Promoting Quality Malaria Medicines Through SBCC

Learn how to combat substandard, spurious, falsified, falsely-labeled and counterfeit – or SSFFC – malaria medicines.

About this I-Kit

Substandard, spurious, falsified, falsely-labeled and counterfeit – or SSFFC – malaria medicines cause undue harm because they cannot effectively treat malaria. SSFFC malaria medicines can also negatively influence consumer behavior, threaten national healthcare systems and contribute to artemisinin resistance. 

This Implementation Kit (I-Kit) provides national and local stakeholders, as well as program managers, with key considerations and a roadmap for designing and implementing a country-specific social and behavior change communication (SBCC) campaign that protects the public from poor quality malaria medicines and responds to the threat of SSFFC medicines in their country.

This I-Kit includes key information health practitioners need to combat issues of poor quality or diverted malaria medicines in their area, and resources to better understand their prevalence and the impact of SSFFC antimalarials. It includes suggestions for identifying partnerships and selecting appropriate audiences and theories to strengthen SBCC strategies. This Promoting Quality Malaria Medicines through SBCC I-Kit can be reviewed using its online version here, or can be downloaded as PDFs.



The I-Kit is organized as follows:

Background, Justification and Global Activities

Provides the necessary background and information to use the I-Kit, as well as information on global and country examples to combat SSFFC malaria medicines and promote positive medicine use behaviors.

Promoting Quality Medicines

Describes five essential elements for designing and implementing a campaign to promote the use of good quality malaria medicines.

Working with the Media

Provides guidance, tools and resources for engaging with the media to combat SSFFC malaria medicines.

Global SSFFC Malaria Medicine Resources

Provides resources and tools for understanding the malaria medicine situation, as well as developing and advocating for strategies to address medicine quality issues. Provides descriptions and links to resources and tools for protecting and advocating for malaria medicine quality.

What are SSFFC Malaria Medicines?

Substandard, spurious, falsified, falsely-labeled and counterfeit (SSFFC) malaria medicines are artemisinin-based combination therapy (ACT), or monotherapies, which cannot properly treat malaria due to poor quality. Malaria medicines are at higher risk for quality issues because they are in high demand in malaria-endemic countries. As a result, they are targeted by illicit manufacturers and are often improperly transported and stored by informal medicine vendors and drug smugglers alike. SSFFC malaria medicines generally fall into three categories (Kaur et al., 2015):


Medicine that does not contain enough active ingredient due to unintentional errors caused in manufacturing.


Medicine that does not contain enough or any active ingredient due to intentional fraudulent manufacturing, may carry false representation of their source or identity.



Medicine that does not contain enough active ingredient due to poor conditions in storage environments, handling, or transportation (light, heat, humidity, etc.). Stolen or diverted medicine is at risk of becoming degraded.

Whether they contain toxic, inactive or insufficient ingredients, SSFFC malaria medicines seriously threaten a country’s health system and the patients they serve. Because these medicines do not contain the required amount of the active ingredient, they cannot completely treat malaria and can lead to a worsened case of malaria, or even death. A 2013 study of data from 39 countries estimates that SSFFC malaria medicines may be connected with 122,350 deaths of children under five years old in sub-Saharan Africa. Read more about SSFFC malaria medicines here.

Malaria medicine quality problems and solutions vary from country-to-country. With this in mind, this I-Kit is not a step-by-step guide on how to design and implement one universally effective SBCC program to address substandard and falsified malaria medicines. Instead, the I-Kit serves to provide guidance on how to develop a country-specific SBCC strategy that helps protect the public from poor quality medicines for malaria treatment. This I-Kit can be used as a whole, or the sections that are most important may be used on their own.
This I-Kit is meant for a number of different audiences: 

  • Health promotion officers in ministries of health who are responsible for malaria SBCC programs.
  • Communication specialists within drug regulatory authorities, who are involved in creating public awareness about medicine quality.
  • SBCC specialists working for non-governmental organizations or projects, who are responsible for malaria communication programs.
  • Public relations and marketing specialists working for pharmaceutical companies or trade associations, who are already working on or interested in incorporating SBCC into their marketing and communication work.
  • Global malaria partners or donors who make policy and programmatic decisions and want to educate themselves on how to best respond, given the resources and context where they work. 
This I-Kit is meant to help design and implement SBCC interventions aimed at addressing consumer practices that influence the risk of obtaining SSFFC malaria medicines, including purchasing, using, verifying the authenticity of and reporting substandard malaria medicine. This I-Kit is based on lessons learned from global research and a strategically developed and evaluated program in Nigeria, and provides examples from that experience.

When preparing to design an SSFFC communication plan, the essential elements in Promoting Quality Medicines should be read from beginning to end. The elements are organized in order of consideration, with one leading to the next. While designing and implementing an SBCC program, refer to various elements and examples. This section explains how to share experiences and learnings with other professionals working to combat SSFFCs. SBCC aimed at protecting consumers from substandard and falsified malaria medicines is very new and not much is known about it. Help grow the knowledge base by sharing experiences and lessons learned by clicking here.

HC3 prepared this I-Kit based on its experience in Nigeria, and with input from other countries in Africa. The process involved four steps:

  1. Learning what is known and being done to address SSFFC malaria medicines globally. HC3 conducted an extensive desk review and consulted experts in malaria case management, pharmaceutical quality control, drug regulation and enforcement, pharmaceutical manufacturing and consumer awareness and education. This landscaping exercise indicated that few SBCC activities had been conducted to inform and protect consumers from substandard and falsified malaria medicines.
  2. Organizing a meeting of global stakeholders and representatives from six countries where SSFFC malaria medicines are an issue to learn about their experiences with SBCC to address the problem, and to ask for their inputs into the design of the I-Kit. The meeting revealed that only a few countries had conducted SBCC to address SSFFC malaria medicines, and none of the efforts had been evaluated.
  3. Working with the National Malaria Elimination Program (NMEP), the National Agency for Food and Drug Administration and Control (NAFDAC) and non-governmental stakeholders in Nigeria to design and test an SBCC strategy aimed at protecting families from SSFFC malaria medicines. The campaign HC3 developed with these partners was implemented in the Akwa Ibom State of Nigeria over a five-month period during 2016.
  4. Documenting the process, tools and lessons learned during the Nigeria campaign and sharing them through this I-Kit.

The examples featured in this I-Kit are primarily based on lessons learned while designing and implementing the SSFFC Malaria Medicines SBCC campaign in one state of Nigeria. Through others' contributions, it can be expanded to reflect lessons learned from other countries and contexts. Please share ideas, strategies, materials and research as well as examples via this Contact/Feedback Form.