Piloting the Affordable Medicines Facility-malaria: what will success look like?
Gavin Yamey, Marco Schäferhoff & Dominic Montagu
Volume 90, Number 6, June 2012, 452-460
Table 2. National programmes subsidizing artemisinin-based combination therapiesa
| Country | Lead organization | Launch year | Age group | Outlets | Coverage | Outcome: ACT availability | Outcome: ACT price |
|---|---|---|---|---|---|---|---|
| Cambodia | PSI | 2002 | All age groups | Pharmacies, drug shops | 17 of 20 malaria-endemic provinces | At 1 year: – very low in private facilities: 22% stocked adult ACTs, 6% stocked child ACTs |
At 1 year: – mean consumer price for adult ACTs (US$ 1.07) 70% higher than RRP (US$ 0.63) |
| Cameroon | Government | 2007 | All age groups | Public and private health facilities | National | At 1 year: – low availability of subsidized ACTs at public or private facilities – monotherapies widely available |
At 1 year: – adherence to RRP strong in only one province (Yaoundé Centre) |
| Democratic Republic of Congo | PSI | 2006 | Children aged less than 5 years | Pharmacies | Limited to some districts | At 2 years: – 20.2% (public facilities), 25.8% (part 1 pharmacies), 20% (drug shops), 8.6% (other private outlets) – 66.4% facilities stocked non-artemisinin-based therapy, 47.8% stocked AMT |
At 2 years: – median price of ACTs: US$ 2.75 (public health facilities), US$ 2.29–4.58 (private facilities), US$ 3.89 (all facilities selling ACTs) – ACT price 60% higher than price of the most common antimalarial in outlets selling ACTs |
| Madagascar | PSI | 2003 | Children aged less than 5 years | Pharmacies, private providers, community agents | National | At 5 years: – 85.6% (public facilities), 47.5% (part 1 pharmacies), 20% (drug shops), 0.1–16.5% (other private outlets) – 34.4% facilities stocked non-artemisinin-based therapy, 0.5% stocked AMT |
At 5 years: – median price of ACTs in facilities selling ACTs: US$ 4.04 (ACTs free in public facilities) – ACTs 11.3 times more expensive than the most common antimalarial in outlets selling ACTs |
| Rwanda | PSI | 2007 | Children aged less than 5 years | Pharmacies | National | At 18 months: – high ACT availability in private pharmacies: 80–90% stocked child ACTs (compared with 10% at baseline) – monotherapies effectively banned |
Data unavailable |
| Senegal | Government | 2006 | All age groups | Pharmacies | National | At 1 year: – proportion of all facilities (public and private) stocking ACTs: 44.8% (adult dose), 58.2% (child), 46.3% (infant) – monotherapies widely available |
At 1 year: – strong adherence to RRP in private outlets (observed mean retail price: US$ 1.34; RRP: US$ 1.31) |
ACTs, artemisinin-based combination therapies; AMFm, Affordable Medicines Facility-malaria; AMT, artemisinin monotherapy; PSI, Population Services International; RRP, recommended retail price.
a These programmes were rolled out before the 2010–11 AMFm pilot. Two countries, Cambodia and Madagascar, have also been included in the AMFm pilot phase, and the results from the pilot are due to be reported in 2012.