Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania

Abstract

BackgroundWHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania.Methods/Principal FindingsThree districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities.The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001).ConclusionsA subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently.Trial RegistrationControlled-Trials.com ISRCTN39125414.

Availability and prescription practice of anti-malaria drugs in the private health sector in Yemen

“…Interventions to increase accessibility of ACTs in private pharmacies were supported by a subsidized artemisinin-based combination therapy approach in different developing countries, resulting in an increase in marketing and an increase in malaria patients being treated with ACTs [14,15]. In this pilot project, despite the marketing of ACTs and other recommended antimalaria drugs, the private sector did not support any marketing interventions applied to increase the availability or use of ACTs in the private sector.…”

Subsidising artemisinin-based combination therapy in the private retail sector

“… 8 Based on Sabot 2009. Drug shops in population centres were more likely to stock ACTs than those in more remote areas (P < 0.001).…”

“… 14 Sabot 2009: Children: the mean price paid for ACTs (US$ 0.19) was less than for both sulphadoxine-pyrimethamine (US$ 0.51, P = 0.001) and amodiaquine (US$ 0.86, P < 0.001); the price paid for ACTs did not vary by socioeconomic status or geographical location across all age groups; All age groups: the mean price for ACTs (US$ 0.58) did not differ from the price of sulphadoxine-pyrimethamine (US$ 0.67), but was higher than for amodiaquine (US$ 0.48, P < 0.001).…”

Private Sector Provision of Oral Rehydration Therapy for Child Diarrhea in Sub-Saharan Africa

“…Strategies of engagement with the private sector in Kenya and Tanzania have shown to be effective at increasing child take-up of malaria medication. 36,37 Similar strategies should be pursued for ORT.…”