Open Access Research

Closing the access barrier for effective anti-malarials in the private sector in rural Uganda: consortium for ACT private sector subsidy (CAPSS) pilot study

Ambrose O Talisuna12*, Penny Grewal Daumerie1, Andrew Balyeku1, Timothy Egan1, Bram Piot1, Renia Coghlan1, Maud Lugand1, Godfrey Bwire1, John Bosco Rwakimari3, Richard Ndyomugyenyi3, Fred Kato3, Maria Byangire3, Paul Kagwa3, Fred Sebisubi3, David Nahamya4, Angela Bonabana4, Susan Mpanga-Mukasa5, Peter Buyungo5, Julius Lukwago5, Allan Batte5, Grace Nakanwagi6, James Tibenderana6, Kinny Nayer7, Kishore Reddy7, Nilesh Dokwal7, Sylvester Rugumambaju8, Saul Kidde9, Jaya Banerji1 and George Jagoe1

Author Affiliations

1 Medicines for Malaria Venture-MMV, PO Box 1826 20, rte de Pré-Bois, Geneva 15, 1215, Switzerland

2 Malaria Public Health & Epidemiology Cluster, University of Oxford-KEMRI-Wellcome Trust Research Programme and Worldwide Antimalarial Resistance Network-WWARN, P. O. Box 43640, Nairobi, 00 100, Kenya

3 Uganda Ministry of Health-Ug-MoH, Po Box 7272, Kampala, Uganda

4 Uganda National Drug Authority-NDA, Kampala, Uganda

5 Programme for Accessible Health Communication and Education-PACE, Kampala, Uganda

6 Malaria Consortium-MC, Kampala, Uganda

7 Surgipharm Pharmaceuticals, Kampala, Uganda

8 I+Solutions, Pharmaceutical Management Support, Westdam 3b, Woerden, GA, 3441, The Netherlands

9 Management Sciences for Health-MSH, Kampala, Uganda

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Malaria Journal 2012, 11:356  doi:10.1186/1475-2875-11-356

Published: 29 October 2012

Abstract

Background

Artemisinin-based combination therapy (ACT), the treatment of choice for uncomplicated falciparum malaria, is unaffordable and generally inaccessible in the private sector, the first port of call for most malaria treatment across rural Africa. Between August 2007 and May 2010, the Uganda Ministry of Health and the Medicines for Malaria Venture conducted the Consortium for ACT Private Sector Subsidy (CAPSS) pilot study to test whether access to ACT in the private sector could be improved through the provision of a high level supply chain subsidy.

Methods

Four intervention districts were purposefully selected to receive branded subsidized medicines - “ACT with a leaf”, while the fifth district acted as the control. Baseline and evaluation outlet exit surveys and retail audits were conducted at licensed and unlicensed drug outlets in the intervention and control districts. A survey-adjusted, multivariate logistic regression model was used to analyse the intervention’s impact on: ACT uptake and price; purchase of ACT within 24 hours of symptom onset; ACT availability and displacement of sub-optimal anti-malarial.

Results

At baseline, ACT accounted for less than 1% of anti-malarials purchased from licensed drug shops for children less than five years old. However, at evaluation, “ACT with a leaf” accounted for 69% of anti-malarial purchased in the interventions districts. Purchase of ACT within 24 hours of symptom onset for children under five years rose from 0.8% at baseline to 26.2% (95% CI: 23.2-29.2%) at evaluation in the intervention districts. In the control district, it rose modestly from 1.8% to 5.6% (95% CI: 4.0-7.3%). The odds of purchasing ACT within 24 hours in the intervention districts compared to the control was 0.46 (95% CI: 0.08-2.68, p=0.4) at baseline and significant increased to 6.11 (95% CI: 4.32-8.62, p<0.0001) at evaluation. Children less than five years of age had “ACT with a leaf” purchased for them more often than those aged above five years. There was no evidence of price gouging.

Conclusions

These data demonstrate that a supply-side subsidy and an intensive communications campaign significantly increased the uptake and use of ACT in the private sector in Uganda.

Keywords:
Falciparum malaria; Artemisinin-based combination therapy; Subsidized medicines; “ACT with a leaf”; Private sector; Affordable medicines facility- malaria; Uganda