Affordable Medicines Facility malaria

1
Affordable Medicines Facility - malaria

• Innovative financing for malaria treatment

2
What is the problem?

• In 2006, approximately 250 million people
  contracted malaria and nearly one million people
  died, mostly children
• Malaria parasites increasingly resistant to
  older, cheaper treatments, such as Chloroquine
  (CQ) and Sulfadoxine-Pyrimethamine (SP)
• WHO recommends artemisinin-based combination
  therapies (ACTs) but they
• Are unaffordable compared with CQ and SP
• Account for only 1 in 5 anti-malarial treatments
  taken
• Have very limited availability in the private
  sector
• Furthermore
• Artemisinin monotherapies increase the risk of
  resistance

3
Limited availability of ACTs
Note Other category includes Mefloquine,
Amodiaquine and others. ACT data based on WHO
estimates and manufacturer interviews. Source
Biosynthetic Artemisinin Roll-Out Strategy,
BCG/Institute for OneWorld Health, WHO, Dalberg.
4
High average ACT prices
Note Ranges indicate variance across countries
and products excluding outliers N
(observations) (ACT, 222) (AMT, 227) (CQ, 37)
(SP, 118).

5
AMFm - Goals and Objectives

• Goal 1
• Contribute to Malaria Mortality Reduction
• Goal 2
• Delay Resistance to Artemisinin
• These goals will be achieved by
• 1 Increasing affordability of ACTs
• Price equivalent to or lower than CQ/SP
• 2 Increasing availability of ACTs
• Scale up through public, private, NGO sectors
• 3 Crowding out artemisinin monotherapies
• Decrease likelihood of artemisinin resistance

6
From idea to policy and practice

• Original idea from Institute of Medicine
  Committee Report (Prof. Kenneth Arrow and
  others, 2004)
• Designed by unprecedented global coalition
• RBM Board invited the Global Fund to host and
  manage AMFm (November 2007)
• Board of the Global Fund decided to host and
  manage AMFm (November 2008)
• Global Fund Secretariat now preparing to launch
  Phase 1

7
AMFm How does it work?

• Negotiations with manufacturers to reduce price
  of ACTs
• Co-payments to manufacturers to further reduce
  price of ACTs
• End-user ACT prices become similar to
  less-effective drugs
• Market dynamics to encourage ACT distribution and
  use
• Supporting interventions to ensure safe and
  effective ACT scale-up

8
AMFm will reach all sectors
Multiple eligible ACT manufacturers
Co-payment
First line buyers
Private Buyers
NGO Buyers
Public Buyers
Central medical stores
Wholesalers
Distributors
Medicines
Money
Retailers, private clinics and public providers
Patients
9
AMFm supporting interventions

• Supporting interventions to ensure safe and broad
  access to ACTs
• Countries must implement the following
  activities
• Public education and awareness campaigns
• Training, monitoring and supervision for ACT
  providers
• Planning for national policy and regulatory
  preparedness
• Planning for monitoring of drug quality
• Interventions to reach the poor and other
  vulnerable groups

10
What will AMFm mean for countries?

• Access to affordable ACTs
• Impact on malaria mortality
• Significant financial savings to patients
• Safe and broad scale-up
• Supporting interventions to strengthen the health
  system
• Open platform
• Public, NGO and private sector programs will
  benefit
• Alignment with existing Global Fund systems
• Builds on grant programmes to further expand
  access

11
AMFm Phase 1

• Phased launch to learn lessons in 11 countries
• Benin, Cambodia, Ghana, Kenya, Madagascar, Niger,
  Nigeria, Rwanda, Senegal, Tanzania, Uganda
• Supported by robust monitoring and evaluation
• Including independent evaluation
• Strong financial support from donors
• UNITAID pledged up to 130 million for co-payment
• DFID pledged 40 million for co-payment
• Operational for 24 months
• Implementation begins following Global Fund Board
  meeting in November 2009

12
Towards global roll-out

• Board will decide whether to proceed to global
  roll-out
• Decision expected in 2011
• Expansion to global roll-out anticipated unless
  clear failures observed
• AMFm in all malaria-endemic countries