Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.

<h4>Background</h4>The Affordable Medicines Facility-malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale pro...

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Autores principales:	Rebecca Thomson, Charles Festo, Boniface Johanes, Admirabilis Kalolella, Katia Bruxvoort, Happy Nchimbi, Sarah Tougher, Matthew Cairns, Mark Taylor, Immo Kleinschmidt, Yazoume Ye, Andrea Mann, Ruilin Ren, Barbara Willey, Fred Arnold, Kara Hanson, S Patrick Kachur, Catherine Goodman
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/69a591e1c2444a26b288d71e3776ae93
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spelling	oai:doaj.org-article:69a591e1c2444a26b288d71e3776ae932021-11-18T08:20:00ZHas Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.1932-620310.1371/journal.pone.0095607https://doaj.org/article/69a591e1c2444a26b288d71e3776ae932014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24816649/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The Affordable Medicines Facility-malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side.<h4>Methods</h4>Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks.<h4>Results</h4>The availability of QAACTs increased from 25.5% to 69.5% among all outlet types, with the greatest increase among pharmacies and drug stores, together termed specialised drug sellers (SDSs), where the median QAACT price fell from $5.63 to $0.94. The market share of QAACTs increased from 26.2% to 42.2%, again with the greatest increase in SDSs. Household survey results showed a shift in treatment seeking away from the public sector towards SDSs. Overall, there was no change in the proportion of people with fever obtaining an antimalarial or ACT from baseline to endline. However, when broken down by treatment source, ACT use increased significantly among clients visiting SDSs.<h4>Discussion</h4>Unchanged ACT use overall, despite increases in QAACT availability, affordability and market share in the private sector, reflected a shift in treatment seeking towards private providers. The reasons for this shift are unclear, but likely reflect both persistent stockouts in public facilities, and the increased availability of subsidised ACTs in the private sector.Rebecca ThomsonCharles FestoBoniface JohanesAdmirabilis KalolellaKatia BruxvoortHappy NchimbiSarah TougherMatthew CairnsMark TaylorImmo KleinschmidtYazoume YeAndrea MannRuilin RenBarbara WilleyFred ArnoldKara HansonS Patrick KachurCatherine GoodmanPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 5, p e95607 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Rebecca Thomson Charles Festo Boniface Johanes Admirabilis Kalolella Katia Bruxvoort Happy Nchimbi Sarah Tougher Matthew Cairns Mark Taylor Immo Kleinschmidt Yazoume Ye Andrea Mann Ruilin Ren Barbara Willey Fred Arnold Kara Hanson S Patrick Kachur Catherine Goodman Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
description	<h4>Background</h4>The Affordable Medicines Facility-malaria (AMFm) is primarily an artemisinin combination therapy (ACT) subsidy, aimed at increasing availability, affordability, market share and use of quality-assured ACTs (QAACTs). Mainland Tanzania was one of eight national scale programmes where AMFm was introduced in 2010. Here we present findings from outlet and household surveys before and after AMFm implementation to evaluate its impact from both the supply and demand side.<h4>Methods</h4>Outlet surveys were conducted in 49 randomly selected wards throughout mainland Tanzania in 2010 and 2011, and data on outlet characteristics and stocking patterns were collected from outlets stocking antimalarials. Household surveys were conducted in 240 randomly selected enumeration areas in three regions in 2010 and 2012. Questions about treatment seeking for fever and drugs obtained were asked of individuals reporting fever in the previous two weeks.<h4>Results</h4>The availability of QAACTs increased from 25.5% to 69.5% among all outlet types, with the greatest increase among pharmacies and drug stores, together termed specialised drug sellers (SDSs), where the median QAACT price fell from $5.63 to $0.94. The market share of QAACTs increased from 26.2% to 42.2%, again with the greatest increase in SDSs. Household survey results showed a shift in treatment seeking away from the public sector towards SDSs. Overall, there was no change in the proportion of people with fever obtaining an antimalarial or ACT from baseline to endline. However, when broken down by treatment source, ACT use increased significantly among clients visiting SDSs.<h4>Discussion</h4>Unchanged ACT use overall, despite increases in QAACT availability, affordability and market share in the private sector, reflected a shift in treatment seeking towards private providers. The reasons for this shift are unclear, but likely reflect both persistent stockouts in public facilities, and the increased availability of subsidised ACTs in the private sector.
format	article
author	Rebecca Thomson Charles Festo Boniface Johanes Admirabilis Kalolella Katia Bruxvoort Happy Nchimbi Sarah Tougher Matthew Cairns Mark Taylor Immo Kleinschmidt Yazoume Ye Andrea Mann Ruilin Ren Barbara Willey Fred Arnold Kara Hanson S Patrick Kachur Catherine Goodman
author_facet	Rebecca Thomson Charles Festo Boniface Johanes Admirabilis Kalolella Katia Bruxvoort Happy Nchimbi Sarah Tougher Matthew Cairns Mark Taylor Immo Kleinschmidt Yazoume Ye Andrea Mann Ruilin Ren Barbara Willey Fred Arnold Kara Hanson S Patrick Kachur Catherine Goodman
author_sort	Rebecca Thomson
title	Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
title_short	Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
title_full	Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
title_fullStr	Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
title_full_unstemmed	Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.
title_sort	has tanzania embraced the green leaf? results from outlet and household surveys before and after implementation of the affordable medicines facility-malaria.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/69a591e1c2444a26b288d71e3776ae93
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Has Tanzania embraced the green leaf? Results from outlet and household surveys before and after implementation of the Affordable Medicines Facility-malaria.

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