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. 2015 Oct 9:14:398.
doi: 10.1186/s12936-015-0904-z.

The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention?

Yazoume Ye  1 , Fred Arnold  2 , Abdisalan Noor  3 , Marilyn Wamukoya  4 , John Amuasi  5 , Samuel Blay  6 , Blessing Mberu  7 , Ruilin Ren  8 , Catherine Kyobutungi  9 , Frederick Wekesah  10 , Hellen Gatakaa  11 , Mitsuru Toda  12 , Julius Njogu  13 , Illah Evance  14 , Kathryn O'Connell  15 , Tanya Shewchuk  16 , Sarah Thougher  17 , Andrea Mann  18 , Barbara Willey  19 , Catherine Goodman  20 , Kara Hanson  21
Affiliations

The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention?

Yazoume Ye et al. Malar J. .

Abstract

Background: To assess the availability, price and market share of quality-assured artemisinin-based combination therapy (QAACT) in remote areas (RAs) compared with non-remote areas (nRAs) in Kenya and Ghana at end-line of the Affordable Medicines Facility-malaria (AMFm) intervention.

Methods: Areas were classified by remoteness using a composite index computed from estimated travel times to three levels of service centres. The index was used to five categories of remoteness, which were then grouped into two categories of remote and non-remote areas. The number of public or private outlets with the potential to sell or distribute anti-malarial medicines, screened in nRAs and RAs, respectively, was 501 and 194 in Ghana and 9980 and 2353 in Kenya. The analysis compares RAs with nRAs in terms of availability, price and market share of QAACT in each country.

Results: QAACT were similarly available in RAs as nRAs in Ghana and Kenya. In both countries, there was no statistical difference in availability of QAACT with AMFm logo between RAs and nRAs in public health facilities (PHFs), while private-for-profit (PFP) outlets had lower availability in RA than in nRAs (Ghana: 66.0 vs 82.2 %, p < 0.0001; Kenya: 44.9 vs 63.5 %, p = <0.0001. The median price of QAACT with AMFm logo for PFP outlets in RAs (USD1.25 in Ghana and USD0.69 in Kenya) was above the recommended retail price in Ghana (US$0.95) and Kenya (US$0.46), and much higher than in nRAs for both countries. QAACT with AMFm logo represented the majority of QAACT in RAs and nRAs in Kenya and Ghana. In the PFP sector in Ghana, the market share for QAACT with AMFm logo was significantly higher in RAs than in nRAs (75.6 vs 51.4 %, p < 0.0001). In contrast, in similar outlets in Kenya, the market share of QAACT with AMFm logo was significantly lower in RAs than in nRAs (39.4 vs 65.1 %, p < 0.0001).

Conclusion: The findings indicate the AMFm programme contributed to making QAACT more available in RAs in these two countries. Therefore, the AMFm approach can inform other health interventions aiming at reaching hard-to-reach populations, particularly in the context of universal access to health interventions. However, further examination of the factors accounting for the deep penetration of the AMFm programme into RAs is needed to inform actions to improve the healthcare delivery system, particularly in RAs.

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Figures

Fig. 1
Fig. 1
Remoteness classification map showing the location of clusters sampled in the remote areas for the AMFm Independent Evaluation remote area survey, 2012
Fig. 2
Fig. 2
Market share of anti-malarials by anti-malarial type in remote and non-remote areas, 2011–2012
See this image and copyright information in PMC

References

    1. Talisuna A, Grewal P, Rwakimari JB, Mukasa S, Jagoe G, Banerji J, et al. Cost is killing patients: subsidising effective antimalarials. Lancet. 2009;374:1224–1226. doi: 10.1016/S0140-6736(09)61767-0. - DOI - PubMed
    1. The Global Fund to Fight AIDS, Tuberculosis and Malaria. Affordable Medicines Facility-malaria. Geneva; 2008.
    1. Adeyi O, Atun R. Universal access to malaria medicines: innovation in financing and delivery. Lancet. 2010;376:1869–1871. doi: 10.1016/S0140-6736(10)61189-0. - DOI - PubMed
    1. Tougher S, ACTwatch Group, Ye Y, Amuasi JH, Kourgueni IA, Thomson R, et al. 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;380:1916–26. - PubMed
    1. AMFm Independent Evaluation Team . Independent Evaluation of Phase 1 of the Affordable Medicines Facility-malaria (AMFm): Multi-country Independent Evaluation Report. Calverton: ICF International and London School of Hygiene and Tropical Medicine; 2012.

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