Expanding access to effective antimalarial treatment through the private sector

Research carried out by the School has been central in informing policy on broadening access to effective antimalarial treatments, by highlighting the importance of the private sector in developing countries.

The School’s research played an influential role in the creation of the Affordable Medicines Facility – malaria (AMFm), a financing mechanism designed to improve access to drugs through subsidies and price negotiations.

Catherine Goodman, now reader at the School, who was later joined by Kara Hanson, professor of health system economics, began looking at the role of private shops in delivering malaria medicines in 2000.

The research fell into three main areas.  First, it investigated the use of the private sector for malaria case management. The results showed that antimalarial medicines were widely available from retail outlets which, in many areas, provided better access to the drugs than health facilities and were widely used by the population.

As well as highlighting the importance of these shops the research also showed the widespread use of artemisinin monotherapies, which increase the risk of drug resistance and whose withdrawal the World Health Organization has recommended.

Secondly, researchers collected data on the practices of private sector drug retailers. Standardised metrics were developed to capture the range of antimalarials available in an outlet, their prices, mark ups and volumes sold.

A third stream of research evaluated the impact of private sector interventions.  In 2004 the United States Institute of Medicine suggested a subsidy programme to increase access to artemisinin-based combination therapies (ACTs) and reduce the availability of artemisinin monotherapies. Prior to the roll out of this subsidy through AMFm, this hypothesis was tested in Kenya and Tanzania by the School’s researchers in 2008 to 2010. The School’s research was one of the few pieces of empirical research available and it underlined the need to include the private sector in any subsidy programme, as well as helping to calculate the optimum price for ACTs.

The AMFm was implemented in seven African countries from 2010-2013, with the School’s research informing key elements of its design. Goodman and Hanson were members of an AMFm independent evaluation team and led the design and analysis of the outlet surveys, together with colleagues Sarah Tougher, Barbara Willey, Andrea Mann and Ben Palafox.

The evaluation showed that more people were buying ACTs, with ACT market share increasing by between 16 and 40 percentage points in five of the seven AMFm countries. Effective treatments were also reaching rural and remote areas.

The School’s research methods have been adapted and used by ACTwatch, a consortium to monitor implementation of the AMFm, which also helped stimulate funding for new policy and research. The AMFm has now been integrated into the Global Fund’s core grant programme.