In response to the recent news of the incorporation of the Affordable Medicines for Malaria scheme (AMFm) into the financial processes of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Malaria Consortium believes that the continuation of the AMFm in whatever form is important, particularly in countries where it has already been implemented. However, its effectiveness will continue to depend on the reliability of supply chains and must include introduction of parasite-based diagnosis.
The AMFm is a sustainable way to facilitate private sector sales of anti-malarial medication and testing kits. It works through government subsidies for drugs and diagnostic tests, thereby making them more affordable. The subsidies also have the effect of reducing stock-outs of the drugs and tests, resulting in improved overall access to the medications.
With this change in management, countries in receipt of Global Fund grants will now be required to spend a portion of that funding on a local AMFm scheme. The possible inclusion of rapid diagnostic tests (RDTs) into the programme would mean that millions more people would have access to effective parasitical diagnosis of malaria. This will allow global supplies of artemisinin based combination therapies (ACTs), currently the most effective treatment for malaria, to be more rationally applied, reducing stock-outs and making the medicines more available to those most in need.
In fact, since the roll out of the AMFm, stock-outs of ACTs are much less common. Through our involvement in the USAID-PMI funded Stop Malaria Project in Uganda, we have observed that 88 percent of the 34 project districts did not experience stock-out of ACTs between October 2011 and September 2012.
However, the AMFm model has been criticised for encouraging the sale of ACTs without a confirmed diagnoses, a practice which it is believed may be linked to the emergence of ACT resistant strains of malaria.
Malaria Consortium agrees that there needs to be greater emphasis on the use of parasite-based diagnosis that is both widely and consistently available through the use of affordable RDTs for malaria. These need to be available in both the public and private sectors, and at community level, where anti-malarial treatment is available. While there will be challenges to encouraging use of diagnosis in the private sector, however, which can mean drugs are not sold, we believe these challenges can be surmounted.
The biggest challenge remains in the training of health workers in the use of the diagnostic kits, something that Malaria Consortium has been involved in since 2009. Through the Stop Malaria Project and our Comic Relief funded Mbale project, we have trained more than 5,700 health facility level workers in 35 districts, and over 6,600 community health workers in nine of those districts on the integrated management of malaria including the use of RDTs. Through the AMFm, Uganda will also be receiving 15 million rapid diagnostic tests for malaria for distribution through the public sector.
For more information please view the original Global Fund announcement.
For a recent article on the issue from IRIN, click here.
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