What lessons can be taken away from the Affordable Medicines Facility-malaria pilot?
What we found
After examining the results of a 2-year pilot in seven African countries (Ghana, Kenya, Madagascar, Niger, Nigeria, and Tanzania, including Zanzibar and Uganda), the authors drew four main conclusions that should be taken into account in subsequent phases of AMFm:
- “The more countries involved, the lower the drug prices and risk of leakage to other countries.”
As a result of the AMFm pilot, wholesale drug prices have dropped up to 80% from direct negotiations with manufacturers. Expanding AMFm to more countries would help stabilize ACT prices across borders.
- “There should be a transition to reduce subsidies over time.”
While countries with high malaria burden and low purchasing power may need subsidies for ACTs for the next few years, over time this need should decrease due to technological advancements and increased demand for AMFm drugs.
- “Rapid diagnostic tests for malaria are needed in the private sector.”
Since many fevers in malaria-endemic countries are not caused by malaria, integrating rapid diagnostic tests (RDTs) into the treatment of febrile illness will be an important way to conserve antimalarials moving forward. This can be done using pricing strategies that encourage providers to sell RDTs and patients to use them.
- “A broader febrile illness agenda is crucial.”
The authors state: “We believe it is time to expand our approach to fever case management from disease-focused treatment to patient-centered treatment…Health systems could more effectively manage both malaria and pneumonia by addressing the more general problem of febrile illness, rather than proceeding from a specific etiology or funding source.”
Why it matters
In mid-November 2012, the board of directors of Global Fund to Fight AIDS, Tuberculosis, and Malaria will decide whether to continue, modify, or terminate AMFm. This decision has broad implications for the availability and affordability of effective malaria medications going forward. As the piece concludes:
“Termination of AMFm will create instability in artemisinin production, will reduce access to affordable ACTs, and will be seen as abandonment – both by the many people who depend on AMGm and by the ACT producers. It will cause the kind of reaction that will detract from efforts to reduce deaths from malaria, to engage the private sector in providing community-based health care in poor countries, and to build credible health diplomacy.”