The impact of the private sector co-payment mechanism on the private market for ACT in Nigeria

Supply of rapid diagnostic tests and artemisinin-based combination therapy (ACT) medicines needs to be synchronised to prevent high levels of ACT misuse.

Background

The private sector plays a large role in malaria treatment provision in Nigeria. To improve access to, and afordability of, quality-assured artemisinin-based combination therapy (QA-ACT) within this sector, the Afordable Medicines Facility-Malaria began operations in 2010 and transitioned to a private sector co-payment mechanism (PSCM) until 2017. To assess the impact of the scheme on the ACT market, cross-sectional household and outlet surveys were conducted in 2018 to coincide with the fnal stockages of ACT medicines procured under the PSCM.

Methods

An outlet survey was conducted targeting private pharmacies and Proprietary and Patent Medicine Vendors (PPMVs) across diferent regions of Nigeria to assess supply-side market factors related to availability and cost of anti-malarials, including artemisinin-based combinations subsidised under the PSCM (called green leaf ACT on account of their green leaf logo) and those not subsidised (non-green leaf ACT). A concurrent household survey was conducted to determine demand-side factors related to treatment-seeking practices, ACT brand preference and purchase decision. Data were compared with previous ACTWatch surveys to consider change over time.

Results

Availability of artemisinin-based combinations increased signifcantly over the PSCM period and was almost universal by the time of the 2018 market survey. This increase was seen particularly among PPMVs. While the cost of green leaf ACT remained relatively stable over time, the cost of non-green leaf ACT reduced signifcantly so that by 2018 they had equivalent afordability. Unsubsidised brands were also available in diferent formulations and dosages, with double-strength artemisinin-based combination reported as the most frequently purchased dosage type, and child artemisinin-based combinations popular in suspension and dispersible forms (forms not subsidised by the PSCM).

Conclusions

The PSCM had a clear impact on increasing not only the reach of subsidized QA brands, but also of non-subsidised brands. Increased market competition led to innovation from unsubsidised brands and large reductions in costs to make them competitive with subsidised brands. Concerns are drawn from the large market share that non-QA brands have managed to gain as well as the continued market share of oral artemisinin monotherapies. Continued monitoring of the market is recommended, along with improved local capacity for QA-certifcation and monitoring.

Published in Malaria Journal 

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Country: Nigeria

Keywords: Costing and economic impact evaluation | Monitoring and evaluation | Private sector | Research | Malaria | Treatment | SDGs