Conventional wisdom often overlooks the private sector as an effective partner in malaria elimination. Profit-driven, poor quality products and quality of care, weak adherence to national guidelines and use of diagnostics, unmotivated to report data, unorganised and unsustainable engagement are all charges laid at the private sector’s door. However, PSI’s experience in the Greater Mekong Subregion (GMS) – where 40-60% of the population first seek treatment in the private sector (Bennett et al. Malar J (2017) 16:252) – is challenging these accepted truths.
In Cambodia, Lao PDR, Myanmar and Vietnam, Population Services International (PSI) works with over 20,000 private providers, from registered doctors and pharmacists, to non-health outlets including grocery stores and rubber plantations. In 2017, this network conducted and reported on 1,266,041 rapid diagnostic tests, and treated 43,315 confirmed cases in accordance with national guidelines – representing up to 53% of national officially reported cases. Routine assessments show continued improvements in quality of care, and consistently high reporting rates. PSI’s interventions have also demonstrated the effectiveness of shaping the market to remove dangerous oral artemisinin monotherapy drugs, and replace them with quality assured artemisinin combination therapy throughout private supply channels.
Emerging research also suggests that as malaria declines in the GMS and malaria-related services become a shrinking contributor to private providers’ profit margins, that intrinsic factors – such as reputation, connection, contribution and skill-building – are motivating continued engagement. As countries in the GMS accelerate elimination efforts in order to achieve ambitious objectives, National Malaria Control Programs will increasingly need timely, quality data from public, private and community sources, and to know that all outlets where people seek treatment, are adhering to national guidelines. PSI’s iterated experiences offer a pathway to how the private sector can be a meaningful and essential partner in national and regional elimination efforts