Fighting Malaria Together Newsletter - August 2011

Improving access to subsidized antimalarials in Kenya

Dr. Elizabeth Juma, Programme Manager, National Malaria Control Programme, Kenya

In Kenya, subsidized antimalarials improve access to effective and affordable malaria treatment through the private sector.

In April 2011, the Kenyan private sector placed orders for over 13 million doses and received nearly 9 million doses of subsidized antimalarial medication as part of a pilot program supported by the Affordable Medicine Facility—malaria (AMFm) through the Global Fund to Fight AIDS, Tuberculosis and Malaria. The program uses an innovative financing mechanism to improve access to affordable, quality artemisinin-based combination therapies (ACTs) and to reduce the use of non-recommended monotherapies.

When the program was launched, ACTs accounted for only 20 percent of anti-malarial treatments obtained from both public and private health facilities. Although ACTs in particular were provided almost entirely by the public sector, over 40 percent of patients were accessing general anti-malarial treatments through the private sector, where ACTs accounted for only 5 percent of available treatments. Cost was the primary reason that ACT use was so low; prior to the launch the average price for an adult dose in a private sector facility was US$7.40. Because of this, many patients preferred to buy cheaper, less effective medicines. Not only was this a dangerous precedent for those seeking treatment, it also encouraged the use of non-recommended artemisinin monotherapies—directly contributing to the development of artemisinin-resistant strains of malaria.

In August 2010, Kenya became one of the first of nine participating countries to launch the pilot project to provide access to subsidized antimalarials. The subsidized ACTs were made available for purchase by the private sector with a recommended price of US$0.50. As the Kenyan government does not control the prices of medications, a communications campaign was launched to ensure that shopkeepers and pharmacists charged a fair price for the drugs. The campaign also included messaging about the importance of obtaining the results of a malaria test before receiving treatment, as well as encouraging net use and seeking prompt treatment for small children. For four months, ads were run on television and radio in English and local languages letting people know what the medicines were, where they were available, and what they should pay for them. The packaging of subsidized ACTs was marked with a green leaf, so consumers would know that they were receiving quality medicine and the expected price they should pay.

In just a few months, the change in compliance in the number of chemists stocking the medicine at a fair price was remarkable. In March 2011, the Division of Malaria Control conducted a survey covering 270 private pharmacies in all districts of Nyanza province and found that at least 80 percent were stocking the subsidized ACTs at an average price of US$0.47. At only one pharmacy was the antimalarial being sold for higher than the recommended price (at US$1.18). Demand has gone up exponentially and, in less than a year, the private sector has ordered subsidized ACTs equivalent to nearly three-quarters of what the public sector uses in a year. People are calling us and telling us that they went to rural health facilities and still found the medicines available at affordable prices. Now, people no longer have to choose between buying expensive medication or food for their families, and more lives are being saved.

The pilot project is funded through the AMFm by UNITAID, the Bill & Melinda Gates Foundation, and the World Bank, and is managed by the Global Fund. The pilot will end in June 2012, and evaluation of the project is already underway. At the end of the pilot, the Global Fund and the project donors will review data to determine how and where to expand the project.