title: Insights into the Affordable Medicines Facility-malaria in Ghana: the role of caregivers and licensed chemical sellers in four regions.
abstract: The Affordable Medicine Facility-malaria (AMFm) was an innovative global financing mechanism for the provision of quality-assured artemisinin-based combination therapy (ACT) across both the private and public health sectors in eight countries in sub-Saharan Africa. This study evaluated the effectiveness of AMFm subsidies in increasing access to ACT in Ghana and documented malaria management practices at the household and community levels during the implementation of the AMFm.
  
  
  
  This study, conducted in four regions in Ghana between January, 2011 to December, 2012, employed cross-sectional mixed-methods design that included qualitative and quantitative elements, specifically household surveys, focus group discussions (FGD) and in-depth interviews.
  
  
  
  The study indicated high ACT availability, adequate provider knowledge and reasonably low quality-assured ACT use in the study areas, all of which are a reflection of a high market share of ACT in these hard-to-reach areas of the country. Adequate recognition of childhood malaria symptoms by licensed chemical seller (LCS) attendants was observed. A preference by caregivers for LCS over health facilities for seeking treatment solutions to childhood malaria was found.
  
  
  
  Artemisinin-based combination therapy with the AMFm logo was accessible and affordable for most people seeking treatment from health facilities and LCS shops in rural areas. Caregivers and LCS were seen to play key roles in the health of the community especially with children under 5 years of age.
authors.affiliation: Office of Research, Innovation and Development, University of Ghana, Legon, Accra, Ghana.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Adjei
authors.affiliation: Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Winch
authors.affiliation: Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Amos
authors.initials: A
authors.lastname: Laar
authors.affiliation: Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sullivan
authors.affiliation: Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: Kwame S
authors.initials: KS
authors.lastname: Sakyi
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Stephens
authors.affiliation: Centre for Tropical, Clinical, Pharmacology and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
authors.forename: George O
authors.initials: GO
authors.lastname: Adjei
authors.affiliation: Ashanti Akim Central Municipal Health Directorate, Ghana Health Services, Konongo, Ghana.
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Boateng
authors.affiliation: National Malaria Control Programme, Ministry of Health, Accra, Ghana.
authors.forename: Vivian N Ama
authors.initials: VN
authors.lastname: Aubyn
authors.affiliation: Gonja Health Directorate, Ghana Health Services, Accra, Ghana.
authors.forename: Chrysantus
authors.initials: C
authors.lastname: Kubio
authors.affiliation: Child and Associates, Accra, Ghana.
authors.forename: Julliette
authors.initials: J
authors.lastname: Tuakli
authors.affiliation: Regional Health Directorate, Ghana Health Services, Accra, Ghana.
authors.forename: Linda
authors.initials: L
authors.lastname: Vanotoo
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Bernard B
authors.initials: BB
authors.lastname: Bortei
authors.affiliation: Shama District Health Directorate, Ghana Health Services, Shama, Ghana.
authors.forename: Maame
authors.initials: M
authors.lastname: Amo-Addae
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Felix
authors.initials: F
authors.lastname: Sorvor
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Coleman
authors.affiliation: Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dalglish
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Richmond
authors.initials: R
authors.lastname: Owusu
authors.affiliation: Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: Tsega
authors.initials: T
authors.lastname: Gebreyesus
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Edward
authors.initials: E
authors.lastname: Essuman
authors.affiliation: Department of Paediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Greene
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Ankomah
authors.affiliation: Department of International Health, Social and Behavioural Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
authors.forename: Kiely
authors.initials: K
authors.lastname: Houston
authors.affiliation: National Malaria Control Programme, Ministry of Health, Accra, Ghana.
authors.forename: Constance
authors.initials: C
authors.lastname: Bart-Plange
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana.
authors.forename: Samuel
authors.initials: S
authors.lastname: Salamat
authors.affiliation: Kpone Katamanso District Health Directorate, Ghana Health Services, Kpone, Tema, Ghana.
authors.forename: Ebenezer A
authors.initials: EA
authors.lastname: Addison
authors.affiliation: Department of Biological, Environmental and Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana, P.O. Box LG 13, Legon, Accra, Ghana. iaquakyi@ug.edu.gh.
authors.forename: Isabella A
authors.initials: IA
authors.lastname: Quakyi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005869:Ghana / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D007783:Lactones / Q000627:therapeutic use*; D008288:Malaria / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010595:Pharmacists / Q000523:psychology*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D007783:Lactones; C075875:artemisin
keywords: Affordable Medicines Facility-malaria; Artemisinin-based combination therapy; Caregivers; Licensed chemical sellers