Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia

Abstract Background Indonesia is the second country with the highest number of malaria cases in Southeast Asia. Private health providers including community pharmacies often become the first point of care for the population seeking malaria treatment; however, public–private partnerships for malaria...

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Autores principales:	Astri Ferdiana, Utsamani Cintyamena, Luthfi Azizatunnisa’, Edi Sunandar, Ari Probandari
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Indonesia Malaria Private sector Pharmacies Public–private partnership Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/56b4a83d5ea346ea893d44ec1b54a013
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spelling	oai:doaj.org-article:56b4a83d5ea346ea893d44ec1b54a0132021-11-21T12:03:00ZFinding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia10.1186/s40545-021-00347-22052-3211https://doaj.org/article/56b4a83d5ea346ea893d44ec1b54a0132021-11-01T00:00:00Zhttps://doi.org/10.1186/s40545-021-00347-2https://doaj.org/toc/2052-3211Abstract Background Indonesia is the second country with the highest number of malaria cases in Southeast Asia. Private health providers including community pharmacies often become the first point of care for the population seeking malaria treatment; however, public–private partnerships for malaria control are not widely implemented. This paper explores the acceptability of a public-private partnership program on the provision of subsidized artemisinin-based combination therapies (ACTs) in community pharmacies from the perspectives of private health providers, patients, and program implementers. Methods The study was conducted in Manokwari District in West Papua Province, one of the highest endemic districts in Indonesia. Qualitative methods using interviews and focus group discussions (FGDs) were employed to explore the following dimensions of acceptability: affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy. Study participants were program implementers, private health providers, and pharmacy clients. Audio-recorded interviews were transcribed and analyzed using thematic analysis. Secondary data on malaria cases and the use of ACTs reported by community pharmacies were also recorded. Results Only one-fourth of the total community pharmacies in Manokwari participated in the partnership, suggesting low coverage of the program. The proportion of malaria cases reported by community pharmacies increased from 6.9% in 2018 to 30.7% of cases. Most participants had a positive attitude towards the program, which might be associated with the perceived effectiveness of the partnership in improving access to ACTs. Despite the good understanding of the intervention by the participating pharmacies, limited involvement of private physicians often resulted in non-standardized treatment practices. The partnership also imposed a burden on private health providers in terms of human resources and time which entailed significant opportunity costs. A number of ethical issues might undermine the equity of access to ACTs. Conclusion Despite the positive attitude to the partnership, the perceived burden might outweigh the tangible benefits, posing threats to scaling up the intervention and sustainability. Innovations to simplify the administrative procedures in combination with performance-based incentives are needed to improve implementation. Engagement of patients and physicians is needed to increase the effectiveness of the partnership.Astri FerdianaUtsamani CintyamenaLuthfi Azizatunnisa’Edi SunandarAri ProbandariBMCarticleIndonesiaMalariaPrivate sectorPharmaciesPublic–private partnershipTherapeutics. PharmacologyRM1-950Pharmacy and materia medicaRS1-441ENJournal of Pharmaceutical Policy and Practice, Vol 14, Iss S1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Indonesia Malaria Private sector Pharmacies Public–private partnership Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
spellingShingle	Indonesia Malaria Private sector Pharmacies Public–private partnership Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441 Astri Ferdiana Utsamani Cintyamena Luthfi Azizatunnisa’ Edi Sunandar Ari Probandari Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
description	Abstract Background Indonesia is the second country with the highest number of malaria cases in Southeast Asia. Private health providers including community pharmacies often become the first point of care for the population seeking malaria treatment; however, public–private partnerships for malaria control are not widely implemented. This paper explores the acceptability of a public-private partnership program on the provision of subsidized artemisinin-based combination therapies (ACTs) in community pharmacies from the perspectives of private health providers, patients, and program implementers. Methods The study was conducted in Manokwari District in West Papua Province, one of the highest endemic districts in Indonesia. Qualitative methods using interviews and focus group discussions (FGDs) were employed to explore the following dimensions of acceptability: affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy. Study participants were program implementers, private health providers, and pharmacy clients. Audio-recorded interviews were transcribed and analyzed using thematic analysis. Secondary data on malaria cases and the use of ACTs reported by community pharmacies were also recorded. Results Only one-fourth of the total community pharmacies in Manokwari participated in the partnership, suggesting low coverage of the program. The proportion of malaria cases reported by community pharmacies increased from 6.9% in 2018 to 30.7% of cases. Most participants had a positive attitude towards the program, which might be associated with the perceived effectiveness of the partnership in improving access to ACTs. Despite the good understanding of the intervention by the participating pharmacies, limited involvement of private physicians often resulted in non-standardized treatment practices. The partnership also imposed a burden on private health providers in terms of human resources and time which entailed significant opportunity costs. A number of ethical issues might undermine the equity of access to ACTs. Conclusion Despite the positive attitude to the partnership, the perceived burden might outweigh the tangible benefits, posing threats to scaling up the intervention and sustainability. Innovations to simplify the administrative procedures in combination with performance-based incentives are needed to improve implementation. Engagement of patients and physicians is needed to increase the effectiveness of the partnership.
format	article
author	Astri Ferdiana Utsamani Cintyamena Luthfi Azizatunnisa’ Edi Sunandar Ari Probandari
author_facet	Astri Ferdiana Utsamani Cintyamena Luthfi Azizatunnisa’ Edi Sunandar Ari Probandari
author_sort	Astri Ferdiana
title	Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
title_short	Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
title_full	Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
title_fullStr	Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
title_full_unstemmed	Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia
title_sort	finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in manokwari, indonesia
publisher	BMC
publishDate	2021
url	https://doaj.org/article/56b4a83d5ea346ea893d44ec1b54a013
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Finding the right balance: implementation of public–private partnership in artemisinin-based combination therapy provision in Manokwari, Indonesia

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