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 i.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…. ii.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… iii.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…. iv.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!!