Accessibility, availability and affordability of anti-malarials in a rural district in Kenya after implementation of a national subsidy scheme.
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.
Type
Journal articleSubject
AntimalarialsArtemisinins
Drug Combinations
Ethanolamines
Financing, Government
Fluorenes
Health Policy
Health Services Accessibility
Humans
Kenya
Malaria
Pilot Projects
Rural Population
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https://hdl.handle.net/10161/5946Published Version (Please cite this version)
10.1186/1475-2875-10-316Publication Info
Smith, Nathan; Obala, Andrew; Simiyu, Chrispinus; Menya, Diana; Khwa-Otsyula, Barasa;
& O'Meara, Wendy Prudhomme (2011). Accessibility, availability and affordability of anti-malarials in a rural district
in Kenya after implementation of a national subsidy scheme. Malar J, 10. pp. 316. 10.1186/1475-2875-10-316. Retrieved from https://hdl.handle.net/10161/5946.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Wendy P O'Meara
Associate Professor of Medicine
Dr. Wendy O’Meara is an Associate Professor at Duke University School of Medicine
in the Division of Infectious Diseases, visiting professor at Moi University, and
the Associate Director for Research of the Duke Global Health Institute. She has been
based full-time in Kenya since 2007.
Dr. O’Meara’s team is interested in improving rational drug use for suspected malaria
fevers through expanding the use of diagnostic tools in the community and in health
facilities. As

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