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International initiative slashes cost of anti-malaria drugs in several African countries

21 April 2011

Geneva – An international initiative to put affordable and effective anti-malaria drugs within reach of people in often remote communities in Africa is making rapid progress. In four implementing countries, Ghana, Kenya, Madagascar and Nigeria life-saving malaria treatment can now be bought in private stores and pharmacies for as little as 50 U.S. cents. Before the launch of the program, these treatments cost up to 20 times as much. The only way most people in Africa could get effective malaria drugs for free was by travelling long distances to reach public health clinics.

The Affordable Medicines Facility – malaria (AMFm) gets key financial support from UNITAID, the United Kingdom and the Bill & Melinda Gates Foundation, technical support from members of the Roll Back Malaria (RBM) Partnership and it is hosted by the Global Fund. The initiative which began last year is being piloted in eight countries -- Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar), Uganda and Cambodia – to enable lessons to be learnt before a potential global rollout. Early results are now visible in the four countries that began implementing earlier.

AMFm aims to make anti-malarial drugs, known as artemisinin-based combination therapies (ACTs), available as widely and cheaply as possible. About 225 million people fall ill with malaria every year and 780,000 die from the disease.

Although the World Health Organisation specifically recommends ACTs as first-line treatment for Plasmodium falciparum malaria, the most deadly form of the disease, the drug accounts for only about one in five of all treatments taken for malaria and until recently it has only been available for free or at low cost in public health facilities.

Most people buy anti-malaria treatments in private shops and pharmacies where ACTs were not available at an affordable price before the launch of AMFm. These shops sell older, cheap medicines such as chloroquine and sulfadoxine-pyrimethamine which are no longer effective because the Plasmodium falciparum is increasingly resistant to them.

The objective of the AMFm program is to drive out these ineffective therapies by bringing down ACT treatment costs drastically and making the drugs more accessible for millions of people.

"We are making further progress in fighting malaria in Africa by providing affordable treatment to millions of people through the Affordable Medicines Facility for malaria" said Prof. Michel Kazatchkine, Executive Director of the Global Fund. "The Affordable Medicines Facility - malaria is a major step forward. It uses innovative financing methods to save lives by providing affordable and effective medicines to more people in need through the public, NGO and private sectors". Working with Roll Back Malaria partners, AMFm is bringing life-saving treatments to millions of people.

The innovation works like this: the Global Fund first negotiates a discounted price for ACTs with drug manufacturers and then pays most of the reduced price on behalf of importers from the private, NGO and public sectors, leading to an average sales price of less than 10 cents. The reduced prices allow private wholesalers to sell the ACTs to retailers at a profit. Pharmacies and stores in turn sell the drugs to patients and caregivers with an additional mark-up, while keeping the retail price affordable.

As of early April 2011, the Global Fund has approved AMFm payments for over 75 million courses of ACT treatment. Early findings show that the AMFm is working, with dramatic falls in over-the-counter drug prices in several African countries.

A formal price survey in Kenya showed that most retailers were selling subsidized ACTs at or slightly more than the recommended local price, equivalent to about 50 U.S. cents. This is about one-twentieth the price of unsubsidised ACTs.

In Ghana informal price checks show that subsidised ACTs are selling in shops in parts of the capital, Accra, at prices ranging from 60 US cents to US$ 1.20, down from US$ 9 per adult treatment before the AMFm.

In Madagascar informal price checks in early 2011 showed that the private sector retail price of AMFm co-paid ACTs was about US$ 0.40 equivalent per adult treatment in the capital city of Antananarivo, and about US$ 0.50 outside the city. Before AMFm, ACTs recommended by the World Health Organization sold for US$ 8.51-9.36 per adult treatment in the private sector.

In Nigeria, where AMFm was introduced in March 2011, ACTs that are not co-paid by the AMFm cost about 1,000 – 1,500 Naira (US$ 6.70 – 9.50) per adult treatment. The Society for Family Health (SFH), a not-for-profit NGO started distribution of AMFm co-paid ACTs in Nigeria in March 2011. Thanks to the vastly reduced purchase price of co-paid ACTs under AMFm, SFH will sell a full course of treatment for children aged under five years in private health facilities and outlets at US$ 0.20. The adult course of treatment is expected to sell for US$ 0.80.

In the eight countries where the AMFm is being implemented, governments are supporting the initiative with public awareness campaigns and training for ACT providers.