Project to increase availability of malaria drug has worked, study finds

BMJ 2012; 345 doi: (Published 02 November 2012) Cite this as: BMJ 2012;345:e7451
  1. Anne Gulland
  1. 1London

An evaluation of a controversial initiative to broaden access to malaria medicines has found that in pilot studies it rapidly increased the availability and lowered the price of the drugs.1

A paper in the Lancet looks at the Affordable Medicines Facility malaria (AMFm), an initiative launched by the Global Fund to fight Aids, Tuberculosis and Malaria in 2010 to increase uptake of quality assured artemisinin based combination therapies (QAACTs). The facility was introduced because of concerns that uptake of these treatments, the most effective way to treat malaria, was too low because of their high cost and poor availability. There was also concern about the emergence of artemisinin resistance, exacerbated by use of monotherapies.

The fund negotiated a global subsidy with manufacturers and launched eight pilot sites in seven countries to provide the drugs to private sellers, the main source of malaria treatment in sub-Saharan Africa.

Between August 2010 and the end of 2011, 155.8 million doses of QAACTs—financed through the facility—were delivered to participating pilots. Support was also given in the form of communication campaigns, recommended retail prices, and provider training.

Researchers found that the facility had a “dramatic effect” on the private market, through large increases in QAACT availability and market share, and decreases in prices (except in Uganda). The paper said the changes were “substantial and achieved in only a few months, which showed the power of tapping into the distributional capacity of the private sector.”

The facility had a particularly large effect on the private sector where QAACT market share increased in seven of the pilots, with an increase of between 26% and 52% in six countries. QAACT prices fell by up to 80% in six countries, with the decrease ranging from $1.28 (£0.8; €1) to $4.82 per dose.

However, there are many critics of the scheme, one of whose major funders is the UK government, and Oxfam released a report urging the Global Fund to scrap it.2

Mohga Kamal Yanni, author of the report and senior health policy adviser at the charity, told an event to launch Oxfam’s report that the evaluation of the facility was flawed because it did not look at whether it had increased access to drugs among vulnerable groups.

“The malaria subsidy increased sales but there is no credible evidence that it saved lives because we don’t know who used the medicines and we don’t know whether they reached vulnerable groups,” she said.

David McCoy, a senior clinical lecturer in global health at Queen Mary University, said that any intervention that reduced the cost of high quality medicines had to be welcomed. He added that using such a narrow set of parameters to measure the facility’s success was “inappropriate.”

He added, “There is a tendency in global health to adopt biotechnological and pharmaceutical solutions to problems that are far more complex, as opposed to a more comprehensive solution that addresses health system support and community health workers, who have a big role to play in helping malaria control.”

Authors of the Lancet paper acknowledged that they did not set out to measure health outcomes. “As secondary data about use become available from appropriately timed endpoint household surveys, we will need to reassess conclusions about AMFm’s effect on access to effective treatment,” they said.

An editorial accompanying the paper urges the Global Fund to keep the facility going when it meets next week.3 “We must acknowledge that an efficient approach to subsidising antimalarial drugs has worked, making them available in the private sector where people go to buy them,” it said.


Cite this as: BMJ 2012;345:e7451