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    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.


    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.


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The Global Fund, a few years ago, began subsidizing WHO-recommended artemisinin-based combination therapies, (ACTs) bearing the green logo in Ghana and 7 other countries. This co- paid pilot programme helped to expand access  to  quality and affordable anti- malaria medicines until 2012. However, in 2013, the pilot stage  entered a one year transition phase. A new model has begun  to  include  stakeholders  in  the private sector under a Private Sector Co-payment Mechanism. Ghana is participating in this new model.  Vivian N.A.  Aubyn  of  the  National  Malaria Control Programme (NMCP), the implementing agency in Ghana, explains the private sector co-payment  mechanism in an interview with  the  African Media and Malaria  Research  Network (AMMREN).     

AMMREN: Can you tell us more about the new AMFm programme  and the Private  Sector Co-payment Mechanism financing model?
The AMFm was a pilot in 8  countries meant  to  expand  access  to  quality assured  artemisinin-based  combination therapies (QAACTs). It was a proof of  concept  i.e.  to  find  out  if  it  was possible to subsidize QAACTs to remove financial limitations to QAACTs especially for the poor and  vulnerable and  to  improve  access  to  these medicines  for  rural  and  hard  to reach  communities.    It  used  the capacities of the public, private-for- profit  and  private-not-for-profit (NGOs)  sector. The AMFm implementation in these pilot  countries provided  lessons  that  have  influenced  the  design  of  the  Private Sector Co-payment Mechanism (PSCM). The PSCM therfore replaces  the  Affordable  Medicines Facility  for  malaria  subsidy  for QAACTs  and uses lessons learnt to expand Access.    It is private sector focused:    in  the  private-for-profit and private-not-for- profit sector.

AMMREN: What is the  difference between the old AMFm financing arrangements and this new one?

The AMFm was financed separately from  Ghana's  core  Global  Fund Malaria Grant but the PSCM will  be financed from Ghana's core  Global Fund Malaria Grant. That  is, it is now  dependent  on  Ghana  represented by the Principal Recipient to decide whether it wants to set aside some of the funds under the Global Fund  Grant  to  be  used  to  expand access to QAACTs through the private pharmaceutical sector.

AMMREN: Can you tell us the stages involved  in  this  Private Sector  Co-payment  Mechanism financing model?

The PSCM has the same core elements of the AMFm except that it is  focused  mainly  in  the  private sector.   This is because  the imple- mentation  in  the  private  sector resulted  in  higher  expansion  in access to QAACTS than in the public sector.

AMMREN: What about sustainability to ensure  constant supply  of  these  affordable  and quality ACTs?

One of the challenges of the  AMFm was sustainability; because it was a proof of concept  sustainability which was not built into the design.  The  PSCM  has  been  designed  to enable countries to sustain the gains made under the pilot and to expand such  gains.     Since  the  PSCM  is dependent  on  each  country  to  set  aside some of its grant funds, as long as  countries  are  willing  and  are successful  with  their  grant  application they will have funds for the PSCM.  Also,  countries  can  seek  domestic resources to fund the subsidy and or seek  support  from  other  donors  to fund the subsidy.

AMMREN:  Who  are  the  first  line buyers (FLB) and how do they fit in this new arrangement?  

The  first line buyers (FLBs) are  in- country licensed importers of  ACTs who  have  entered  into  a  contract called  an  “Undertaking/Agreement” with the  Global Fund to import the QAACTs into Ghana and to respect the terms and  conditions  of  the  Agree- ment. The Local Funding Agent (LFA) which represents the  Global Fund in Ghana conducts periodic spot checks on FLBs at the  request of the Global Fund to ensure that FLBs respect the terms  of the Agreement and most importantly adhere to the  objectives of the PSCM.

AMMREN: Recently a Ghana Private Sector  Co-payment  Mechanism Task Force was set up. What is the purpose of this task force?
The main role of the Task Force is  to advise and provide guidance on  the implementation of the PSCM.  Other duties  are  to  collaborate  with  the Ministry  of  Health,  Ghana  Health Service  and  the  NMCP  to  establish First Line Buyer conditions of participation,  monitor the Co-payment Mechanism implementation and take action on the results of retail price and availability surveys that will be carried out as part of the  implementation of the PSCM.

AMMREN: What role can the media play to ensure the  success  of this new financing programme?

The  media  informs  and  educates; with the PSCM  implementation it is important  for  the  media  to  let  the public know that the QAACTS marked by  the  'Green  leaf ”  logo  are  still available in pharmacies and chemical shops as well as in the hospitals; that these medicines are  of high quality and efficacious for  the treatment of uncomplicated  malaria. The media should  encourage  the  population  to test and be confirmed to have malaria before they use the green leaf medicines  and  to  help  disseminate information  that  will  help  improve the  health  of  the  people  living  in Ghana.

AMMREN: What are the other  key supporting interventions  to ensure a  smooth  implementation of this programme?

As  in  the  implementation  of  the AMFm, the PSCM will be supported by the monitoring of the  availability of the  QAACTs  and  the  price  by  the Pharmacy  Council  to ensure adherence to the guidelines on pricing and distribution.  The Principal Recipient through  the  NMCP  will  lead  the process for Behaviour Change Communication  to  encourage  the population  to  seek  early  treatment when they  suspect  they are unwell, test before treatment, and also direct them to engage in preventive behaviours. Other interventions  will be pharmacovigilance testing.

AMMREN: Tell us more about plans to include diagnostic testing in the Private Sector Co-payment Mechanism  financing programme to scale-up diagnostic testing in the private sector.

The strategic direction of the National Malaria Control Program, agreed  on by all stakeholders and in conformity with WHO guidelines is parasitological  confirmation  of  all suspected  malaria  cases  either  by microscopy or RDT before treatment.

The objective is to treat only malaria positive  cases  so  as  to  target  the medicines to those who need it most, promote  rational  use  of  medicines, prevent resistance to artemisinin due to misuse and to encourage differential diagnosis of fevers to ensure that the  population get the appropriate treatment for their illnesses.

AMMREN: How long will this Private Sector Co-payment Mechanism financing  programme last?

Private  Sector  Co-payment  Mechanism (PSCM) has been integrated into Ghana's Global  Fund Malaria Grant; what  this  means  is  that  anytime Ghana applies for a Global Fund Grant it has to set aside some of the funds to be  used  for  providing  a  subsidy  to QAACTs through the private for profit pharmaceutical  sector  represented by the First Line Buyers.  Such funds will be kept at  the Global Fund and disbursed when the FLBs make orders for the QAACTS.  

Therefore as long as Ghana is successful with its Global Fund Malaria  Grant  application  and  is willing as the Principal  Recipient to set aside some of the  funds for the PSCM during the application process, then the PSCM will continue.

AMMREN: How will the public sector such as public hospitals and pharmacies at these hospitals continue to assess ACTs?

The public sector purchase of ACTs is currently under what is called Voluntary Pooled Procurement (VPP) which is led by the Global  Fund. The Green Leaf QAACTs are also part of the public  sector  procurements  carried out by the Global Fund.  

Hospitals and Clinics should go through  the  approved  channels  for getting ACTs which is usually through their  regional  medical  stores  who pick them from the  Central Medical Stores.

Twelfth Edition