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Effect 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

Journal

Lancet

Category: Publications

Author: Sarah Tougher, the ACTwatch Group, Yazoume Ye, John H Amuasi, Idrissa A Kourgueni, Rebecca Thomson, Catherine Goodman, Andrea G Mann, Ruilin Ren, Barbara A Willey, Catherine A Adegoke, Abdinasir Amin, Daniel Ansong, Katia Bruxvoort, Diadier A Diallo, Grac

Published Date: 01 December 2012

Summary

Background

Malaria is one of the greatest causes of mortality worldwide. Use of the most eff ective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Aff ordable Medicines Facility—malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the eff ect of AMFm on QAACT price, availability, and market share, 6–15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar).

Methods

We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identifi ed on the basis of the Global Fund’s quality assurance policy. Changes in availability, price, and market share were assessed against specifi ed success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process.

Findings

In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8–51·9 percentage points), and market share (15·9–40·3 percentage points), driven mainly by changes in the private for-profi t sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline.

Interpretation

Subsidies combined with supporting interventions can be eff ective in rapidly improving avail ability, price, and market share of QAACTs, particularly in the private for-profi t sector. Decisions about the future of AMFm should also consider the eff ect on use in vulnerable populations, access to malaria diagnostics, and cost-eff ectiveness. Funding The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.

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