CONTAINMENT

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AMFm’s Contribution to Universal Access to Effective Malaria Treatment

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The Affordable Medicines Facility-Malaria (AMFm) is a mechanism to increase access to quality assured artemisinin-based combination therapy.

All Cambodians will have full access to effective malaria treatment in the AMFm scheme. Pix by WHO/Sonny Krishnan

Universal access to effective malaria treatment is among the United Nations’ Millennium Development Goals. This also is among the goals of the Roll Back Malaria Partnership.

In spite of high-level commitments, political will and substantial increases in financing, the attainment of this goal has remained elusive in most malaria endemic countries, especially in relation to artemisinin-based combination therapy (ACT), the treatment recommended as first-line by the World Health Organization (WHO) for uncomplicated malaria caused by Plasmodium falciparum.

The Affordable Medicines Facility-malaria (AMFm) is a new financing mechanism to expand access to effective malaria treatment. A response to the dual challenge of poor access to quality-assured anti-malarial medicines and threats of parasite resistance to treatment, the AMFm combines price negotiations with a factory-gate buyer subsidy to reduce the price of ACT.

The AMFm will use price signals and a combination of public and private sector channels to achieve multiple public health objectives. These objectives include replacing older and increasingly ineffective anti-malarial medicines, such as chloroquine and sulphadoxine-pyrimethamine with ACT, displacing oral artemisinin monotherapies from the market, and prolonging the lifespan of ACT by reducing the likelihood of resistance to artemisinin.

The AMFm is hosted by the Global Fund to Fight AIDS, Tuberculosis and Malaria. The pilot phase of the programme, which includes Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, the United Republic of Tanzania and Uganda, is scheduled to last from 2010 to 2012.

The AMFm is funded from multiple sources including a co-payment fund of US$216 million, financed by the Bill & Melinda Gates Foundation, the UK Government, and UNITAID. In addition, the Global Fund provides US$127 million to fund supporting interventions at the country level.

Enabling appropriate and rational use of ACT

To preserve the effectiveness of ACT over time, it is important that these life-saving medicines are used appropriately. A number of studies have shown that malaria case management, particularly in the retail sector, is unsatisfactory.

The private sector, in particular drug outlets, should be supported and capacitated to provide appropriate and rational management of malaria. Integrated approaches aimed at improving understanding and treatment of malaria can lead to tangible improvements in management of malaria. Building on lessons learned so far, the AMFm will work with countries and technical partners to build the skills of drug shop attendants using promising models, such as the Tanzania Accredited Drugs Dispensing Outlets (ADDOs).

Regulation can play an important role in enhancing access to ACT and improving the quality of care. A number of studies have reported that subsidizing ACT may need to be supported by effective regulatory policies for the intervention to be effective in crowding out less effective anti-malarials from the market. Countries in AMFm Phase 1 may use funds from the Global Fund to strengthen in-country regulatory systems.

Related to regulation is product quality. The AMFm will work with partners to adopt policies that assure product quality. For instance, AMFm uses the Global Fund’s quality assurance policy, which requires the procurement of WHO-prequalified products and those that have passed stringent quality assessment. Product branding serves to establish bonds among buyers, sellers and products. In many malaria-endemic countries there are various products available for the treatment of malaria. The availability of a wide range of products can makes it harder for buyers to distinguish quality-assured products from others. ACT under the AMFm will bear a distinct logo that will serve as an identifier and sales driver.

Finally, it is important to expand access to the parasitological confirmation of malaria, with a view to ensuring that only those who have malaria receive ACT as treatment. Most cases of presumptive treatment with ACT take place in the private sector. In the near- to medium-term, it is highly unlikely that effective public sector services will replace the private sector in most malaria-endemic countries.

Therefore, universal access to diagnostics requires the achievement of universal access to these technologies in the private sector. Given the new WHO’s normative guideline on the goal of universal access to diagnostics, it is important to identify the most suitable financing mechanisms for expanded access to diagnostics in the private sector, and to better understand the most feasible ways of expanding the use of diagnostics, particularly in the formal and informal private sectors.

The operations research elements of AMFm Phase 1 provide opportunities to learn how to increase coverage of diagnostics in the private sector in a way that can inform scaling up to universal access.

This is a condensed open-access article “The quest for universal access to effective malaria treatment: how can the AMFm contribute?” written by Lloyd Matowe and Olusoji Adeyi that was published in the Malaria Journal 2010, Vol 9, issue 274.

 

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Written by malariacontainment

November 14, 2010 at 9:45 am

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