Improving Access To Malaria Medicine Through Private-Sector Subsidies In Seven African Countries

Abstract

Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.

Caregiver responses and association with delayed care-seeking in children with uncomplicated and severe malaria

“…Despite limitations, by providing medicines promptly, drug shops provide vital services close to communities at risk. Indeed, through training and price subsidies [4, 47] the quality of services offered at drug shops has been improved [35]. However, it remains unclear if acceptable standards of managing children with malaria can be attained and gains sustained at drug shops [48–51].…”

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

“…For instance, the availability of QAACTs in Ghana increased in both urban and rural areas by 52 and 35% respectively [14]; the national average price of ACT decreased from $3.42 to 1.13 per treatment in private facilities [11]; in rural areas, the price of ACTs dropped from $2.74 to 0.94 [14]; the market share of QAACTs increased by 45.3% in private health facilities [14]. QAACTs were found to have been available in remote areas of Ghana at the completion of the AMFm program as well [15].…”

Determinants of price setting decisions on anti-malarial drugs at retail shops in Cambodia

“…Experiences in using RRPs on anti-malarial drugs have proved to have different effects on consumer prices across settings [ 47 – 49 ]. In Cambodia, since the start of the national programme in 2001, the subsidized ACT always had a printed RRP though retail prices generally exceeded it [ 24 , 47 ].…”

“…In the three countries in which timely communication campaigns about the AMFm subsidy and RRP were implemented, including Kenya, the Republic of Tanzania (mainland and Zanzibar) and Ghana, median ACT prices were at the RRP levels. By contrast, in countries where promotion activities were delayed or less intense, the median ACT price was above the RRP [ 49 ].…”