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The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention?
Malar J. 2015 Oct 09; 14:398.MJ

Abstract

BACKGROUND

To assess the availability, price and market share of quality-assured artemisinin-based combination therapy (QAACT) in remote areas (RAs) compared with non-remote areas (nRAs) in Kenya and Ghana at end-line of the Affordable Medicines Facility-malaria (AMFm) intervention.

METHODS

Areas were classified by remoteness using a composite index computed from estimated travel times to three levels of service centres. The index was used to five categories of remoteness, which were then grouped into two categories of remote and non-remote areas. The number of public or private outlets with the potential to sell or distribute anti-malarial medicines, screened in nRAs and RAs, respectively, was 501 and 194 in Ghana and 9980 and 2353 in Kenya. The analysis compares RAs with nRAs in terms of availability, price and market share of QAACT in each country.

RESULTS

QAACT were similarly available in RAs as nRAs in Ghana and Kenya. In both countries, there was no statistical difference in availability of QAACT with AMFm logo between RAs and nRAs in public health facilities (PHFs), while private-for-profit (PFP) outlets had lower availability in RA than in nRAs (Ghana: 66.0 vs 82.2 %, p < 0.0001; Kenya: 44.9 vs 63.5 %, p = <0.0001. The median price of QAACT with AMFm logo for PFP outlets in RAs (USD1.25 in Ghana and USD0.69 in Kenya) was above the recommended retail price in Ghana (US$0.95) and Kenya (US$0.46), and much higher than in nRAs for both countries. QAACT with AMFm logo represented the majority of QAACT in RAs and nRAs in Kenya and Ghana. In the PFP sector in Ghana, the market share for QAACT with AMFm logo was significantly higher in RAs than in nRAs (75.6 vs 51.4 %, p < 0.0001). In contrast, in similar outlets in Kenya, the market share of QAACT with AMFm logo was significantly lower in RAs than in nRAs (39.4 vs 65.1 %, p < 0.0001).

CONCLUSION

The findings indicate the AMFm programme contributed to making QAACT more available in RAs in these two countries. Therefore, the AMFm approach can inform other health interventions aiming at reaching hard-to-reach populations, particularly in the context of universal access to health interventions. However, further examination of the factors accounting for the deep penetration of the AMFm programme into RAs is needed to inform actions to improve the healthcare delivery system, particularly in RAs.

Authors+Show Affiliations

ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA. yazoume.ye@icfi.com.ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA. fred.arnold@icfi.com.KEMRI/Wellcome Trust, Nairobi, Kenya. anoor@nairobi.kemri-wellcome.org.African Population and Health Research Center, Nairobi, Kenya. mwamukoya@aphrc.org.Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana. amuas001@umn.edu.Komfo Anokye Teaching Hospital, Kumasi, Ghana. sbnguah@gmail.com.African Population and Health Research Center, Nairobi, Kenya. bmberu@aphrc.org.ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA. Ruilin.Ren@icfi.com.African Population and Health Research Center, Nairobi, Kenya. ckyobutungi@aphrc.org.African Population and Health Research Center, Nairobi, Kenya. fwekesah@aphrc.org.ICF International, 530 Gaither Road, Suite 500, Rockville, MD, 20850, USA. Hellen.Gatakaa@icfi.com.Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan. mitsuru.toda@gmail.com.The ACTwatch project (Population Services International), Nairobi, Kenya. jngigi@psi.org.The ACTwatch project (Population Services International), Nairobi, Kenya. illah@psi.org.The ACTwatch project (Population Services International), Nairobi, Kenya. kaoconnell@hotmail.com.The ACTwatch project (Population Services International), Nairobi, Kenya. shewchuktanya@yahoo.com.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Sarah.Tougher@lshtm.ac.uk.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Andrea.Mann@lshtm.ac.uk.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Barbara.Willey@lshtm.ac.uk.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Catherine.Goodman@lshtm.ac.uk.Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK. Kara.Hanson@lshtm.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26452625

