ACT subsidies: do they work?

No.

According to a recent report by the Evidence to Policy Initiative (funded by the Gates Foundation which in turn also supported the ACT subsidy idea) . The conclusions are no surprise (see here and here for previous discussions on the idea of selling subsidized artemisinin combination therapy in pharmacies). The summary points were:

  • Pilots found a rapid rise in ACT availability in private outlets (pharmacies, drug stores, and other retail outlets), as did one national program. Subsidies were associated with reduced consumer prices (i.e., these subsidies were largely passed along the supply chain to the consumer)
  • ACT market share increased rapidly in pilots, crowding out other anti-malarials (e.g., CQ, SP, artemisinin monotherapy), but market share did not increase rapidly in national programs
  • Pilots found conflicting evidence on ACT use (one trial was positive, one was negative) and national programs found very little change in use
  • The available evidence suggests that ACT price subsidies have less impact among poor, remote communities than among wealthier, urban communities

Notice the first two points arose from small pilots, while the latter deal with scaled programs and are more important to note. None of the evaluations addressed patient-facing outcomes, as a good friend would quickly point out, which are likely to be even worse. Thanks to Devi for the link.

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