Abstract:
Abstract
Background: Poor access to prompt and effective treatment for malaria contributes to high mortality and severe
morbidity. In Kenya, it is estimated that only 12% of children receive anti-malarials for their fever within 24 hours. The
first point of care for many fevers is a local medicine retailer, such as a pharmacy or chemist. The role of the medicine
retailer as an important distribution point for malaria medicines has been recognized and several different strategies
have been used to improve the services that these retailers provide. Despite these efforts, many mothers still
purchase ineffective drugs because they are less expensive than effective artemisinin combination therapy (ACT).
One strategy that is being piloted in several countries is an international subsidy targeted at anti-malarials supplied
through the retail sector. The goal of this strategy is to make ACT as affordable as ineffective alternatives. The
programme, called the Affordable Medicines Facility - malaria was rolled out in Kenya in August 2010.
Methods: In December 2010, the affordability and accessibility of malaria medicines in a rural district in Kenya
were evaluated using a complete census of all public and private facilities, chemists, pharmacists, and other malaria
medicine retailers within the Webuye Demographic Surveillance Area. Availability, types, and prices of anti-malarials
were assessed. There are 13 public or mission facilities and 97 medicine retailers (registered and unregistered).
Results: The average distance from a home to the nearest public health facility is 2 km, but the average distance to the
nearest medicine retailer is half that. Quinine is the most frequently stocked anti-malarial (61% of retailers). More
medicine retailers stocked sulphadoxine-pyramethamine (SP; 57%) than ACT (44%). Eleven percent of retailers stocked
AMFm subsidized artemether-lumefantrine (AL). No retailers had chloroquine in stock and only five were selling
artemisinin monotherapy. The mean price of any brand of AL, the recommended first-line drug in Kenya, was $2.7 USD.
Brands purchased under the AMFm programme cost 40% less than non-AMFm brands. Artemisinin monotherapies cost
on average more than twice as much as AMFm-brand AL. SP cost only $0.5, a fraction of the price of ACT.
Conclusions: AMFm-subsidized anti-malarials are considerably less expensive than unsubsidized AL, but the price
difference between effective and ineffective therapies is still large
