The Global Fund to Fight AIDS, Tuberculosis and Malaria has released a commissioned final report that will help inform its decision on whether to expand, modify or terminate an innovative financing mechanism against malaria.
The success of the pilot phase of the Affordable Medicines Facility for malaria was measured against several benchmarks: increased availability, market share and relative price of quality-assured artemisinin-based combination therapies compared with other malaria medications. Some benchmarks have been met, but success varies among phase one’s eight pilot areas.
The program was able to boost availability of QAACTs in four countries: Ghana, Kenya, Tanzania and Uganda. Price and market share of the drug relative to artemisinin monotherapy also showed positive results across all pilot countries; in some countries though, AMT already fared poorly against the baseline.
The price of another malaria medicine in tablet form, however, remains competitive in Ghana, Nigeria and Uganda. It is difficult to match prices in Nigeria, for instance, where tablets are sold for $0.47 each; QAACTs are priced $1.48 across all outlets in the country. But the report also cited poor adherence to the recommended retail price in Nigeria, which may be due to low awareness or “market pressures linked to the exercise of the Global Fund demand levers.”
The program’s impact on the private for-profit sector has been a “game changer,” according to the report, except in Niger and Madagascar, where orders of ACTs were “very low.” This, the report says, could be due to lack of awareness through mass media campaigns, structure of the sector, political and economic instability, and weather conditions.
But the impact of AMFm on the public sector has been limited. The result can be attributed to delays in procurements and issuance of Global Fund grant requirements, according to the report. While it remains to be seen whether a new Global Fund financing model could address this problem, possible cuts to the U.S. global health budget are likely to exacerbate it. President Barack Obama’s proposed 2013 U.S. spending plan reduced by 4.8 percent the budget of the U.S. President’s Malaria Initiative, which supplies ACTs to countries experiencing procurement delays, Roger Bate and Kimberley Hess wrote in an article for the American Enterprise Institute.
AMFm works to expand people’s access to ACTs. It negotiates with ACT manufacturers to reduce prices of the drug, subsidizes ACTs through copayments and supports interventions for proper ACT use.
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