Update on the Affordable Medicines Facility malaria (AMFm) PSM Working Group November 2012

Transcription

1 Update on the Affordable Medicines Facility malaria (AMFm) PSM Working Group November 2012

2 Phase 1 was a Test of Concept AMFm comprises three elements: 1) Negotiations with ACT manufacturers Same reduced price to public and private sector first-line buyers 2) Buyer subsidy (co-payments) at top of global supply chain Further reduce price of ACTs to first line buyers 3) Supporting interventions to ensure effective ACT scale-up Uses pre-existing supply chains in all sectors: public, private non-profit, private for-profit Operational in nine pilots in eight countries: Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar), Uganda

3 AMFm Phase 1 Independent Evaluation Commissioned by the Secretariat, per Board DP Part of AMFm Phase 1 M&E Technical Framework developed in partnership Pre/post study design: National-level outlet surveys, urban and rural areas Country case studies: context and implementation process Secondary analysis of available household survey data Remote areas study in two fast moving countries Benchmarks established ex-ante for key indicators: success after 12 months of implementation Different evaluated implementation period for each pilot

4 Achievement of pre-defined success benchmarks For the three upstream objectives re QAACTs: Increased availability and affordability: 5/8 pilots achieved Increased market share: 4/8 pilots achieved or surpassed in both urban and rural areas; AND remote areas For the one downstream objective: - Increasing use (including by vulnerable populations) Data not available for inclusion in Independent Evaluation Report; supplementary report to be released today 12 November 2012 CHAI review of national-scale surveys from 3 pilots indicates increased use of ACTs among children receiving antimalarials, including among the poorest groups For the artemisinin monotherapy objectives: Met in all pilots with sufficient AMTs in the market to make the benchmarks relevant 4

5 Success metrics: Summary Ghana Kenya Madagascar Niger Nigeria Tanzania mainland Uganda Zanzibar Benchmark percentage point increase in QAACT availability (p=0.99) 10 (p=0.99) 26 (p=0.14) Median price of QAACTs with AMFm logo is < 3 times the median price of the most popular antimalarial in tablet form that is not a QAACT (ratio) 3.0 (p=0.81) (p=0.99) (p=0.99) Median price of QAACTs with AMFm logo is less than the median price of AMT tablets (difference, QAACT AMT) percentage point increase in market share of QAACTs (p=0.01) 8.6 (p=0.61) -8.8 (p=0.99) (p=0.23) 17 (p=0.08) Decrease in market share of oral AMTs (percentage point change) 4. 5 percentage point increase in percentage of children with fever who received ACT treatment -3.9 (p=0.03) na na na na na na na na Note that the outlet survey was not powered to detect a 10% change in market share in Madagascar, Tanzania mainland and Uganda -12

6 Review of evidence from IE AMFm Working Group (WG), RBM Taskforce and TERG have reviewed the evidence from AMFm Phase 1 AMFm had significant impact in the private for profit sector in 6 out of 8 pilots Rapid response; Widespread availability; Little evidence of profiteering Fewer fundamental changes to public sector antimalarial supply Linked to procurement and grant disbursement challenges which pre-dated the AMFm Despite this, increase in market share observed in 4 pilots Public-private coordination Longer duration of implementation of full model (co-paid ACTs, large-scale mass media campaign) appears correlated with achievement of success benchmarks AMFm Brown-bag Discussion Geneva, 12 November 2012

7 Considerations going forward Importance of private sector in malaria treatment Dominant role in some countries; critical to reaching global treatment targets Changing malaria landscape: less fevers due to malaria Need to scale-up access to diagnostic testing (consistent with guidance from technical partners and country wishes) Supporting interventions essential: Mass communications; recommended retail prices; provider training; regulatory actions

8 Percentage of total antimalarial sale volumes Market share by outlet type: All antimalarial categories (Baseline) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Ghana Kenya Madagascar Niger Nigeria Tanzania mainland Uganda Zanzibar Public health facility Private not-for-profit health facility Private for-profit outlet Community health worker AMFm Update for PSM WG Geneva, 19 November 2012

9 Percentage of outlets with any diagnostic test for malaria Outlets stocking any diagnostic test for malaria among public and private for-profit outlets with antimalarials in stock Ghana Kenya Madagascar Niger Nigeria Tanzania Uganda Zanzibar mainland Public health facilities (Baseline) Public health facilities (Endline) Private for-profit facilities (Basline) Private for-profit facilities (Endline)

