ArticlesEffect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data
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Background
Malaria is a major cause of mortality in Africa. However, the use of artemisinin-based combination therapies (ACTs), the most effective treatment for uncomplicated malaria, remains far below that which is needed to fight the disease.1 In 12 of 16 malaria endemic countries in Africa, less than 60% of antimalarial drugs used by febrile children under-5 were ACTs.2, 3, 4 Reasons for low ACT uptake include: unreliable public sector supply; high prices and limited availability in the private sector,
Study design
Our evaluation had a non-experimental design, with before-and-after comparisons of price, availability, and market share in each pilot setting, and detailed documentation of implementation process and context.21
Nationally representative baseline and endpoint surveys of outlets stocking antimalarial treatment were done in each pilot. Methods for these surveys were adapted from the ACTwatch project.22 Baseline data collection took place between August and December, 2010, in most pilots, generally
Results
Table 1 shows the samples at baseline and endpoint; the sample breakdown by outlet type is shown in the appendix. Differences in the number of outlets visited reflect variation in the number of selected clusters across countries and data collection rounds, and cross-country variations in the sampling approach (appendix).
Response rates, as measured by the percentage of outlets visited that were screened, were 90% or above in all pilots except Kenya, reflecting more frequent visiting of
Discussion
Large changes were recorded from baseline to endpoint in QAACT availability, price, and market share in most of the eight pilots after implementation of the AMFm programme. Success benchmarks were clearly met in five pilots for availability, five for QAACT price relative to the most popular treatment that is not a QAACT, and four for QAACT market share. These 1-year benchmarks were met, although all pilots had less than 12 months of full implementation of supporting interventions (figure 1).
References (33)
- et al.
Cost is killing patients: subsidising effective antimalarials
Lancet
(2009) Affordable medicines facility for malaria: reasonable or rash?
Lancet
(2010)- et al.
Universal access to malaria medicines: innovation in financing and delivery
Lancet
(2010) World Malaria Report 2010
(2010)ACTwatch Household Surveys (Democratic Republic of the Congo, Republic of Benin, Republic of Zambia)
Demographic and Health Surveys (Malawi, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, United Republic of Tanzania, Zimbabwe)
Malaria Indicator Surveys (Angola, Kenya, Liberia, Madagascar, Nigeria, Uganda)
- et al.
Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania
PLoS One
(2009) - et al.
Artemisinin resistance: current status and scenarios for containment
Nat Rev Microbiol
(2010) - et al.
Saving lives and buying time: economics of malaria drugs in an age of resistance
(2004)
The impact of retail-sector delivery of artemether–lumefantrine on malaria treatment of children under five in Kenya: a cluster randomized controlled trial
PLoS Med
Distribution of artemisinin-based combination therapies through private sector channels: lessons from four country case studies
Socially-marketed rapid diagnostic tests and ACT in the private sector: ten years of experience in Cambodia
Malaria J
A global subsidy: key to affordable drugs for malaria?
Health Aff
Focusing on quality patient care in the new global subsidy for malaria medicines
PLoS Med
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