Citation

Ye, Yazoume, et al. "The Affordable Medicines Facility-malaria (AMFm): Are Remote Areas Benefiting From the Intervention?" Malaria Journal, vol. 14, 2015, p. 398.
Ye Y, Arnold F, Noor A, et al. The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention? Malar J. 2015;14:398.
Ye, Y., Arnold, F., Noor, A., Wamukoya, M., Amuasi, J., Blay, S., Mberu, B., Ren, R., Kyobutungi, C., Wekesah, F., Gatakaa, H., Toda, M., Njogu, J., Evance, I., O'Connell, K., Shewchuk, T., Thougher, S., Mann, A., Willey, B., ... Hanson, K. (2015). The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention? Malaria Journal, 14, 398. https://doi.org/10.1186/s12936-015-0904-z
Ye Y, et al. The Affordable Medicines Facility-malaria (AMFm): Are Remote Areas Benefiting From the Intervention. Malar J. 2015 Oct 9;14:398. PubMed PMID: 26452625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Affordable Medicines Facility-malaria (AMFm): are remote areas benefiting from the intervention? AU - Ye,Yazoume, AU - Arnold,Fred, AU - Noor,Abdisalan, AU - Wamukoya,Marilyn, AU - Amuasi,John, AU - Blay,Samuel, AU - Mberu,Blessing, AU - Ren,Ruilin, AU - Kyobutungi,Catherine, AU - Wekesah,Frederick, AU - Gatakaa,Hellen, AU - Toda,Mitsuru, AU - Njogu,Julius, AU - Evance,Illah, AU - O'Connell,Kathryn, AU - Shewchuk,Tanya, AU - Thougher,Sarah, AU - Mann,Andrea, AU - Willey,Barbara, AU - Goodman,Catherine, AU - Hanson,Kara, Y1 - 2015/10/09/ PY - 2015/06/30/received PY - 2015/09/13/accepted PY - 2015/10/11/entrez PY - 2015/10/11/pubmed PY - 2016/6/24/medline SP - 398 EP - 398 JF - Malaria journal JO - Malar J VL - 14 N2 - BACKGROUND: To assess the availability, price and market share of quality-assured artemisinin-based combination therapy (QAACT) in remote areas (RAs) compared with non-remote areas (nRAs) in Kenya and Ghana at end-line of the Affordable Medicines Facility-malaria (AMFm) intervention. METHODS: Areas were classified by remoteness using a composite index computed from estimated travel times to three levels of service centres. The index was used to five categories of remoteness, which were then grouped into two categories of remote and non-remote areas. The number of public or private outlets with the potential to sell or distribute anti-malarial medicines, screened in nRAs and RAs, respectively, was 501 and 194 in Ghana and 9980 and 2353 in Kenya. The analysis compares RAs with nRAs in terms of availability, price and market share of QAACT in each country. RESULTS: QAACT were similarly available in RAs as nRAs in Ghana and Kenya. In both countries, there was no statistical difference in availability of QAACT with AMFm logo between RAs and nRAs in public health facilities (PHFs), while private-for-profit (PFP) outlets had lower availability in RA than in nRAs (Ghana: 66.0 vs 82.2 %, p < 0.0001; Kenya: 44.9 vs 63.5 %, p = <0.0001. The median price of QAACT with AMFm logo for PFP outlets in RAs (USD1.25 in Ghana and USD0.69 in Kenya) was above the recommended retail price in Ghana (US$0.95) and Kenya (US$0.46), and much higher than in nRAs for both countries. QAACT with AMFm logo represented the majority of QAACT in RAs and nRAs in Kenya and Ghana. In the PFP sector in Ghana, the market share for QAACT with AMFm logo was significantly higher in RAs than in nRAs (75.6 vs 51.4 %, p < 0.0001). In contrast, in similar outlets in Kenya, the market share of QAACT with AMFm logo was significantly lower in RAs than in nRAs (39.4 vs 65.1 %, p < 0.0001). CONCLUSION: The findings indicate the AMFm programme contributed to making QAACT more available in RAs in these two countries. Therefore, the AMFm approach can inform other health interventions aiming at reaching hard-to-reach populations, particularly in the context of universal access to health interventions. However, further examination of the factors accounting for the deep penetration of the AMFm programme into RAs is needed to inform actions to improve the healthcare delivery system, particularly in RAs. SN - 1475-2875 UR - https://www.unboundmedicine.com/medline/citation/26452625/The_Affordable_Medicines_Facility_malaria__AMFm_:_are_remote_areas_benefiting_from_the_intervention L2 - https://malariajournal.biomedcentral.com/articles/10.1186/s12936-015-0904-z DB - PRIME DP - Unbound Medicine ER -