Better access to effective antimalarials

The Affordable Medicines Facility for malaria

Malaria is one of the main reasons why people use health services in sub-Saharan Africa, placing a considerable burden on primary health care.

The Affordable Medicines Facility – malaria (AMFm) is a supply-side intervention designed to reduce malaria mortality by improving the availability and affordability of effective treatment. It also aims to delay the development of drug resistance through the use of artemisinin, in combination with other medicines, rather than as a monotherapy.

In most malaria-endemic countries artemisinin-based combination therapies (ACTs) are the recommended first-line treatment for malaria and the only effective treatment against its most lethal forms. Governments have made progress in expanding access to ACTs through the public health system, although many patients have limited access to public facilities and use the informal health sector, including non-governmental organisations (NGOs), private vendors and traditional healers. However, the high price makes ACTs inaccessible to the 50 percent of patients who seek malaria treatment from drug retailers in sub-Saharan Africa.

The key features of the AMFm are:

• A global buyer co-payment for ACTs that lowers the manufacturer sales price paid by first-line buyers, such as national wholesalers, Ministries of Health and NGOs.
• An increased supply of ACTs to public and private sector providers and lower prices paid by patients, resulting in increased access via primary healthcare centres, private sector pharmacies and drug stores.
• By reducing the price of ACTs, it is anticipated that AMFm will discourage the supply of the less-effective treatments that dominate the market and of artemisinin-based monotherapies that increase the risk of drug resistance.

There is a risk that the subsidy intended to make ACTs affordable would in practice be reduced and absorbed as the drugs move along the supply chain. This risk will be reduced by using complementary interventions, such as consumer information, or setting a recommended retail price.

Access to ACTs by people living in poverty – those without public facilities and unable to afford ACTs at subsidised prices – is a concern. The AMFm will support an enhanced public sector and NGO distribution of ACTs, often without charge but supplementary initiatives at PHC level, such as home-based management of malaria, will still be needed.

Lindsay Mangham and Kara Hanson
Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Lindsay.Mangham@lshtm.ac.uk
kara.hanson@lshtm.ac.uk

See also

'Affordable Medicines Facility – Malaria (AMFm) Technical Design', prepared AMFm Task Force of the Roll Back Malaria Partnership, November 2007 (PDF)
http://rbm.who.int/partnership/tf/globalsubsidy/AMFmTechProposal.pdf

'Conquering Malaria', by Joel Breman et al, pages 413-432, in Disease Control Priorities in Developing Countries (2nd Edition), Oxford University Press: New York, edited by Dean Jameson et al, 2006
www.dcp2.org/pubs/DCP

'Medicine Sellers and Malaria Treatment in Sub-Saharan Africa: What Do They Do and How Can Their Practice be Improved?', American Journal of Tropical Medicine and Hygiene, 77 (Supp 6), pages 203-218, by Catherine Goodman et al, 2007
www.ajtmh.org/cgi/content/full/77/6_Suppl/203

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