Amani Thomas Mori, Eliangiringa Amos Kaale

1. Priority setting for implementation of Artemisinin based combination therapy policy in Tanzania: Evaluation against accountability for reasonableness framework Amani Thomas Mori, Eliangiringa Amos Kaale

2. Introduction • By 2009, nearly all countries in SSA had changed treatment policies to ACT (WHO, 2009) • Unfortunately treatment policy change involves decision about choices • AfR is an ethical framework to guide priority setting decisions in health (Daniels, 2002) • AfR enhance acceptability & legitimacy of priority setting decisions outcomes • Four conditions of AfR: Publicity, relevance, appeals & revision and enforcement

3. Methods • Qualitative study • In-depth key informant interviews with fifteen participants and guideline reviews • Key informants: TFDA, MSD, NMCP, MOHSW, WHO, Academicians, Physicians • Analysis by editing organizing style

4. Results • Relevance condition- ( Not fully satisfied) Lesson learned • The decision was grounded on scientific evidences of clinical efficacy , safety and formulation profiles • Neither of its components had reports of resistance • Pharmaco-economic evidences? • Limited stakeholders involvement, lack of professional and countrywide representation • Lack of explicit procedures for participation

5. Results cont…. • Publicity condition- (Not satisfied) Lessons learned • The decision but not the rationale behind it was publicized through radios, televisions and newspapers in Swahili language

6. Results cont… • Appeals & revision condition – (Not satisfied) Lessons learned • No clear way for affected stakeholders to convey their concerns, they use newspapers • New developments, arguments and deliberations have no clear way back to the policy table

7. Results cont…. • Enforcement condition – (Not satisfied) Lessons learned • No enforcement mechanisms despite concerns about Pharmaceutical companies lobbying for policy change • There is a need to establish independent watchdogs to ensure policies are made through fair processes

8. Conclusion • The priority setting decision of Artemether-lumefantrine as first line antimalaria drug failed to fully satisfy the four conditions of AfR framework

9. Future research area • Use of Pharmacoeconomic evidences to inform decision making in low-income countries in the formulation of: • Formularies • Treatment guidelines • Essential medicine lists Thank you for Listening!!