title: Improving access to malaria medicine through private-sector subsidies in seven African countries.
abstract: Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.
authors.affiliation: Sarah Tougher (Sarah.Tougher@lshtm.ac.uk) is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tougher
authors.affiliation: Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Mann
authors.affiliation: Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland.
authors.forename: Yazoume
authors.initials: Y
authors.lastname: Ye
authors.affiliation: Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger.
authors.forename: Idrissa A
authors.initials: IA
authors.lastname: Kourgueni
authors.affiliation: Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Thomson
authors.affiliation: John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana.
authors.forename: John H
authors.initials: JH
authors.lastname: Amuasi
authors.affiliation: Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland.
authors.forename: Ruilin
authors.initials: R
authors.lastname: Ren
authors.affiliation: Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Willey
authors.affiliation: Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
authors.affiliation: Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine.
authors.forename: Katia
authors.initials: K
authors.lastname: Bruxvoort
authors.affiliation: Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland.
authors.forename: Graciela
authors.initials: G
authors.lastname: Diap
authors.affiliation: Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania.
authors.forename: Charles
authors.initials: C
authors.lastname: Festo
authors.affiliation: Boniface Johanes is a researcher at the Ifakara Health Institute.
authors.forename: Boniface
authors.initials: B
authors.lastname: Johanes
authors.affiliation: Admirabilis Kalolella a researcher at the Ifakara Health Institute.
authors.forename: Admirabilis
authors.initials: A
authors.lastname: Kalolella
authors.affiliation: Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger.
authors.forename: Oumarou
authors.initials: O
authors.lastname: Mallam
authors.affiliation: Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya.
authors.forename: Blessing
authors.initials: B
authors.lastname: Mberu
authors.affiliation: Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal.
authors.forename: Salif
authors.initials: S
authors.lastname: Ndiaye
authors.affiliation: Samual Blay Nguah is a researcher at the research and development unit at KATH.
authors.forename: Samual Blay
authors.initials: SB
authors.lastname: Nguah
authors.affiliation: Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger.
authors.forename: Moctar
authors.initials: M
authors.lastname: Seydou
authors.affiliation: Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia.
authors.forename: Mark
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Marilyn Wamukoya is a researcher at APHRC.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Wamukoya
authors.affiliation: Fred Arnold is a senior fellow at ICF International in Rockville, Maryland.
authors.forename: Fred
authors.initials: F
authors.lastname: Arnold
authors.affiliation: Kara Hanson is a professor of health systems economics and head of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine.
authors.forename: Kara
authors.initials: K
authors.lastname: Hanson
authors.affiliation: Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine.
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000191:economics* / Q000600:supply & distribution*; D037621:Artemisinins / Q000191:economics* / Q000600:supply & distribution*; D016000:Cluster Analysis; D003132:Commerce / Q000191:economics; D003906:Developing Countries; D004351:Drug Resistance; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D058996:Quality Improvement
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
keywords: Developing World < International/global health studies; Health Economics; Malaria; Pharmaceuticals