Bulletin of the World Health Organization

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.