Two Years Post Affordable Medicines Facility for Malaria Program: Availability and Prices of Anti-malarial Drugs in Central Ghana

Overview

Journal J Pharm Policy Pract

Date 2017 May 4

PMID 28465829

Citations 6

Authors

Alexander Freeman

Anthony Kwarteng

Lawrence Gyabaa Febir

Seeba Amenga-Etego

Seth Owusu-Agyei

Kwaku Poku Asante

Affiliations

Soon will be listed here.

Abstract

Background: The Affordable Medicines Facility for malaria (AMFm) Program was a subsidy aimed at artemisinin-based combination therapies (ACTs) in order to increase availability, affordability, and market share of ACTs in 8 malaria endemic countries in Africa. The WHO supervised the manufacture of the subsidized products, named them Quality Assured ACTs (QAACT) and printed a Green Leaf Logo on all QAACT packages. Ghana began to receive the subsidized QAACTs in 2010.

Methods: A cross-sectional stock survey was conducted at 63 licensed chemical shops (LCS) and private pharmacies in two districts of the Brong-Ahafo region of Ghana to determine the availability and price of all anti-malarial treatments. Drug outlets were visited over a 3-weeks period in October and November of 2014, about 2 years after the end of AMFm program.

Results: At least one QAACT was available in 88.9% (95% CI 80.9% - 96.8%) of all drug outlets with no difference between urban and rural locations. Non-Assured ACTs (NAACT) were significantly more available in urban drug outlets [75.0% availability (95% CI 59.1% - 90.9%)] than in rural drug outlets [16.1% availability (95% CI 2.4% - 29.9%)]. The top selling product was Artemether Lumefantrine with the Green Leaf Logo, a QAACT. There was a significant difference in the mean price of a QAACT [$1.04 USD (95% CI $0.98 - $1.11)], and the mean price of a NAACT in both the urban and rural areas [$2.46 USD (95% CI $2.11 - $2.81)]. There was no significant difference in the price of any product that was available in urban and rural settings.

Conclusion: About 2 years after the AMFm program, subsidized QAACTs in Ghana were widely available and more affordable than NAACTs in the Kintampo North District and Kintampo South Municipality of Ghana. The AMFm program appeared to have mostly succeeded in making QAACTs available and affordable.

Citing Articles

Evaluation of Segmentation, Rotation, and Geographic Delivery Approaches for Deployment of Multiple First-Line Treatment (MFT) to Respond to Antimalarial Drug Resistance in Africa: A Qualitative Study in Seven Sub-Sahara Countries.

Audibert C, Aspinall A, Tchouatieu A, Hugo P Trop Med Infect Dis. 2024; 9(5).

PMID: 38787026 PMC: 11125622. DOI: 10.3390/tropicalmed9050093.

Experience of healthcare personnel on Co-payment mechanism and the implications on its use in private drug outlets in Uganda.

Ocan M, Bakubi R, Nakalembe L, Ekusai-Sebatta D, Sam N PLoS One. 2024; 19(5):e0297416.

PMID: 38758832 PMC: 11101086. DOI: 10.1371/journal.pone.0297416.

Antimalarial stocking decisions among medicine retailers in Ghana: implications for quality management and control of malaria.

Osman A, Amoako Johnson F, Mariwah S, Amoako-Sakyi D, Owusu S, Ekor M BMJ Glob Health. 2023; 6(Suppl 3).

PMID: 37734858 PMC: 10846845. DOI: 10.1136/bmjgh-2023-013426.

The emergence of chloroquine-sensitive Plasmodium falciparum is influenced by selected communities in some parts of the Central Region of Ghana.

Asare K, Africa J, Mbata J, Opoku Y Malar J. 2021; 20(1):447.

PMID: 34823528 PMC: 8620919. DOI: 10.1186/s12936-021-03985-8.

Amplification of GTP-cyclohydrolase 1 gene in Plasmodium falciparum isolates with the quadruple mutant of dihydrofolate reductase and dihydropteroate synthase genes in Ghana.

Osei M, Ansah F, Matrevi S, Asante K, Awandare G, Quashie N PLoS One. 2018; 13(9):e0204871.

PMID: 30265714 PMC: 6162080. DOI: 10.1371/journal.pone.0204871.

