Has Tanzania Embraced the Green Leaf? Results from Outlet and Household Surveys before and after Implementation of the Affordable Medicines Facility -Malaria

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Thomson, Rebecca ; Festo, Charles ; Johanes, Boniface ; Kalolella, Admirabilis ; Bruxvoort, Katia ; Nchimbi, Happy ; Tougher, Sarah ; Cairns, Matthew ; Taylor, Mark ; Kleinschmidt, Immo ; Ye, Yazoume ; Mann, Andrea ; Ren, Ruilin ; Willey, Barbara ; Arnold, Fred ; Hanson, Kara ; Kachur, S. Patrick ; Goodman, Catherine
• Description:
  Background
  
  The Affordable Medicines Facility - malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side.
  
  Methods
  
  Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks.
  
  Results
  
  The availability of QAACTs increased from 25.5% to 69.5% among all outlet types, with the greatest increase among pharmacies and drug stores, together termed specialised drug sellers (SDSs), where the median QAACT price fell from $5.63 to $0.94. The market share of QAACTs increased from 26.2% to 42.2%, again with the greatest increase in SDSs. Household survey results showed a shift in treatment seeking away from the public sector towards SDSs. Overall, there was no change in the proportion of people with fever obtaining an antimalarial or ACT from baseline to endline. However, when broken down by treatment source, ACT use increased significantly among clients visiting SDSs.
  
  Discussion
  
  Unchanged ACT use overall, despite increases in QAACT availability, affordability and market share in the private sector, reflected a shift in treatment seeking towards private providers. The reasons for this shift are unclear, but likely reflect both persistent stockouts in public facilities, and the increased availability of subsidised ACTs in the private sector.
  
  
• Subjects:
  Antimalarials Artemisinins Drug Costs Family Characteristics Health Services Accessibility Health Surveys Humans Malaria Pharmacies Private Sector Program Evaluation Public Sector Surveys And Questionnaires

  More +
• Source:
  PLoS One. 2014; 9(5).
• Document Type:
  Journal Article
• Funding:
  MR/J012394/1/Medical Research Council/United Kingdom
• Place as Subject:
  Tanzania
• Volume:
  9
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9d4502b9556dd37f69ff1bd267fddcf0e5d386a84b62705629e618543f49222e
• Download URL:
  https://stacks.cdc.gov/view/cdc/27393/cdc_27393_DS1.pdf
• File Type:
  [PDF - 886.42 KB ]