Effect of the Affordable Medicines Facility for malaria (AMFm) on the availability of antimalarials in Nigeria.

Background: Malaria is one of the most important causes of mortality worldwide. Use of the most effective treatments remains inadequate for those in need and there is concern over the emergence of resistance. Rapid, accurate and accessible detection of malaria parasites plays a role in promoting more rational use of increasingly costly drugs in many endemic areas. Rapid diagnostic tests (RDTs) offer the potential to provide accurate diagnosis to all at-risk populations for the first time, reaching those unable to access good quality microscopy services. In 2010, the Global Fund launched the Affordable Medicines Facility for malaria (AMFm) designed to increase access and use of good quality artemisinin-based combination therapies (ACTs) for malaria treatment. AMFm involves manufacturer price negotiations, subsidies and other interventions. The aim of this study was to document the availability of ACTs and RDTs provided under the National Malaria Elimination Programme via the AMFm financing strategy.

Materials and methods: Investigators were systematically selected and trained on the data collection tool from the World Health Organization/Health Action International (WHO/HAI) Workbook. Data was collected from public and private facilities in 12 states in the six geopolitical zones of Nigeria in April and May 2014. Returned survey forms were checked, entered and verified. Data analysis was carried out using the embedded analysis toolkit in the WHO/HAI Workbook after double-entry and auto-checking of data. Data was analysed for the public and private sectors.

Results: Seven AMFm products are available in the country, and include AL (IPCA), Artemef (Cipla), Coartem AMFm (Novartis), Combisunate (Ajanta), Lumartem (Cipla) as well as Arsuamoon (Guilin) and Coarsucam (Sanofi-Winthrop). The results reveal that antimalarials are largely concentrated in the private sector (private pharmacies and PPMVs). About 86% of the surveyed facilities had at least one AMFm AL product whereas only 18% had any AMFm AA product. Results show that the availability of the various AMFm AL products varies across the country. Lumartem by Cipla has the highest national availability with 26.4%, closely followed by AL (IPCA) with 25.7%. Twenty seven (%) of the facilities had an RDT in stock.

Conclusion: The results obtained in this survey show that continuous monitoring of the antimalarial drug landscape is required to track progress in the fight against malaria in the country.