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  • Volume 1

Stealing in the name of subsidy

By Isaiah Esipisu - Kenya

The Affordable Medicines Facility - malaria (AMFm) may be saving lives and justifying a continuation, but it is also throwing up realities that demand practical checks and balances.

In fact what began as grapevine reports seem to be confirmed by investigations which show that the anti-malarialdrug subsidy programme to enhance access to treatment in selected African countries has suffered a setback because the medicines are being diverted to non-targeted countries and outlets.

According to a new study published in the Malaria World Journal in February 2012, the anti-malarial drugs subsidised under AMFm are the new targets for corrupt practices across the borders.

AMFm is a financing mechanism run by the Global Fund to Fight AIDS TB and Malaria (GF) to expand access to the best treatments of malaria, artemisinin-based combination therapies (ACTs).

Through the scheme, the drugs have been co-paid, bringing the cost of a dose to half a dollar down, from five dollars.

But a new research has found out that multiple countries are already taking advantage of the pricing inequalities in the anti-malarial market by selling subsidised ACTs to non-registered pharmacies and across international borders.

 “This is not only illegal, it may also undermine the success of the AMFm subsidy,” reports the study.

Diverted subsidised medicines were found in 11 of 14 cities investigated, and in four of those, over half the pharmacies researchers visited had diverted subsidised malaria products.

Five of the cities investigated namely Accra, Dar es Salaam, Kampala, Lagosand Nairobi, were participating in the AMFm.

Shockingly however, non-participating cities such as Addis Ababa, Cotonou, Lomé, Luanda, Lusaka and Maputo had the subsidized drugs for sale even though they are not part of the pilot project.

The researchers warned that if no measures are put in place to stop such thefts it could lead to stock-outs in targeted countries, thus accelerate the use of less effective medicines such as chloroquine and sulfadoxine-pyrimethamine (SP).

Spot checks in 15 Nairobi based pharmacies in mid-March 2012 confirmed the fears of the researchers.

“We have not received supplies of the subsidized drugs for the past two months,” said Joan Kaleche, a pharmacist in Nairobi.

But among the 15 the only pharmacy that was selling the highly effective drugs was along Latema Street within the city. However, it sold anti-malarial drugs (Coartem) meant to be given free of charge in hospitals, provided through the same Global Fund program.

Other pharmacies within Nairobi city centre and within different estates had turned to selling sulfadoxine-pyrimethamine drugs (Fansidar and Metakelfin), which according to the World Health Organisation policy, should not be used for malaria treatment because they are less effective.

“We have no choice, but to sell the most appropriate alternative drugs,” said Linda Atieno, a pharmaceutical technologist in Dandora sprawling estate in Nairobi.

According to the researchers, it is impossible to tell the scale of the diversion. However,in two cities (Cotonou and Lomé) in non-AMFm countrieswhich border AMFm-participating countries (Nigeria and Ghana), over half the pharmacies apparently sold divertedAMFm products. 

“There is a possibility that some of theseproducts are counterfeit AMFm products,” reports the study. Though the researchers recommend a follow-up study to analyse the drugs, it recognizes the fact that so far, there has been no reports of counterfeit AMFm products or even the logo.

As a result of the drug theft across borders, the research scientists from the US based American Enterprise Institute, and from a non-governmental organization – ‘Africa Fighting Malaria’ are now advocating the withdrawal of the AMFm scheme as a solution.

“The Global Fund, which oversees the AMFm, shouldfund a thorough independent review of its distribution proceduresto ascertain where the AMFm drugs are being stolen from, and where they are going. This should be followedby policy solutions, including the possible termination of the AMFm,” said the researchers.

They further recommended that the Global Fund should as well assess the qualityof the diverted medicines, since stolen products are probablystored in poor conditions that could degrade products,increasing the likelihood of drug resistance.

AMFm donors subsidisethe price of ACTs in the public and private sectors by negotiating a reduced price for the drugs with manufacturers. The donor then pays the majority of the reduced price of the medicine tomanufacturers, lowering the cost to first-line buyers.

First linebuyers purchase the high quality anti-malarial drugs directly from manufacturers at a very low cost of up to 10 per cent of the original price. The effect is passed on to the final consumer, who ends up paying affordable amounts of money for the drugs.

According to evidence, poor people whose families live on less than a dollar per day have been able to afford the drugs due to the subsidy. But termination of the AMFm would mean that the highly subsidised drugs become unaffordable, a situation that will obviously perpetuate the spread of malaria.

“Since AMFm Phase 1 is a large-scale exploration of a new concept, we are also learning from it. Several technical partners are conducting operational research, the results of which can help to fine-tune the model in the future, depending on the decision of the Global Fund Board,” Dr Olusoji Adeyi, the Director AMFm at the Global Fund told Eyes on Malaria.

He spoke of evaluation being done on the first phase of the AMFm by an independent evaluator as decided by the Global Fund Board. 

“The results of the independent evaluation will inform the Global Fund Board’s decision on the future of the AMFm.  That decision is expected in November 2012,” he said.

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