Abstract
BackgroundThe Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. This paper reports private for-profit provider awareness of key features of the AMFm programme, and changes in provider knowledge of appropriate malaria treatment.MethodsThis study had a non-experimental design based on nationally representative surveys of outlets stocking anti-malarials before (2009/10) and after (2011) the AMFm roll-out.ResultsBased on data from over 19,500 outlets, results show that in four of eight settings, where communication campaigns were implemented for 5–9 months, 76%-94% awareness of the AMFm ‘green leaf’ logo, 57%-74% awareness of the ACT subsidy programme, and 52%-80% awareness of the correct recommended retail price (RRP) of subsidized ACT were recorded. However, in the remaining four settings where communication campaigns were implemented for three months or less, levels were substantially lower. In six of eight settings, increases of at least 10 percentage points in private for-profit providers’ knowledge of the correct first-line treatment for uncomplicated malaria were seen; and in three of these the levels of knowledge achieved at endline were over 80%.ConclusionsThe results support the interpretation that, in addition to the availability of subsidized ACT, the intensity of communication campaigns may have contributed to the reported levels of AMFm-related awareness and knowledge among private for-profit providers. Future subsidy programmes for anti-malarials or other treatments should similarly include communication activities.
Highlights
The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use
Promotional messages frequently focused on ACT as recommended anti-malarial treatment, availability of good quality ACT identified by the ‘green leaf’ AMFm logo, and on the recommended retail price (RRP)
AMFm-related provider training was conducted for providers from all sectors in Ghana, Niger, Nigeria, Uganda and Zanzibar, while private for-profit providers were targeted in Kenya and Tanzania mainland, and the public sector in Madagascar
Summary
The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. Artemisinin-based combination therapy (ACT) is the recommended first-line treatment for uncomplicated Plasmodium falciparum infection throughout Africa, its use remains far below need and differs between urban and rural areas [1]. The reasons for this include unreliable public sector supply, high prices and limited availability in the private sector, and patient selftreatment with less expensive monotherapies [2]. Interventions to support AMFm implementation and promote appropriate anti-malarial use included communication campaigns, training of anti-malarial providers, setting of a recommended retail price (RRP), pharmacovigilance and post-marketing surveillance, and regulatory interventions such as enforcement of the ban on oral artemisinin monotherapy sales and changes to the prescription-only status of ACT
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