The INESS studies seek to inform policy makers by providing rationale choices for adoption of effective drugs. Estimating costs and cost-effectiveness of the studies is crucial as the studies are rolled out to enable policy makers make a sound choice among the various alternatives presented as first line drugs or as drugs for special groups of the population. There are two main goals of costing the introduction of a new antimalarial for the INESS Studies. The first is to provide evidence on whether the new antimalarial is of high, moderate, or low cost-effectiveness compared to the existing first line drugs in use in participating countries. The second is to provide health planners and donors with information on the cash expenditures (the financial costs) that would be needed to introduce a new policy for the new antimalarials in the first place and then to keep it running. The first type of information would assist decision-makers in countries as well as other African countries that are considering using the new antimalarials and the financial analysis would be useful for monitoring, planning and budgeting purposes.

Further, policy change usually involves changing the drug policy guidelines, developing treatment guidelines, developing a training manual for health workers and implements, developing IEC materials, distribution guidelines, sensitization at the various levels, advocacy and lobbying with key stakeholders which requires documentation of the entire process and costing the process to help inform policy makers. Also the new drugs have to be procured and cost of the drugs, the procurement process and the distribution and regulation regarding the drug needs to be documented and the cost ascertained. Service delivery factors such as training health workers, private providers, supervision, and sensitization at the community level are all factors that will influence a country to want to change its drug policy.

Thus in order to capture and cost the process of policy change we will first review and collect data to document the process of policy change for antimalarial drug policy in each country.

Different levels of policy change will be identified and the process documented. Different levels of policy change such as the national, regional/provincial and the district level is envisaged for the stakeholder interviews.

Data on the global drug subsidy in countries will collated to document the process and the cost of this subsidy. District level contextual factors such as floods, drought, policy change at the district level that are likely to have an impact on the outcomes of the INESS studies should be observed, documented and the costs obtained in each district and site.