title: 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.
abstract: Most people with febrile illness are treated in the private drug retail sector. Ghana was among nine countries piloting the Global Fund Affordable Medicines Facility - malaria (AMFm). AMFm aimed to: increase artemisinin combination therapy (ACT) affordability; increase ACT availability; increase ACT use; and 'crowd out' artemisinin monotherapies.
  
  
  
  Three censuses were carried out 2 months before (2010), 2 months after and 2.5 years after (2013) the first co-paid ACTs to assess changes in antimalarial (AM) availability and price in private retail shops in a Ghanaian rural district to assess the sustainability of the initial gains. Supply, stock-out and cost were explored.
  
  
  
  Of 62 shops in the district, 56 participated with 398, 388 and 442 brands of AMs in the shops during the 3 censuses. The proportion of ACTs increased over the period while monotherapies reduced. Herbal-based AM preparations comprised 40-45% of AMs in stock with minimal variation over the period. ACTs were the most sold AM type for all ages but overall buying and selling prices of Quality Assured-ACTs increased by 40-100%.
  
  
  
  Initial gains in ACT availability were sustained, but not improved on 2.5 years after AMFm. Widespread availability of unproven herbal medicines is a concern; AMFm had little impact on this.
authors.affiliation: Dangme West District Health Directorate, Ghana Health Service, P.O. Box DD1, Dodowa, Ghana Ansahekdr@yahoo.co.uk.
authors.forename: Evelyn K
authors.initials: EK
authors.lastname: Ansah
authors.affiliation: London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Christopher Jm
authors.initials: CJ
authors.lastname: Whitty
authors.affiliation: National Malaria Control Programme, Ghana Health Service, P.O. Box KB493, Korle-Bu, Accra, Ghana.
authors.forename: Constance
authors.initials: C
authors.lastname: Bart-Plange
authors.affiliation: Dodowa Health Research Center, Ghana Health Service, P.O. Box DD1, Dodowa, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use*; D003132:Commerce; D004359:Drug Therapy, Combination; D005869:Ghana; D006268:Health Facilities; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000188:drug therapy*; D010594:Pharmacies; D017149:Private Sector; D012424:Rural Population
chemical_list: D000962:Antimalarials; D037621:Artemisinins; C031327:artemisinin
keywords: AMFm; Affordability; Chemical Seller; Drug Retail Shop; Ghana; Malaria