Is Affordability and Accessibility All It Takes?

Abstract

The Affordable Medicine Facility – malaria (AMFm) was a pilot project established to subsidize quality-assured artemisinin-based combination therapies (QAACTs) in eight malaria-endemic African regions: Kenya, Uganda, Ghana, Niger, Nigeria, Madagascar, Tanzania (mainland) and Zanzibar. The objectives of the program were to increase the affordability and availability of artemisimin-based combination therapies (ACT), as well as the market share relative to other less effective antimalarial medicines. Overall, the AMFm program had a greater impact in the private-for-profit sector than the public sector. In general, public services do not work as well as their private counterparts in most countries. Inadequate services in remote areas necessitate prohibitively long journeys to access resources and care. In general, the private sector was able to provide supplies of ACTs, as long as it was profitable. Seven countries showed significant increases in availability in the private sector, six regions had significant decreases in QAACT cost, with declines ranging from $1.28 to $4.82, and all eight regions had increases in market share. Impact in remote regions was substantial, with 60% (Ghana) and 48.5% (Kenya) of facilities in remote areas stocking QAACTs. Negotiations with manufacturers, the involvement of the private sector, and supporting interventions were critical in the success of AMFm. The AMFm pilot project then transitioned into a private sector co-payment mechanism involving only six countries. The AMFm program was not sustainable due to the enormous costs of the program, potentially due to unnecessary and excessive orders of ACTs, with an estimated total of 500 million USD. Fixing this sustainability issue would make a program such as this one more applicable to other malaria-endemic countries, which have limited financial resources.