Study design

 ACTwatch

The study design provides a description of the research objectives, methodology, and data collection procedures.  Individual study designs were developed per country.

The outlet survey studies both the public and private sectors in order to have a complete picture of the anti-malarial market within a country at the retail level. The survey is conducted approximately three times over the life of the project in each country to measure trends over time.  A cross-sectional survey is conducted of outlets with the potential to stock and dispense anti-malarials to patients/caregivers. The outlet survey measures price, availability, and volumes of anti-malarial medicines and the price and availability of RDTs.  The sample is based on a one-staged cluster design using probability proportion to population size, that provides nationally representative data sufficiently powered to allow for comparisons over time, between the public and private sectors and across sub-populations where stratified. The sampling strategy was designed to detect a 20 percentage point change in the primary outcome measure, availability of ACT. The cluster selected was an administrative unit with on average 10,000 to 15,000 inhabitants, such as a sub-district or parish.  Stratification was determined by consulting with the Ministry of Health (MOH) in each country to identify characteristics of sub-populations that are relevant for policy consideration.

The objective of the household survey component is to monitor consumer treatment-seeking behaviour for fever. It is a population based, cross-sectional survey that takes place twice over the length of the project, at baseline and end-line, either at the same time or soon after the collection of outlet survey data. It takes place in the same geographical areas as the outlet survey and allows for comparisons over time and across strata, where relevant. It is powered to detect a 20 percentage point difference in the key outcome indicator “the proportion of children under five with fever in the past two weeks who used any anti-malarial the same or next day of the onset of fever”.

The supply chain component employs quantitative and qualitative methods to study the distribution chain for anti-malarial drugs from factory gate / port of entry to consumer, mark-ups along the supply chain, market structure, including level and forms of competition, and the policy/regulatory environment. The objective is to provide policy makers with a map of the supply chain for anti-malarials and RDTs, including evidence on wholesaler volumes and the components of the consumer price in the context of the current market and policy influences on the supply chain. Data collection methods include a structured survey of wholesalers of anti-malarials and qualitative in-depth interviews throughout the distribution chain.

Here are some examples of full study designs for each research component. If you are interested in the documentation relevant to a particular survey/country, please contact mlittrell [at] psi [dot] org.

FPwatch

FPwatch is a cross-sectional study that provides estimates for key family planning market indicators at the retail level. Standardized methods and questionnaires allow for comparisons between countries to give a complete picture of the FP market.

Sampling and outlet selection: Statistical sampling is conducted in each country to select probability-proportion-to-population-size clusters with, on average, 10,000 to 15,000 inhabitants (such as a sub-district). Nationally representative outlet sites are then identified within the clusters. Further country-specific stratification, such as rural/urban designations, are determined in each country to identify relevant sub-populations.

Outlet types: The main types of outlets surveyed include public and private not for-profit health facilities, community health workers (CHWs)/health posts, private for-profit health facilities, registered and unregistered pharmacies, drug shops, and general retailers.

Eligibility criteria: Outlets are included in the survey if they

1) Had modern contraceptive commodities including oral contraceptives, emergency contraceptives, injectables, implants or IUDs in stock at the time of survey or in the previous three months, OR
2) Offer contraceptive services including contraceptive injections, implant or IUD insertions, or male or female sterilizations.

 

Data collection:  Trained data collectors conduct full contraceptive audits in eligible outlets. Among outlets offering eligible contraceptive services, providers are interviewed to provide information for each type of service.

Key outlet indicators: Contraceptive availability, market share, method mix availability, price, service readiness

If you are interested in the documentation relevant to a particular survey/country, please contact mlittrell [at] psi [dot] org.