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Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data

Tougher, Sarah, Ye, Yazoume, Amuasi, John H, Kourgueni, Idrissa A, Thomson, Rebecca, Goodman, Catherine, Mann, Andrea G, Ren, Ruilin, Willey, Barbara A, Adegoke, Catherine A, Amin, Abdinasir, Ansong, Daniel, Bruxvoort, Katia, Diallo, Diadier A, Diap, Graciela, Festo, Charles, Johanes, Boniface, Juma, Elizabeth, Kalolella, Admirabilis, Malam, Oumarou, Mberu, Blessing, Ndiaye, Salif, Nguah, Samuel B, Seydou, Moctar, Taylor, Mark, Rueda, Sergio Torres, Wamukoya, Marilyn, Arnold, Fred, Hanson, Kara·2012·The Lancet

DOI 10.1016/s0140-6736(12)61732-2

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Abstract

Background Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). Methods We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. Findings In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. Interpretation Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. Funding The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.

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Authors: Tougher, S., Ye, Y., Amuasi, J. H., Kourgueni, I. A., Thomson, R., Goodman, C., Mann, A. G., Ren, R., Willey, B. A., Adegoke, C. A., Amin, A., Ansong, D., Bruxvoort, K., Diallo, D. A., Diap, G., Festo, C., Johanes, B., Juma, E., Kalolella, A., Malam, O., Mberu, B., Ndiaye, S., Nguah, S. B., Seydou, M., Taylor, M., Rueda, S. T., Wamukoya, M., Arnold, F., & Hanson, K.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
University of Minnesota (US)
Ifakara Health Institute (TZ)
ICF International (United States) (US)
Komfo Anokye Teaching Hospital (GH)
Drugs for Neglected Diseases Initiative (CH)
Kenya Medical Research Institute (KE)
African Population and Health Research Center (KE)
Institut de Recherche pour le Développement (SN)
Corresponding author: Tougher, Sarah
ORCID: Tougher, Sarah
Amuasi, John H
Thomson, Rebecca
Goodman, Catherine
Willey, Barbara A
Ansong, Daniel
Bruxvoort, Katia
Festo, Charles
Juma, Elizabeth
Mberu, Blessing
Nguah, Samuel B
Taylor, Mark
Rueda, Sergio Torres
Hanson, Kara
Venue: The Lancet
Publisher: Elsevier BV
Published: 2012-12
Volume: 380
Issue: 9857
Pages: 1916-1926
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(12)61732-2
OpenAlex: W2122992752
Cited by: 173
References: 22
Citations by year: 2026: 4 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 6 · 2018: 8 · 2017: 26 · 2016: 16 · 2015: 27 · 2014: 23 · 2013: 18 · 2012: 3
FWCI: 54.35
Type: journal article
Language: en
Update notices: erratum (2014-11-22)
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
Keywords: Affordable Medicines Facility-malaria, artemisinin-based combination therapy, drug availability, market share, artemisinin monotherapy, drug subsidies, public sector, malaria treatment access, Global Fund, antimalarial drug resistance, Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, Tanzania
MeSH terms: Africa, Antimalarials, Humans, Lactones, Malaria, Marketing of Health Services, Pharmacies, Pilot Projects, Drug Costs, Private Sector, Public Sector, Artemisinins

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Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data

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