Evaluation of the AMT2ACT Programme (2013-2016)

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Client

DFID

Project Location

Project Duration

3 years

Total Value

N/A

Value of Montrose Component

$900,000

Situation

  • Drug resistant malaria is a recent threat to the Greater Mekong sub-region and malaria endemic countries at large, and is especially prevalent in Myanmar.
  • DFID’s Artemisinin Monotherapy Replacement Programme (AMTR), implemented by Population Services International (PSI), was one of a number of interventions aimed at containing the spread of resistance.
  • AMTR replaced malaria monotherapies (AMTs), known to contribute to resistance, with combination therapies (ACTs) in private pharmaceutical and health centres in Myanmar, through supply chain subsidies and deliveries.
  • It also included a behavioural change component, aimed at ensuring customers/patients recognise ACTs and demand them from private sector suppliers.

Solution

  • Montrose carried out a three-year independent evaluation of DFID Myanmar’s Artemisinin Monotherapy Replacement Programme, which aims to replace malaria monotherapy drugs in the private sector to support the containment of drug resistant malaria in Myanmar and the Greater Mekong sub-region.
  • A Montrose / Tropical Health team of international malaria, epidemiology, private sector health provision, supply chain and value for money experts teamed up with Myanmar national medical doctors for a series of research visits to Myanmar over the course of the evaluation.
  • The evaluation assessed the effectiveness of the outputs achieved, for example: the replacement of monotherapy drugs in the private sector; the introduction of diagnosis and testing in the informal private sector; and behaviour change strategies aimed at encouraging patients to use new combination therapy drugs
  • It assessed whether and to what level the outcome targets have been achieved, and the value for money of the programme in delivering its outputs and outcomes.
  • The evaluation also identified, documented and disseminated lessons learnt for wider interest where results have or have not been achieved.

Impact

  • The evaluation produced six-monthly monitoring and value for money reports for DFID Myanmar.  In addition, a series of publishable papers have been produced on a number of strategic issues.  These papers cover the following topics:

 

    1. Lessons learnt on incentivising the distribution and use of Rapid Diagnostic Tests for the diagnosis of malaria by private sector providers
    2. The role of the private pharmaceutical sector in containing drug resistance in Myanmar
    3. The impact of AMTR in containing drug resistance
    4. A study into the treatment seeking behaviour of customers/patients within Myanmar
    5. A sensitivity analysis of the calculation of Disability Adjusted Life Years (DALYs) in the context of AMTR
    6. A consideration of options for adding Primaquine to the standard treatment guidelines for uncomplicated falciparum malaria in Myanmar
    7. A qualitative analysis of the decision making processes amongst migrant worker populations in Myanmar regarding the use of private or public sector health providers
    8. An examination of the role of the broader Myanmar corporate sector in contributing to the spread or containment of drug resistance

 

  • Five of these papers were launched at a major meeting of stakeholders which included government, development agencies, NGOs, researchers, corporate sector, private providers and civil society on 1 April 2015 in Yangon.  They can be found here:

 

Myanmar AMTR Independent Evaluation – Working Paper 1 – DALYs – v2

Myanmar AMTR Independent Evaluation – Working Paper 2 – Primaquine – v2

Myanmar AMTR Independent Evaluation – Working Paper 3 – Migratory Worker…

Myanmar AMTR Independent Evaluation – Working Paper 4 – Corporate Role -…

Myanmar AMTR Independent Evaluation – Case Study 2 – Private Providers -…