Communicating the AMFm message: exploring the effect of communication and training interventions on private for-profit provider awareness and knowledge related to a multi-country anti-malarial subsidy intervention.
BACKGROUND
The Affordable Medicines Facility - malaria (AMFm), implemented at national scale in eight African countries or territories, subsidized quality-assured artemisinin combination therapy (ACT) and included communication campaigns to support implementation and promote appropriate anti-malarial use. This paper reports private for-profit provider awareness of key features of the AMFm programme, and changes in provider knowledge of appropriate malaria treatment.


METHODS
This study had a non-experimental design based on nationally representative surveys of outlets stocking anti-malarials before (2009/10) and after (2011) the AMFm roll-out.


RESULTS
Based on data from over 19,500 outlets, results show that in four of eight settings, where communication campaigns were implemented for 5-9 months, 76%-94% awareness of the AMFm 'green leaf' logo, 57%-74% awareness of the ACT subsidy programme, and 52%-80% awareness of the correct recommended retail price (RRP) of subsidized ACT were recorded. However, in the remaining four settings where communication campaigns were implemented for three months or less, levels were substantially lower. In six of eight settings, increases of at least 10 percentage points in private for-profit providers' knowledge of the correct first-line treatment for uncomplicated malaria were seen; and in three of these the levels of knowledge achieved at endline were over 80%.


CONCLUSIONS
The results support the interpretation that, in addition to the availability of subsidized ACT, the intensity of communication campaigns may have contributed to the reported levels of AMFm-related awareness and knowledge among private for-profit providers. Future subsidy programmes for anti-malarials or other treatments should similarly include communication activities.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. barbara.willey@lshtm.ac.uk.
Barbara A
BA
Willey
Sarah
S
Tougher
Yazoume
Y
Ye
Andrea G
AG
Mann
Rebecca
R
Thomson
Idrissa A
IA
Kourgueni
John H
JH
Amuasi
Ruilin
R
Ren
Marilyn
M
Wamukoya
Sergio Torres
ST
Rueda
Mark
M
Taylor
Moctar
M
Seydou
Samuel Blay
SB
Nguah
Salif
S
Ndiaye
Blessing
B
Mberu
Oumarou
O
Malam
Admirabilis
A
Kalolella
Elizabeth
E
Juma
Boniface
B
Johanes
Charles
C
Festo
Graciela
G
Diap
Didier
D
Diallo
Katia
K
Bruxvoort
Daniel
D
Ansong
Abdinasir
A
Amin
Catherine A
CA
Adegoke
Kara
K
Hanson
Fred
F
Arnold
Catherine
C
Goodman
D017954:Africa South of the Sahara; D000962:Antimalarials / Q000191:economics / Q000600:supply & distribution; D037621:Artemisinins / Q000191:economics / Q000600:supply & distribution; D003142:Communication; D004338:Drug Combinations; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy; D017149:Private Sector
D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C031327:artemisinin