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Tougher S, Mann AG, Ye Y, Kourgueni IA, Thomson R, Amuasi JH, Ren R, Willey BA, Ansong D, Bruxvoort K, Diap G, Festo C, Johanes B, Kalolella A, Mallam O, Mberu B, Ndiaye S, Nguah SB, Seydou M, Taylor M, Wamukoya M, Arnold F, Hanson K, Goodman C. Improving access to malaria medicine through private-sector subsidies in seven African countries. Health Aff (Millwood) 2016; 33:1576-85. [PMID: 25201662 DOI: 10.1377/hlthaff.2014.0104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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.
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Affiliation(s)
- Sarah Tougher
- Sarah Tougher is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom
| | - Andrea G Mann
- Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | | | - Yazoume Ye
- Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland
| | - Idrissa A Kourgueni
- 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
| | - Rebecca Thomson
- Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine
| | - John H Amuasi
- 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
| | - Ruilin Ren
- Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland
| | - Barbara A Willey
- Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine
| | - Daniel Ansong
- 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
| | - Katia Bruxvoort
- Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine
| | - Graciela Diap
- Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland
| | - Charles Festo
- Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania
| | - Boniface Johanes
- Boniface Johanes is a researcher at the Ifakara Health Institute
| | | | - Oumarou Mallam
- Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger
| | - Blessing Mberu
- Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya
| | - Salif Ndiaye
- Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal
| | - Samual Blay Nguah
- Samual Blay Nguah is a researcher at the research and development unit at KATH
| | - Moctar Seydou
- Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger
| | - Mark Taylor
- Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia
| | | | - Fred Arnold
- Fred Arnold is a senior fellow at ICF International in Rockville, Maryland
| | - Kara Hanson
- 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
| | - Catherine Goodman
- Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine
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