September 04, 2012
This is a joint post with Heather Lanthorn, a doctoral candidate at Harvard School of Public Health. In mid-July, amidst the busy global-health month of July, in between the Family Planning summit and the AIDS conference, the near-final draft of the independent evaluation of the Affordable Medicines Facility - Malaria (AMFm) was released.
What is AMFm? It is a financing initiative to (1) increase the supply of antimalarial drugs, specifically quality approved the artemisinin-based combination therapies (ACTs), through negotiations and co-payments at the top of the supply chain and (2) to increase demand for ACTs through country-specific supporting interventions.This evaluation report represents quite an expansion: an earlier AMFm evaluation report published in March 2012 was 194 pages while we, and the Global Fund, now have 675 pages to consume and process (that March report was a teaser, wasn’t it?). The authors deserve credit for organizing a 7-country evaluation over a short period of time: kudos to the folks at ICF International and LSHTM, as well as the ‘data contributors’ from 5 different organizations working in sub-Saharan Africa. Never intended to be an experiment or quasi-experiment, the pre-post evaluation of the AMFm has so far been interpreted cautiously and optimistically; we’re encouraged by this. But given that the evaluation considers trends in the outcomes of interest before and after AMFm in only the chosen AMFm countries, the evaluation lacks a counterfactual or comparison group. At a minimum, it would be helpful to know whether similar trends in the outcomes also occurred in non-AMFm countries, or having more measurements before AMFm began. As decided during a 2008 Global Fund Board Meeting (the 18th, in New Delhi, GF/B18/7), it is now time for the Global Fund Board – hosts of the AMFm – to determine whether to “expand, accelerate, terminate or suspend the AMFm.” Though other considerations such as funding will undoubtedly play a role, the Board will rely in large part on this independent technical evaluation to determine the future of the AMFm with the Global Fund. The focal points of the evaluation are the benchmarks of success laid out in January 2011 to assess the availability and affordability of ACTs, including to the vulnerable. More specifically, the benchmarks address at set specific thresholds for:
- Availability: “The proportion of all facilities, private and public, stocking [quality-assured ACTs, including those with the AMFm ‘green leaf’ logo,’ hereafter: c/QA.ACTs], among outlets with any antimalarials in stock at the time of the survey”
- Market share: “Total volume of c/QA.ACTs sold or distributed as a proportion of the total volume of all antimalarials sold or distributed in the last week [7 days].”
- Use: “Proportion of children under age 5 with fever who received a c/QA.ACT on the day that the fever started or on the following day”
- Price: “Adult equivalent treatment dose” of the dominant non-cQA.ACT used to treat malaria, generally SP or chloroquine
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