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15 November 2012
GENEVA – The Global Fund Board decided to integrate the Affordable Medicines Facility - malaria (AMFm) into core Global Fund grant management and financial processes, following an orderly transition period in 2013. The decision was reached after extensive consultations with implementers, technical partners and donors about lessons learned from a pilot phase of AMFm.
The AMFm was created to improve access to artemisinin-based combination therapies (ACTs), the most effective anti-malaria treatment. The AMFm pilot phase was launched in April 2009 and began operations in July 2010. As demonstrated by an independent evaluation, it increased availability and drove down the price of ACTs through a factory-gate subsidy on behalf of buyers in pilot countries, combined with measures to support the safe and effective scale-up of access to ACTs. The pilot phase ends on 31 December 2012.
During a transition period in 2013, the lessons learned from the operations and resourcing of Phase 1 of the AMFm, such as manufacturer negotiations and the co-payment mechanism, will be integrated into core Global Fund processes. At its September 2012 meeting, the Board extended the Global Fund’s mandate to host the AMFm until 31 December 2013 in order to ensure that access to quality-assured ACTs is not disrupted during the transition phase.
Under the new, integrated model, eligible countries will be able to allocate funding from their core Global Fund grants and determine how the money should be spent. Following an assessment by technical partners, the AMFm model may be further modified to include malaria rapid diagnostic tests (RDTs).
“This has had a huge impact, which is why so many of us give it our full support,” said Onyebuchi Chukwu, Minister of Health for Nigeria.
Once the integration is completed, all eligible countries that wish to expand access to ACTs and malaria diagnostic testing through the private sector will be able to do so building on the lessons learned from AMFm Phase 1.
“By introducing modifications and integrating it into the Global Fund grant processes, the Board has improved this valuable mechanism and made it available to all eligible countries that wish to implement it,” said Gabriel Jaramillo, General Manager of the Global Fund. “The collaboration of implementers, technical partners, manufacturers and donors was essential to the successful outcome of this process.”
The scale-up of ACTs and RDTs will be governed by each country’s strategy. More country-driven, this integrated model will be launched with the new funding model. As with all requests for Global Fund grants, funding for a private sector subsidy component will be subject to review, along with each country’s proposal, by an independent panel of experts to determine whether the model is appropriate for the context and consistent with current normative guidance.
With the integration of the AMFm model into Global Fund processes, there will no longer be a separate fund with external donor contributions to cover co-payments. Countries will be responsible for allocating resources to implement a private sector strategy to expand access to malaria diagnosis and treatment in the private sector from their Global Fund malaria grants. It is hoped that the costs of a subsidy will decrease over time with the development of new technologies, improved targeting of ACTs, and declining malaria incidence.
All ACTs and RDTs to be co-paid through the new model must comply with the Global Fund’s quality-assurance policy.
The transition period will be funded in the same way as the AMFm pilot. ACT co-payments will be financed through contributions from external donors and supporting interventions will be financed through existing Global Fund malaria grants.
However, current and potential donors have indicated that they will provide funding to support an orderly and responsible transition by AMFm pilot countries to the integrated model. The funding available for the transition will be communicated to pilot countries and partners as soon as it is known.
To date, AMFm has subsidized nearly 320 million ACT treatments in Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar) and Uganda. This subsidy is financed through contributions of US$336 million from UNITAID, the governments of the United Kingdom and Canada, and the Bill & Melinda Gates Foundation. Technical support is provided by members of the Roll Back Malaria Partnership. A further amount of up to US$127 million comes from the extension of existing Global Fund malaria grants to finance supporting interventions at country level.
The Board decision on the AMFm was informed by extensive consultations with stakeholders and an independent evaluation, commissioned by the Global Fund to assess the extent to which the initiative has achieved the main objectives laid out for its pilot phase.
According to the independent evaluation, the AMFm pilot was successful in increasing availability, decreasing retail prices, and increasing market share of quality-assured ACTs. The evaluation also found that in 5 of 8 pilot countries, ACTs were dramatically more available, and prices for patients were significantly reduced.
The impact of the program on morbidity and mortality was not assessed in the independent evaluation.
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