Launch of the Affordable Medicines Facility for Malaria

Today, the Affordable Medicines Facility for Malaria was unveiled in Norway (great NY Times piece) with an initial $225 million. The subsidy program aims to increase the availability of affordable artemisinin combination therapies (ACT) – the recommended first line treatments for malaria – through private drug shops. Many people in some countries self-treat with antimalarials bought from these private shops since they can be closer to their home, don’t have long queues, etc. ACTs are rarely bought because of their higher prices so the idea is to make them inexpensive and reduce the incentive to buy otherwise cheaper, but less efficacious, antimalarials.

The article suggests that “For a poor farmer in Cameroon or a poor market woman in Ghana, the difference between 20 cents and $8 is huge” which is true but fails to mention that in many countries ACTs are available free of charge through public and private health facilities. ACTs are already subsidized through national control programs though the extent of their reach could be expanded. I must admit I have my doubts about this plan. First, as Dr. Bernard Nahlen notes in the Times article, there’s scant evidence for a scale-up of this approach. The deputy director of the President’s Malaria Initiative (a solid CDC EIS alumnus – random aside I think CDC involvement is a key reason for PMI’s to date success) is justified in his skepticism. The bulk of data are basic case studies from a few Clinton Foundation pilot projects. Second, even if more rigorous evaluations demonstrate some impact, is it really a desirable way forward?

We need more delivery channels and increasing the availability of ACTs is critical, but it should be done as a component of improving overall case management. The idea of encouraging  indiscriminate pill-popping (even if it is the current scenario) with better drugs probably does not align with most countries health priorities. Additionally, there are also the inherent risks of missing other etiologies of fever and increasing drug pressure. On the other hand, cheap ACTs in drug kiosks may be able to provide quick wins in areas which have seen little progress, but countries should think carefully before embarking on this road. It may be an OK stop gap to stave off some morbidity and mortality in places with non-existent health systems but could sabotage development in the long run.

A follow-up comment I posted on Science magazine’s blog which I think adds some more information:

Going the private route is not new. Global Fund drugs get distributed through private channels in many countries whether it is NGOs or partnerships with industries that have medical facilities. What is newer is the use of drug kiosks but even Cambodia for a few years has been marketing ACTs through private shops – with questionable impact. We’ll see how this effort progresses but it is not likely to help build health systems.


2 Responses to “Launch of the Affordable Medicines Facility for Malaria”

  1. 2 Alanna April 30, 2009 at 1:51 am

    I share your concern about scaling up. It’s going to be hard to push this big enough to make a real difference.

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