Malaria Case Management After the Affordable Medicines Facility for Malaria (AMFm): Availability, Quality, and Market Share for ACTs in Kenya’s Private Pharmacies

Abstract:

Between 2011 and 2016, the Affordable Medicines Facility-Malaria (AMFm) subsidy program substantially increased access to WHO prequalified artemisinin combination therapies (ACTs) through Africa’s private sector pharmacies and drug-sellers. While the program was rigorously and extensively evaluated, little is known about private-sector case management of malaria in the period since its discontinuation. This paper leverages digital point-of-sale data from 250 pharmacies and private-sector clinics, combined with Indian export data for pharmaceuticals, to examine anti-malarial prescribing and importation practices in the Kenyan private sector after the AMFm. We find that the AMFm has driven an enduring shift to ACT usage even after the subsidy’s discontinuation; however, non-WHO prequalified products have captured a growing portion of overall market share. As of 2019, the price of artemether lumefantrine (AL) in the Kenyan private sector had returned to the level seen at the close of AMFm. Rapid diagnostic tests remain underutilized in the private sector, which is consistent with prior literature and suggests room for intervention. The findings highlight the continued importance of the private sector in malaria case management in Kenya, and the value of technological innovation in providing unique insights on how to shape private sector malaria treatment.