The two-year trial balloon of the Affordable Medicines Facility, malaria (AMFm) is well underway in its eight pilot countries trying to make quality ACTs available cheaply, but it seems some people are trying to let the air out of the balloon.Â In particular, one suspects that aspects of the way AMFm might be managed in some settings goes against the business-minded nature of private sector proprietors of malaria drugs.
Ghana was one of the first to get started. Ghana’s news source, Joy Online, led on this topic with a finding that, “A survey conducted by the Pharmacy Council from March to May this year, has revealed that some private pharmacy shops in five regions have been selling anti-malarial drugs for more than 200 per cent of the approved price.”
Early indications in December 2010 were that shops were keeping to the recommended price of 1-2 Cedis (0.60-1.20 USD) for adult doses.Â The recent survey found prices as high as 4-5 Cedis.
The goal of the low prices was to ‘crowd out’ unapproved or non-recommended ACTs and other malaria medicines by offering WHO prequalified ACTs at subsidized prices similar to those of chloroquine or sulphadoxine-pyrimethamine, the former first line medicines. This would have had the added benefit of encouraging people to buy ACTs instead of the old medicines for which parasite resistance has developed. Ghana Business News explained that, “Despite the availability of the Artemisinin-based combination therapies (ACTs) in the country chloroquine continues to be the second most used medicine in the treatment of malaria.”
Obviously in Ghana, other forces are at work. For example Joy Online reported …
- some shop keepers were buying through unauthorized sources that added extra cost the procurement process
- many shops were still selling unapproved medicines such as chloroquine and artesunate monotherapies that were as cheap to the customer as the AMFm ACTs, but which gave the seller a larger profit
- there is no legally binding way to ensure shop keepers adhere to the recommended price
Maybe the market is to large and diverse for price controls on one product to work, especially voluntary ones.
On the other hand, the ‘high end’ prices found in the survey are still lower that the pre-AMFm market prices of up to 9 USD in Ghana. The experiment continues and given the large role that private informal providers play in reaching global and national malaria treatment targets, we will all be watching the results closely.