References

Adjei A, Winch P, Laar A, Sullivan Jr D, Sakyi K, Stephens J . Insights into the Affordable Medicines Facility-malaria in Ghana: the role of caregivers and licensed chemical sellers in four regions. Malar J. 2016; 15(1):263. PMC: 4862058. DOI: 10.1186/s12936-016-1307-5. View

Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G . Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved?. Am J Trop Med Hyg. 2008; 77(6 Suppl):203-18. PMC: 2657822. View

Owusu-Agyei S, Nettey O, Zandoh C, Sulemana A, Adda R, Amenga-Etego S . Demographic patterns and trends in Central Ghana: baseline indicators from the Kintampo Health and Demographic Surveillance System. Glob Health Action. 2013; 5:1-11. PMC: 3529298. DOI: 10.3402/gha.v5i0.19033. View

Maslove D, Mnyusiwalla A, Mills E, McGowan J, Attaran A, Wilson K . Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies. BMC Int Health Hum Rights. 2009; 9:26. PMC: 2782321. DOI: 10.1186/1472-698X-9-26. View

Aborah S, Akweongo P, Adjuik M, Atinga R, Welaga P, Adongo P . The use of non-prescribed anti-malarial drugs for the treatment of malaria in the Bolgatanga municipality, northern Ghana. Malar J. 2013; 12:266. PMC: 3735414. DOI: 10.1186/1475-2875-12-266. View

Ye Y, Arnold F, Noor A, Wamukoya M, Amuasi J, Blay S . The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention?. Malar J. 2015; 14:398. PMC: 4600285. DOI: 10.1186/s12936-015-0904-z. View

Arrow K, Danzon P, Gelband H, Jamison D, Laxminarayan R, Mills A . The Affordable Medicines Facility--malaria: killing it slowly. Lancet. 2012; 380(9857):1889-90. DOI: 10.1016/S0140-6736(12)61843-1. View

Tougher S, Ye Y, Amuasi J, Kourgueni I, Thomson R, Goodman C . 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. Lancet. 2012; 380(9857):1916-26. DOI: 10.1016/S0140-6736(12)61732-2. View

Davis B, Ladner J, Sams K, Tekinturhan E, de Korte D, Saba J . Artemisinin-based combination therapy availability and use in the private sector of five AMFm phase 1 countries. Malar J. 2013; 12:135. PMC: 3637826. DOI: 10.1186/1475-2875-12-135. View

10.

Asante K, Abokyi L, Zandoh C, Owusu R, Awini E, Sulemana A . Community perceptions of malaria and malaria treatment behaviour in a rural district of Ghana: implications for artemisinin combination therapy. BMC Public Health. 2010; 10:409. PMC: 2914078. DOI: 10.1186/1471-2458-10-409. View

11.

Tougher S, Mann A, Ye Y, Kourgueni I, Thomson R, Amuasi J . Improving access to malaria medicine through private-sector subsidies in seven African countries. Health Aff (Millwood). 2014; 33(9):1576-85. DOI: 10.1377/hlthaff.2014.0104. View

12.

Owusu-Agyei S, Asante K, Adjuik M, Adjei G, Awini E, Adams M . Epidemiology of malaria in the forest-savanna transitional zone of Ghana. Malar J. 2009; 8:220. PMC: 2765449. DOI: 10.1186/1475-2875-8-220. View

13.

Murray C, Ortblad K, Guinovart C, Lim S, Wolock T, Roberts D . Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9947):1005-70. PMC: 4202387. DOI: 10.1016/S0140-6736(14)60844-8. View

14.

Yamey G, Schaferhoff M, Montagu D . Piloting the Affordable Medicines Facility-malaria: what will success look like?. Bull World Health Organ. 2012; 90(6):452-60. PMC: 3370360. DOI: 10.2471/BLT.11.091199. View

15.

Fink G, Dickens W, Jordan M, Cohen J . Access to subsidized ACT and malaria treatment--evidence from the first year of the AMFm program in six districts in Uganda. Health Policy Plan. 2013; 29(4):517-27. DOI: 10.1093/heapol/czt041. View

16.

Ansah E, Whitty C, Bart-Plange C, Gyapong M . Changes in the availability and affordability of subsidised artemisinin combination therapy in the private drug retail sector in rural Ghana: before and after the introduction of the AMFm subsidy. Int Health. 2016; 8(6):427-432. PMC: 5181550. DOI: 10.1093/inthealth/ihw041. View

17.

Zwang J, Olliaro P, Barennes H, Bonnet M, Brasseur P, Bukirwa H . Efficacy of artesunate-amodiaquine for treating uncomplicated falciparum malaria in sub-Saharan Africa: a multi-centre analysis. Malar J. 2009; 8:203. PMC: 2745424. DOI: 10.1186/1475-2875-8-203. View

18.

Yadav P, Cohen J, Alphs S, Arkedis J, Larson P, Massaga J . Trends in availability and prices of subsidized ACT over the first year of the AMFm: evidence from remote regions of Tanzania. Malar J. 2012; 11:299. PMC: 3502171. DOI: 10.1186/1475-2875-11-299. View

19.

Asante K, Zandoh C, Dery D, Brown C, Adjei G, Antwi-Dadzie Y . Malaria epidemiology in the Ahafo area of Ghana. Malar J. 2011; 10:211. PMC: 3171375. DOI: 10.1186/1475-2875-10-211. View

20.

Nonvignon J, Aikins M, Chinbuah M, Abbey M, Gyapong M, Garshong B . Treatment choices for fevers in children under-five years in a rural Ghanaian district. Malar J. 2010; 9:188. PMC: 2914057. DOI: 10.1186/1475-2875-9-188. View