Affordable Medicines Facility-malaria (AMFm): Innovative Financing for Better Access

Transcription

1 Affordable Medicines Facility-malaria (AMFm): Innovative Financing for Better Access Medicines For Malaria Venture Stakeholders Meeting, Dar-es-Salaam, 3 June 2011 Olusoji Adeyi, MD, DrPH, MBA Director Affordable Medicines Facility-malaria (AMFm) AMFm MMV Stakeholders Meeting Dar-es-Salaam 3 June 2011

2 Partners in Innovation: Thank You A true public-private partnership : working through all sectors: public, NGOs and private-for-profit Country governments: leadership and commitment RBM Partnership: Leadership, Harmonization Working Group (co-chaired by WHO and CHAI), World Bank, UNICEF, MMV, CDDEP, research & academia Cooperation of ACT manufacturers Cooperation of importers, distributors and retailers Appreciate contributions to the AMFm Co-Payment Fund from: UNITAID, The United Kingdom, and The Bill & Melinda Gates Foundation

3 AMFm - Goals and objectives Goals of the AMFm Contribute to malaria mortality reduction (Saving Lives) Delay resistance to artemisinin (Buying Time) Phase 1 of AMFm is a short-term exercise to demonstrate how well the new business model works and to learn from the pilots Objectives: 1. Increasing affordability of ACTs 2. Increasing availability of ACTs 3. Increasing use of ACTs 4. Crowding out artemisinin monotherapies (AMTs)

4 Rationale: A Tale of 3 Challenges 1. WHO recommends ACTs as 1 st -line treatment for P. falciparum to replace failing CQ and SP, but - ACTs are up to 40 times as expensive as CQ and SP in many places 2. Traditional approaches to development assistance emphasize public sector channels, but the private sector is a dominant source of services in many countries 3. Oral AMTs increase risk of widespread resistance to artemisinin, but they are generally less expensive than quality ACTs and still available in many outlets

5 How does AMFm work? Negotiations with ACT manufacturers Reduce the sales price of ACTs Same price to public and private sector first-line buyers Co-payments to manufacturers to further reduce price of ACTs to first line buyers Under-price AMTs Over time, approach prices of CQ, SP Supporting interventions to ensure safe and effective ACT scale-up Use all sectors: public, private non-profit, private for-profit

6 AMFm Phase 1 ( ) Global Fund Board decision to test AMFm in a first phase 9 pilots in 8 countries Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland), Uganda and Zanzibar AMFm Phase 1 to be assessed by an independent evaluation Global Fund Board to decide on the future of the AMFm as a business line: decision expected in Q4 of 2012

7 Scope of AMFm Phase 1 What it is Innovation in the architecture of financing New approach to development assistance Working with and through all sectors Making the market work for public health Testing how well the basic design works What it is not A new or alternative service delivery mechanism Substitute for govt. clinics or community health workers General primary health care General health system strengthening The solution to all problems in malaria control

8 How is AMFm Phase 1 financed? The AMFm Co-Payment Fund US$ 216 million, funded by contributions from: Bill & Melinda Gates Foundation UNITAID UK (DFID) Supporting Interventions Up to US$ 127 million Funded mainly by the Global Fund Through ACT host grant budget savings made possible through the lower price of ACTs under AMFm

9 All the innovations are working Successful price negotiations Co-payments (~ US$1.07/ treatment on average, incl. freight and insurance) reduced prices to first-line buyers First-line buyers are placing orders through manufacturers The Global Fund is approving eligible orders and making co-payments Countries are implementing their marketing campaigns Co-paid ACTs are on sale in several Phase 1 countries Countries are seeing sharp reductions in retail prices

10 Potential adaptation for RDTs? What is the appropriate financing architecture? What incentives encourage the right decisions? What are the scalable options for financing expanded access in the private sector? Which of these might work faster than others? Which option (or combination) is most suitable? Allocations to diagnostics during Phase 1 CAM GHA KYA MDG NGR NGA TZA UGD ZAN Total US$ 918,000 3,883, ,000 Research only 495,271 14,893,385 4,722, ,489 25,631,203

11 Reach and Richness in RDTs: the Holy Grail? Reach Universal or nearuniversal access Minimal geographic variations Minimal socioeconomic variations Richness Are diagnostic tests used for all suspected cases? Do providers and patients comply with results? When +ve? When ve? (See Cohen et al., 2010) What about non-malarial febrile illnesses?

12 Reach and richness of RDT use in the private sector: inevitable trade-offs in the short-term?. Normative ideal R i c h n e s s Today s reality Reach

13 How long is enough for what? Most importantly, five years is an extraordinarily limited amount of time over which to measure global level outcomes and impact, especially in a new program with a new model. Investments of both new resources and new approaches require time to take root and bear fruit [Source: The Five-Year Evaluation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Synthesis of Study Areas 1, 2 and 3. March 2009].

14 Identifying appropriate comparators Comparisons Effectiveness Cost-effectiveness Financing mechanisms are appropriate comparators? Grants-based mechanism of the Global Fund? US President s Malaria Initiative (PMI)? Booster Program for Malaria Control at the World Bank Service delivery methods alone are not appropriate comparators

15 Comparing like with like and using similar indicators Similar duration of implementation Similar indicators of performance Independence of the evaluator Multi-country scale of operations

16 Direct comparison: which financing model(s) give the best value for money? To estimate and compare the component and total costs (direct and indirect, as well as administrative costs and overheads) of getting an ACT to the end user through alternative channels (public, NGO and for-profit-private), using different financing models, from the perspectives of: The end-user (patient or buyer of ACTs) Governments Donors

17 Global Operations Since mid active First-Line Buyers 122 million courses of treatment ordered About 97% of orders are for fixed-dose combinations 67 million treatments were due to be delivered by end May

18 Country Progress Reports Kenya: to be presented by Kenyan team Ghana: to be presented by Ghanaian team AMFm Status and Interim Lessons Washington DC 8 November 2010

19 Price governs the choices of the poor [Margaret Chan WHO D-G, 2009] For me, one of the most encouraging trends in public health is the power of commitment to unleash the best of human ingenuity. I admire the Affordable Medicines Facility for Malaria initiative as a brilliant innovation. This is the kind of hard-nosed pragmatism that gets results in public health. It looks at the reality of conditions in the developing world, identifies the forces that shape the reality, and then outsmarts them. If price affects access, make the price of the best products competitive, and thus drive ineffective, substandard or counterfeit products off the market.

20 Thank you