Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy.

Margaret Gyapong,Christopher Jm Whitty,Constance Bart-Plange,Evelyn K Ansah

doi:10.1093/inthealth/ihw041

Abstract

BackgroundMost people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility – malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and ‘crowd out’ artemisinin monotherapies.MethodsThree censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored.ResultsOf 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40–45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40–100%.ConclusionsInitial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this.

Highlights

In common with much of Africa, the majority of adults and children with febrile illness in Ghana, including the poorest, are treated in the private retail sector.[1,2,3] Accepting this reality, and on advice from many economic commentators that subsidies would be needed, the Global Fund introduced the innovative Affordable Medicines Facility – malaria (AMFm) initiative, which subsidised high-quality Artemisinin Combination Therapy (ACT) drugs to try to ensure that those buying from the sector had access to effective combinations.[4]
This study aimed to look at the effect in a typical Ghanaian district over the change period, and once the change had become established practice
Antimalarials were classified into four groups as follows: Quality Assured ACTs (QUAACTs), artemisinin monotherapies, nonartemisinin monotherapies, and herbal-based AM

Summary

Introduction

In common with much of Africa, the majority of adults and children with febrile illness in Ghana, including the poorest, are treated in the private retail sector.[1,2,3] Accepting this reality, and on advice from many economic commentators that subsidies would be needed, the Global Fund introduced the innovative Affordable Medicines Facility – malaria (AMFm) initiative, which subsidised high-quality Artemisinin Combination Therapy (ACT) drugs to try to ensure that those buying from the sector had access to effective combinations.[4] The four main objectives of AMFm were to: increase ACT affordability; increase ACT availability; increase ACT use, including among vulnerable groups; and ‘crowd out’ oral artemisinin monotherapies. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility – malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and ‘crowd out’ artemisinin monotherapies

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