Artemisinin-based combination therapies (ACTs) via private sector

ACTs are the recommended malaria treatment in Africa, but only 3% of febrile children access them. It has been argued that access could be significantly increased by subsidising ACT in the private sector to ensure a retail price similar to those of common alternative antimalarials: this proposed subsidy mechanism is hosted by the Global Fund and called the Access to Medicines Facility-malaria (AMFm) and Kenya will become an early beneficiary. However subsidies may be captured by middle-men and not passed on to consumers; the poorest may not benefit because the drugs are not free; and attention may be diverted from the problems of public health facilities. The MPHEG will undertake a series of linked investigations of private sector provision of ACTs under the AMFm exploring a) the impact of ACT subsidies on coverage, quality and equity of antimalarial treatment; b) the influence of the private sector distribution chain on ACT provision and use; and c) identifying the optimal mix and design of interventions to support the ACT subsidy, such as incentives to distribute to remote areas, shopkeeper training, retail price, the role of social marketing and pharmaceutical regulation. A corollary of this work will be a set of tools and approaches to improve the way private sector markets are studied in Africa and will feed into work with collaborators in Tanzania (IMPACT2) and regionally (ACTwatch).