December 15, 2011
Last week CDDEP, in collaboration with the Development Impact Evaluation Initiative of the World Bank, the Spanish Impact Evaluation Fund, the Affordable Medicines Facility-malaria (AMFm) at the Global Fund, and the Clinton Health Access Initiative (CHAI), hosted a workshop on Innovations in Health Care Financing and Service Delivery: Making Malaria Treatment Available.
The event opened with a keynote from Professor Kenneth J. Arrow, Nobel Laureate in Economics and Emeritus Professor at Stanford University. Professor Arrow was chairman of the Institute of Medicine committee that produced the landmark report, Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance, which laid out the architecture for a global subsidy for malaria drugs that was operationalized by the Affordable Medicines Facility malaria (AMFm). One of the major challenges was to make good quality antimalarials affordably available not only in clinics, but in the private sector including the informal private sector where most people in Africa get their malaria treatments. AMFm was established formally in 2008. It took four years of steady work to bring the concept of the IOM report to reality.
Seven years after the report was published and three years after AMFm was established, the first phase of AMFm is being evaluated by an independent group. It’s in the context of this evaluation, and of planning for AMFm phase 2, that the MMTA meeting brought together key players in the malaria financing debate. Here are a few pictures extracted from Professor Arrow’s presentation (also available in the Tools section of the website), which provided the historical context for the next round of thinking on investment in malaria interventions.
1. The past decade has seen unprecedented levels of funding committed to reducing the burden of malaria.
Unfortunately, this upward trend does not continue in 2010, and the ongoing global economic woes put future funding in jeopardy. Future malaria efforts will likely have to do more with less.
2. As funding has increased, reported malaria deaths have declined.
These eight African countries reported significantly fewer malaria deaths in 2009 than in 2004 – promising news for the global health community.
3. Children are increasingly being treated with Artemisinin-based combination therapies (ACTs) for fever.
ACTs are a response to the emergence of resistance to other malaria drugs, including chloroquine. As combination therapies, ACTs minimize selection pressure for resistance to a particular drug. The AMFm subsidy mechanism was intended to increase the availability of ACTs across eight pilot countries. Additional data on the retail prices of AMFm-subsidized ACTs versus non-subsidized ACTs suggest that AMFm has been successful in increasing the accessibility of these medications. Health Action International produces a handy chart comparing AMFm and non-AMFm anti-malarial prices across six African countries:
Source: Health Action International. Retail Prices of ACTs co-paid by the AMFm and other antimalarial medicines: report of price-tracking surveys. Sept/Oct 2011
4. In addition to increases in distribution of ACTS and insecticide-treated nets (ITNs), the use of rapid diagnostic tests (RDTs) is on the rise.
At the time of the IOM report, rapid diagnostic tests were still very new and not available widely in Africa, and their role in malaria management was unclear. Now, as the technology has developed, it has become clear that these tools will improve malaria management, but more importantly, they have the potential to improve the management of all febrile illnesses, only a proportion of which are caused by malaria. The ability to distinguish malaria from other non-malarial febrile illnesses can improve patient care, cut down on ACT waste, and possibly reduce the selection pressure that produces resistance to ACTs. The question remains, though, of what to do about a patient who tests negative for malaria in the absence of other diagnostic tests to determine viral or bacterial febrile illnesses.
The picture painted by the MMTA meeting is this: in a global context where malaria is declining, how can the health community maintain this progress and move toward elimination, even as funding faces a shaky road ahead? Additionally, how can increasing uptake of RDTs for malaria (and other illnesses as they become available) across sectors (public and private, formal and informal) guide treatment for febrile illnesses? The shift in paradigm towards febrile illness management defines the recently launched Febrile Illness Diagnostics Project at CDDEP.
For more information about last week’s meeting, read the press release. And in related news, the 2011 World Malaria Report is now available download it here.
