The Global Fund to fight AIDS, Tuberculosis and Malaria has approved the integration of the Affordable Medicines Facility-malaria (AMFm) into its grant management and core financial processes. AMFm is a financing mechanism created to improve access to effective artemisinin-based combination therapies (ACTs) through subsidies and price negotiations with drug manufacturers.
The decision, announced after a recent meeting of the Global Fund's board, followed an independent evaluation that found that the pilot phase of AMFm, which began in 2010, increased the availability and reduced the price of ACTs.
AMFm will be in transition during 2013, after which eligible countries "will be able to allocate funding from their core Global Fund grants and determine how the money should be spent". Rapid diagnostic tests (RDTs) for malaria may also be incorporated into the programme.
"By introducing modifications and integrating it into the Global Fund grant processes, the board has improved this valuable mechanism and made it available to all eligible countries that wish to implement it," Gabriel Jaramillo, general manager of the Global Fund, said in a statement. "The collaboration of implementers, technical partners, manufacturers and donors was essential to the successful outcome of this process."
Organizations involved in fighting malaria have welcomed the move.
"Since the roll out of the AMFm, stock-outs of ACTs are much less common," said Joslyn Meier, deputy country director for the NGO Malaria Consortium, in Uganda, told IRIN via email. "For example, we have observed through our USAID-PMI [US government's Presidential Malaria Initiative] funded Stop Malaria Project in Uganda, 88 percent of the 34 project districts did not experience stock-out of ACTs between October 2011 and September 2012."
Focus on diagnosis
But the facility is not without its critics. In October, the NGO Oxfam published a paper criticizing AMFm's reliance on non-health professionals in the private sector - including shopkeepers and vendors selling ACTs. "This global subsidy has incentivized medicine sales without diagnosis and shown no evidence that it has served poor people", the authors said.
It is hoped that increasing the availability of RDTs will help ensure people are properly diagnosed before accessing ACTs. According to Malaria Consortium, Uganda will be receiving 15 million RDTs for malaria through AMFm, for distribution through the public sector.
"Going forward, there needs to be increasing emphasis on the use of parasite-based diagnosis that is both widely and consistently available through the use of affordable RDTs for malaria in both the public and private sectors, and at community level, where anti-malarial treatment is available," Meier said.
"There will be challenges to encouraging use of diagnosis in the private sector, however, which [could] mean drugs are not sold [when patients test negative for malaria]. But we believe these challenges can be surmounted. Accurate diagnosis is essential not only to promote rational drug use, but also to ensure global supplies of ACTs reach the people who need them," she continued.
She noted that widespread communications campaigns are needed to ensure communities understand the importance of diagnosis before using ACTs. In Uganda, the Malaria Consortium, working under AMFm, is collaborating with schools and religious leaders and producing radio spots to publicize importance of RDTs and the need for proper adherence to treatment regimens.
"The continuation of the AMFm, in whatever form, is important, particularly in countries where it has already been implemented," Meier said. "However, this will depend on the reliability of supply chains and must include introduction of parasite-based diagnosis."