Tools

Under this Call, Unitaid will consider proposals that include support for the adoption and expanded use of ASPY and potentially other antimalarials as part of MFT strategies.

Areas of work

Proposals are being solicited for the following interventions:

Multi-country, large-scale product introduction support to accelerate demand and adoption of ASPY, and generate evidence for resistance management strategies like multiple first line ACTs.

Multi-country, large-scale product introduction support is needed to support ACT diversification. Support would serve to increase demand for ACTs with limited uptake i.e., ASPY, create early market volumes needed to support efforts of global health partners and to reduce prices, and in parallel address key knowledge gaps. The latter includes demonstrating how to implement ASPY alongside other ACTs while adhering to the specific dosing weight bands, as well as evaluating the feasibility, and cost-effectiveness/willingness to pay for multiple first-line treatment strategies. Strategies can include rotating ACTs, “mosaic” models, or diversifying ACTs by region or age group. Other innovative strategies that consider sub-national tailoring or implementing multiple first-line treatments across the public and private sectors could also be considered. As part of designing suitable strategies, country specific assessments of the ACT landscape are needed to guide approaches. Evidence generated from multi-country projects would therefore be important inputs into WHO policy recommendations and operational guidance, as well as generating evidence to support country-level scale-up.

In general, commodity costs for procurement volumes are assumed to be covered through routine country grants of the Global Fund and PMI. Consideration is being given to a time-limited co-payment or other market shaping interventions for ASPY to allow countries to deploy more expensive ACTs without compromising overall treatment coverage.

Settings of interest

1. Countries with evidence of partial artemisinin resistance
   Priority countries are those where resistance has already been detected including Eritrea, Rwanda, Tanzania, Kenya and Uganda
2. Countries with concerns of reduced or declined efficacy
   In countries such as Burkina Faso, the Democratic Republic of Congo, and Angola, treatment failures have recently been reported at some sites, however the method of detection used is not recommended by WHO. Until it is known whether methodological issues may have confounded results in these countries, these countries remain a potential concern, and there is still a need to reduce AL use while increasing the uptake of other available ACTs.
3. Countries without evidence of partial artemisinin resistance or reduced efficacy
   In countries where resistance has yet to be reported, there is still a need to reduce the reliance on AL and remove barriers to utilizing other available ACTs. Countries for consideration include those with a high resistance risk, high malaria transmission rates, country willingness and readiness to diversify ACT use (e.g., product registration or existing inclusion in national guidelines), diversity of the implementation setting, and a country’s market size in relation to their ability to generate the volumes needed to achieve scale to lower prices.

Unitaid considers working with communities a critical part of generating demand and strongly encourages adopting inclusive approaches, and the engagement of communities towards improving the lives and health of the most vulnerable people. The role of affected communities and planned collaborations with other relevant groups including grassroots community organizations and Civil Society Organizations at all stages of a project/programme is essential, this engagement can be a key determinant for success. Community-led approaches are important to consider when designing, planning, implementing, and evaluating activities and programmes.

Unitaid sees value in proposals from South-based implementors with experience in leading the implementation of large-scale multi-country projects that support access to health products in countries. We encourage coordination and collaboration across implementors and are interested in proposals that would have regional impact across Africa.

Unitaid is committed to climate and environmental action in its investments, and expect its partners to make similar commitments. Proposals should indicate: (i) Efforts that will be made to minimize carbon emissions from project activities (eg, greener procurement practices, reduced travel through more reliance on in-country based teams and service providers); (ii) Optional: potential opportunities to contribute to broader climate and/or environmental co-benefits, in synergy with core project objectives. Unitaid is open to consider limited funding when necessary to support such discrete activities, subject to Unitaid’s current and future guidelines and financial prioritization. Estimated budget requirements should be explicitly mentioned in the relevant section of the proposal form.

Proposals should be carefully targeted, reflecting focused interventions to address key challenges regarding mitigating antimalaria drug resistance in Africa and access to health products. Proposals are expected to target the specified area of work listed above. Proposals may, but do not have to, cover all activities described within the area of work. Proposals should clearly indicate the level of effort and budget for each activity.

Proposals should demonstrate value for money and measurable impact. Proposals should also include analysis of pathways to impact, scalability, and sustainability of key interventions.

Areas out of scope for this Call include proposals: a) product development; b) volume guarantees; and c) scaling-up artemether-lumefantrine (AL). Activities that are currently under investigation are also out of scope for this call, specifically expanding local manufacturing capacity for quality ASPY and DP.

Through this Call for Proposals, Unitaid aims to improve access to health products of public health importance in low- and middle-income countries, and in particular:

• To contribute to diversifying the use of health products in low- and middle- income countries (LMICs);
• To increase their affordability in LMICs;
• To generate demand and increase their adoption and use in LMICs;
• To create guidance around multiple first-line treatment strategies for malaria.

The objectives outlined above will lead to: (1) better health outcomes due to additional people being treated, or due to people receiving effective treatments (2) financial savings/efficiencies due to the availability and use of more affordable products, and (3) improved and more equitable access by making products available and/or affordable in LMICs. The goal is to enable widespread access to affordable health products through scale-up by governments and partners, to contribute to the global health response to diseases that predominantly affect people in LMICs.