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

Ansah, Evelyn; Whitty, Christopher J. M.; Bart-Plange, Constance; Gyapong, Margaret

doi:10.1093/inthealth/ihw041

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Coming after the Tougher et al study, this study therefore provides an assurance of a sustained effect of AMFm and meets the estimated bench mark of success of the program about 2 years after its conclusion [ 19 ]. Similar observations have been documented in other parts of Ghana [ 20 , 21 ].…”

Section: Discussionsupporting

confidence: 90%

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Two years post affordable medicines facility for malaria program: availability and prices of anti-malarial drugs in central Ghana

Freeman

Kwarteng

Febir

et al. 2017

J of Pharm Policy and Pract

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BackgroundThe Affordable Medicines Facility for malaria (AMFm) Program was a subsidy aimed at artemisinin-based combination therapies (ACTs) in order to increase availability, affordability, and market share of ACTs in 8 malaria endemic countries in Africa. The WHO supervised the manufacture of the subsidized products, named them Quality Assured ACTs (QAACT) and printed a Green Leaf Logo on all QAACT packages. Ghana began to receive the subsidized QAACTs in 2010.MethodsA cross-sectional stock survey was conducted at 63 licensed chemical shops (LCS) and private pharmacies in two districts of the Brong-Ahafo region of Ghana to determine the availability and price of all anti-malarial treatments. Drug outlets were visited over a 3-weeks period in October and November of 2014, about 2 years after the end of AMFm program.ResultsAt least one QAACT was available in 88.9% (95% CI 80.9% – 96.8%) of all drug outlets with no difference between urban and rural locations. Non-Assured ACTs (NAACT) were significantly more available in urban drug outlets [75.0% availability (95% CI 59.1% – 90.9%)] than in rural drug outlets [16.1% availability (95% CI 2.4% – 29.9%)]. The top selling product was Artemether Lumefantrine with the Green Leaf Logo, a QAACT. There was a significant difference in the mean price of a QAACT [$1.04 USD (95% CI $0.98 – $1.11)], and the mean price of a NAACT in both the urban and rural areas [$2.46 USD (95% CI $2.11 – $2.81)]. There was no significant difference in the price of any product that was available in urban and rural settingsConclusionAbout 2 years after the AMFm program, subsidized QAACTs in Ghana were widely available and more affordable than NAACTs in the Kintampo North District and Kintampo South Municipality of Ghana. The AMFm program appeared to have mostly succeeded in making QAACTs available and affordable.

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Section: Discussionsupporting

confidence: 90%

“…This observation is similar to that observed by Ansah et al [20] and meets the price bench mark for the success of AMFm as found by Tougher et al [11]. The cheaper price of the QAACTs may have benefitted the consumer as intended.…”

Section: Discussionsupporting

confidence: 90%

Two years post affordable medicines facility for malaria program: availability and prices of anti-malarial drugs in central Ghana

Freeman

Kwarteng

Febir

et al. 2017

J of Pharm Policy and Pract

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“…Also of concern, the availability of nonstandardized herbal based antimalarials remained high during and after the intervention, sometimes surpassing availability of ACTs. 60 Considering this background and our results, more study is needed to determine if optimal malaria control strategies should include drug shops as key providers of care or if emphasis should be directed primarily towards improving care at public health centers.…”

Section: Discussionmentioning

confidence: 95%

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case–Control Study

Mpimbaza

Ndeezi

Katahoire

et al. 2017

The American Journal of Tropical Medicine and Hygiene

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We studied associations between delayed care seeking, demographic, socioeconomic, and geographic factors and likelihood of severe malaria in Ugandan children. The study was based at Jinja Hospital, Uganda. We enrolled 325 severe malaria cases and 325 uncomplicated malaria controls matched by age and residence. Patient details, an itinerary of events in response to illness, household information, and location of participants' residences were captured. Conditional logistic regression was used to determine risk factors for severe malaria and delayed care seeking. Delayed care seeking (≥ 24 hours after fever onset; odds ratio [OR] 5.50; 95% confidence interval [CI] 2.70, 11.1), seeking care at a drug shop as the initial response to illness (OR 3.62; 95% CI 1.86, 7.03), and increasing distance from place of residence to the nearest health center (OR 1.45; 95% CI 1.17, 1.79) were independent risk factors for severe malaria. On subgroup analysis, delayed care seeking was a significant risk factor in children with severe malaria attributable to severe anemia (OR 15.6; 95% CI 3.02, 80.6), but not unconsciousness (OR 1.13; 95% CI 0.30, 4.28). Seeking care at a drug shop (OR 2.84; 95% CI 1.12, 7.21) and increasing distance to the nearest health center (OR 1.18; 95% CI 1.01, 1.37) were independent risk factors for delayed care seeking. Delayed care seeking and seeking care at a drug shop were risk factors for severe malaria. Seeking care at a drug shop was also a predictor of delayed care seeking. The role of drug shops in contributing to delayed care and risk of severe malaria requires further study.

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“…Moreover, while PFP facilities are the most likely to have essential medicines for NCD in stock, substantial changes in price from week to week introduce uncertainty for patients and can limit access. Others have noted variation over time in private sector cost to consumer for anti-malarials using waves of data spaced months or years apart [ 18 ]. However, we are not aware of any other study that has examined granular data capable of showing week-to-week variations in cost-to-consumer of a range of essential medicines.…”

Section: Discussionmentioning

confidence: 99%

Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis

et al. 2020

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Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.

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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

Cited by 9 publications

References 19 publications

Two years post affordable medicines facility for malaria program: availability and prices of anti-malarial drugs in central Ghana

Two years post affordable medicines facility for malaria program: availability and prices of anti-malarial drugs in central Ghana

Demographic, Socioeconomic, and Geographic Factors Leading to Severe Malaria and Delayed Care Seeking in Ugandan Children: A Case–Control Study

Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis

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