10 Board considerations 1. Notes the findings of the Independent EI on the effectiveness of the AMFm in the eight pilot programs and, in particular, notes the results regarding the upstream success parameters recommended in 2010 by the Technical Evaluation Reference Group ( TERG ). 2. Recognizes that the successes of the AMFm are due to the copayment system, consisting of price negotiations with manufacturers and direct co-payments from the Global Fund to manufacturers on behalf of approved first-line buyers, and the use of supporting interventions. 3. Notes that the results of the IE and the TERG s interpretation of those findings indicate there is sufficient evidence to approve a modified approach to support countries in achieving the Roll Back Malaria targets of universal coverage of malaria treatment if coupled with efforts to improve access to diagnostic testing. 10

11 Board Recommendations Modify the existing AMFm business line by integrating lessons learned from Phase 1 into Global Fund grant management and financial processes Maintain global-level price negotiations and co-payment system Financing from Global Fund grants Assessment by partners of feasibility to include malaria rapid diagnostic tests (RDTs) into co-payment system

12 Board Recommendation Orderly & responsible transition for AMFm pilots in 2013 Urgent need for resource mobilization for private sector co-payments (US$114 to US$154 million) Consult with AMFm pilot countries on transition arrangements and rollout of integrated model Following a responsible transition, ACT co-payments will no longer be available through separate funding mechanism hosted by Global Fund 12

13 Thank you

14 ACTs Approved and Delivered by Sector [As of 30 Sept 2012] At global level: Sector Within countries: Treatments Approved for co-payments (millions) Some public sector entities (facility- and district-level) buy from private sector First Line Buyers to avoid stock-outs from delays in public sector/cms procurement through imports Examples: Ghana, Niger, Nigeria and Tanzania Treatments Delivered (millions) Public Private for-profit Private not-for-profit Total

15 A/L - Relative Percentage of Pack Sizes, pre- and postrevision of co-payment structure and introduction of levers 100% 90% 80% 70% 60% 50% 40% 30% 20% 6 x 4 [68%] 6 x 4 [51%] 6 x 4, 51% 6 x 3 [8%] 6 x 2 [8%] 6 x 3 [9%] 6 x 2 [10%] 6 x 1 [30%] 6 x 4 [35%] 6 x 3 [12%] 6 x 2 [25%] 6 x 1 [29%] 6 x 4 [31%] 6 x 4, 35% 6 x 3 [9%] 6 x 2 [26%] 6 x 1 [35%] Cumulative 6 x 6 4, x 4 31% [43%] 6 x 3, 9% 6 x 3 [9%] 6 x 2, 26% 6 x 2 [18%] 6 x 61, x 35% 1 [30%] As at 28 September 2012 NB: A/L represents 85% of all copayment approvals Child packs: 57% 10% 6 x 1 [16%] 0% July Feb million A/L treatments March 2011-July 2011: Revised copayment structure 87.1 million A/L treatments Aug 2011-Dec 2011 Prioritization levers + revised copayment structure 42.5 million A/L treatments Jan 2012-Sept 2012 Continuation of levers + revised copayment structure 95.4 million A/L treatments July 2010-Sept million A/L treatments AL: Artemether-Lumefantrine, fixed-dose combination and dispersible tablets Adults (35 kgs or more): 6x4 20/120 mg; Child (25 kg up to 35 kg): 6x3 20/120 mg; Child (15 kg up to 25 kg): 6x2 20/120 mg; Infants/Toddlers (5 kg up to 15 kg): 6x1 20/120 mg

16 Some Phase 1 pilots affected by levers more than others Quality-assured ACT treatments requested by private not-for-profit and private for-profit first-line buyers and approved by the Global Fund, Q3 and Q only AMFm Phase 1 Pilot Quantity of quality-assured ACT treatments requested by first-line buyers Quantity of quality-assured ACT treatments approved by the Global Fund Proportion of quality-assured ACT treatments approved by the Global Fund Ghana 28,084,120 7,699,920 27% Kenya 7,263,320 4,071,000 56% Madagascar 317, , % Niger 575, , % Nigeria 62,665,768 15,324,600 24% Tanzania 4,772,200 4,272,200 90% Uganda 5,183,880 2,953,880 57% Zanzibar Total 108,861,482 35,213,794 32%