the next transition to artemisinin derivative combination therapy (ACT). ACTs pose additional questions for policymakers such as:

• Will the drugs be combined in one pill?
• Will different drugs be used for different populations?
• How can they ensure that drugs are taken only in combination and not separately?

The researchers point out that governments undertaking treatment policy change should be aware that this takes time, resources and substantial management capacity at national and local level. They should be prepared for unexpected events that can increase the overall costs of policy change.

Source(s):
‘The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania’, Tropical Medicine and International Health 11(4), pages 452-461, by Jo-Ann Mulligan, Renata Mandike, Natasha Palmer, Holly Williams, Salim Abdulla, Peter Bloland and Ann Mills, 2006
HINARI subscribers can access the full-text article here. Full document.

Funded by: IMPACT-Tanzania; UK Department for International Development (DFID)

id21 Research Highlight: 3 November 2006

Further Information:
Jo-Ann Mulligan
Health Economics and Financing Programme
Department of Public Health and Policy
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1 7HT
UK

Fax: +44 (0) 20 76375391
Contact the contributor: jo.mulligan@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
'Anti-malarial treatment in Tanzania: differences in willingness to pay'

'Artemisinin based combination treatments: new hope for malaria control?'

'The costly burden: malaria in Tanzania'

'Good economics – implementing cost-effective strategies against malaria'

'Zambia switches to artemisinin to treat childhood malaria'

'KwaZulu-Natal's malaria policy success'

'Value for money: cost-effective options for malaria control'