Back to Browse Journals » Research and Reports in Tropical Medicine » Volume 3

Subsidizing artemisinin-based combination therapies: a preliminary investigation of the Affordable Medicines Facility – malaria

Authors Bate R, Hess K, Tren R, Mooney L, Cudjoe F, Ayodele T, Attaran A

Received 8 May 2012

Accepted for publication 5 June 2012

Published 18 July 2012 Volume 2012:3 Pages 63—68


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Roger Bate,1,2 Kimberly Hess,2 Richard Tren,2 Lorraine Mooney,3 Franklin Cudjoe,4 Thompson Ayodele,5 Amir Attaran6

1American Enterprise Institute, Washington, DC, USA; 2Africa Fighting Malaria, Washington, DC, USA; 3Africa Fighting Malaria, Cambridge, United Kingdom; 4IMANI Center for Policy and Education, Accra, Ghana; 5Initiative for Public Policy Analysis, Lagos, Nigeria; 6University of Ottawa, Ottawa, ON, Canada

Background: The Affordable Medicines Facility – malaria (AMFm) is a subsidy mechanism to lower the price of, and hence increase access to, the best antimalarial medicines, artemisinin-based combination therapies (ACTs). While the AMFm stipulates that only quality-approved products are eligible for subsidy, it is not known whether those products, when actually supplied, are of good quality and comport with established pharmacopeial guidance on formulation and content of active ingredients. This study aimed to assess price and quality of AMFm ACTs, to compare AMFm ACTs with non-AMFm ACTs and artemisinin monotherapies, and to assess whether AMFm ACTs have been pilfered and diverted to a nearby country.
Methods: In all, 140 artemisinin-based antimalarial drugs were acquired from 37 pharmacies in Lagos, Nigeria, and Accra, Ghana. An additional ten samples of AMFm ACTs were collected from Lomé, Togo (not participating in the AMFm). Samples were analyzed using high-performance liquid chromatography.
Results: The AMFm ACTs were lower in price than many of the other drugs collected, but by less than anticipated or stipulated by the participating governments of Nigeria and Ghana. The quality of the AMFm ACTs was not universally good: overall, 7.7% had too little active pharmaceutical ingredient (API) and none had too much – these results are not likely to be as a result of random chance. AMFm ACTs were also found to have been diverted, both to pharmacies in Lagos not participating in the AMFm and to a foreign city (Lomé) where the AMFm is not operational.
Conclusion: The AMFm is at best imperfectly displacing undesirable monotherapies, some portion of which are replaced by ACTs lacking sufficient API, which are often sold at prices exceeding government authorization. ACTs sold at a lower price with low-dose API, potentially extrapolated to approximately 100 million treatments ordered under the AMFm for Nigeria and Ghana, represent a possible concern to public health and the promotion of drug resistance.

Keywords: high-performance liquid chromatography, antimalarial drugs, active pharmaceutical ingredient, Ghana, Nigeria

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF] 


Other articles by this author:

Anti-infective medicine quality: analysis of basic product quality by approval status and country of manufacture

Bate R, Mooney L, Hess K, Milligan J, Attaran A

Research and Reports in Tropical Medicine 2012, 3:57-61

Published Date: 16 July 2012

Antimalarial medicine diversion: stock-outs and other public health problems

Roger Bate, Kimberly Hess, Lorraine Mooney

Research and Reports in Tropical Medicine 2010, 1:19-24

Published Date: 2 September 2010

Readers of this article also read:

Traumatic grief in young people in Sub-Saharan Africa: a scoping review

Taggart H, Greatrex-White S

Nursing: Research and Reviews 2015, 5:77-89

Published Date: 16 July 2015

Epithelium-on corneal cross-linking treatment of progressive keratoconus: a prospective, consecutive study

Khairy HA, Marey HM, Ellakwa AF

Clinical Ophthalmology 2014, 8:819-823

Published Date: 29 April 2014

Swedish vineyards: a utopia?

Mårtensson A, Karlsson T, Gustafsson JG

International Journal of Wine Research 2013, 5:39-45

Published Date: 19 July 2013

The role of hemifield sector analysis in multifocal visual evoked potential objective perimetry in the early detection of glaucomatous visual field defects

Mousa MF, Cubbidge RP, Al-Mansouri F, Bener A

Clinical Ophthalmology 2013, 7:843-858

Published Date: 8 May 2013

Risk factors in patients with AFB smear-positive sputum who receive inappropriate antituberculous treatment

Chang CY, Hong JY, Yuan MK, Chang SJ, Lee YM, Chang SC, Hsu LC, Cheng SL

Drug Design, Development and Therapy 2013, 7:53-58

Published Date: 31 January 2013

Radioelectric brain stimulation in the treatment of generalized anxiety disorder with comorbid major depression in a psychiatric hospital: a pilot study

Olivieri E, Vecchiato C, Ignaccolo N, Mannu P, Castagna A, Aravagli L, Fontani V, Rinaldi S.

Neuropsychiatric Disease and Treatment 2011, 7:449-455

Published Date: 4 August 2011

Materiomics: biological protein materials, from nano to macro

Steven Cranford, Markus J Buehler

Nanotechnology, Science and Applications 2010, 3:127-148

Published Date: 12 November 2010