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The Lancet. 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
[Source: The Lancet, full text: (LINK). Abstract, edited.]
Sarah Tougher MDE a, Yazoume Ye PhD b, John H Amuasi MBchB c d, Idrissa A Kourgueni MSc e f, Rebecca Thomson MSc a h, Catherine Goodman PhD a, Andrea G Mann PhD a, Ruilin Ren PhD b, Barbara A Willey PhD a, Catherine A Adegoke PhD i, Abdinasir Amin PhD b, Daniel Ansong MBChB d j, Katia Bruxvoort MPH a h, Diadier A Diallo PhD a, Graciela Diap MD g, Charles Festo BSc h, Boniface Johanes MHSM h, Elizabeth Juma MMed m, Admirabilis Kalolella MPH h, Oumarou Malam BSc f, Blessing Mberu PhD k, Salif Ndiaye MSc l, Samuel B Nguah MBChB d, Moctar Seydou MSc f, Mark Taylor PhD a h n, Sergio Torres Rueda MSc a, Marilyn Wamukoya MPH k, Fred Arnold PhD b, Kara Hanson SD a, the ACTwatch Group
Summary
Background
Malaria is one of the greatest causes of mortality worldwide. Use of the most effective 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 Affordable 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 effect 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 identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified 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-profit 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 effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness.
Funding
The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
a London School of Hygiene and Tropical Medicine, London, UK; b ICF International, Calverton, USA; c University of Minnesota School of Public Health, PhD Program, Division of Health Policy and Management, Minneapolis, USA; d Komfo Anokye Teaching Hospital, Kumasi, Ghana; e Centre International d'Etudes et de Recherches sur les Populations Africaines, Niamey, Niger; f Institut National de la Statistique, Niamey, Niger; g Drugs for Neglected Diseases initiative, Geneva, Switzerland; h Ifakara Health Institute, Dar es Salaam, Tanzania; i Phar-Mark Consultants, Kwara State, Nigeria; j Kwame Nkrumah University of Science and Technology, Department of Child Health, School of Medical Sciences, Kumasi, Ghana; k African Population and Health Research Center, Nairobi, Kenya; l Centre de Recherche pour le D?veloppement Humain, Dakar, Senegal; m Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya; n European Centre for Environment and Human Health, University of Exeter Medical School, UK
Correspondence to: Sarah Tougher, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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The Lancet, Early Online Publication, 31 October 2012
doi:10.1016/S0140-6736(12)61732-2
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
Original Text
doi:10.1016/S0140-6736(12)61732-2
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
Original Text
Sarah Tougher MDE a, Yazoume Ye PhD b, John H Amuasi MBchB c d, Idrissa A Kourgueni MSc e f, Rebecca Thomson MSc a h, Catherine Goodman PhD a, Andrea G Mann PhD a, Ruilin Ren PhD b, Barbara A Willey PhD a, Catherine A Adegoke PhD i, Abdinasir Amin PhD b, Daniel Ansong MBChB d j, Katia Bruxvoort MPH a h, Diadier A Diallo PhD a, Graciela Diap MD g, Charles Festo BSc h, Boniface Johanes MHSM h, Elizabeth Juma MMed m, Admirabilis Kalolella MPH h, Oumarou Malam BSc f, Blessing Mberu PhD k, Salif Ndiaye MSc l, Samuel B Nguah MBChB d, Moctar Seydou MSc f, Mark Taylor PhD a h n, Sergio Torres Rueda MSc a, Marilyn Wamukoya MPH k, Fred Arnold PhD b, Kara Hanson SD a, the ACTwatch Group
Summary
Background
Malaria is one of the greatest causes of mortality worldwide. Use of the most effective 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 Affordable 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 effect 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 identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified 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-profit 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 effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness.
Funding
The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.
a London School of Hygiene and Tropical Medicine, London, UK; b ICF International, Calverton, USA; c University of Minnesota School of Public Health, PhD Program, Division of Health Policy and Management, Minneapolis, USA; d Komfo Anokye Teaching Hospital, Kumasi, Ghana; e Centre International d'Etudes et de Recherches sur les Populations Africaines, Niamey, Niger; f Institut National de la Statistique, Niamey, Niger; g Drugs for Neglected Diseases initiative, Geneva, Switzerland; h Ifakara Health Institute, Dar es Salaam, Tanzania; i Phar-Mark Consultants, Kwara State, Nigeria; j Kwame Nkrumah University of Science and Technology, Department of Child Health, School of Medical Sciences, Kumasi, Ghana; k African Population and Health Research Center, Nairobi, Kenya; l Centre de Recherche pour le D?veloppement Humain, Dakar, Senegal; m Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya; n European Centre for Environment and Human Health, University of Exeter Medical School, UK
Correspondence to: Sarah Tougher, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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