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A framework for stakeholder engagement in the adoption of new antimalarial treatments in Africa: a case study of Nigeria

Published onJun 16, 2023
A framework for stakeholder engagement in the adoption of new antimalarial treatments in Africa: a case study of Nigeria

Introduction: Recent reports of artemisinin resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new antimalarials. We carried out a case study on the evolution and adoption of antimalarial treatment policy processes and the change of management processes in Nigeria with the objective of providing perspectives that will enhance future uptake of new antimalarials, with an emphasis on strategic stakeholder engagement. 

Methods: This case study is based on an analysis of policy documents and by stakeholders’ perspectives drawn from an empirical study conducted in Nigeria, 2019-2020. Mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and qualitative data from relevant stakeholders in Nigeria. We searched online and screened programmes and policy papers for relevance. Historical perspectives were also obtained via verbal accounts from key experts who have been immersed in the national malaria program. Themes for the framework were developed and applied to the case study. 

Results: Based on policy documents reviewed, the adoption phase of implementation of ACTs in Nigeria was swift due to political will, funding and support from the global developmental partners. Although implementation strategies were met with resistance from suppliers, distributors, prescribers, and end-users, the qualitative interviews attributed these to market dynamics, costs and inadequate stakeholder engagement. The post-adoption phase of ACT deployment in Nigeria witnessed more developmental partner support, robust data generation, ACT case-management strengthening and emergence of more evidence on antimalarial use in severe malaria and antenatal care management. We propose a framework for effective stakeholder engagement for future adoption of new antimalarials in Nigeria. The framework covers the pathway from generating evidence to making treatment accessible and affordable to end-users. It also addresses who to engage, the content of engagement and what strategies would support effective engagement with key stakeholders at different levels of the transition process. 

Conclusion: Early and staged engagement of stakeholders from global bodies through regulatory authorities to end-users at the community level is critical to the early adoption of new antimalarials. A framework for these engagements has been proposed as a unique contribution to enhancing this process.

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