Working to Make Malaria Medicines More Affordable

and Accessible in Uganda

By Dr. Flavia Mpanga Kaggwa, Health Specialist, UNICEF Uganda

Uganda has the third highest burden of malaria in Africa, with an estimated
11.5 million malaria cases in 2008 (Uganda Bureau of Statistics (UBOS),
2009). Malaria is responsible for 21% of under fives deaths and remains the
biggest killer of children. Artemether-Lumefantrine (AL), a very efficacious
Arteminisin Combination Therapy (ACT) is the first-line anti-malarial treat-
ment in Uganda. Although AL is free of charge in the public sector (but is
often stocked out because of erratic funding), it costs between US$6-
US$10per dose for an under five dose in the private sector.

I participated in developing Uganda’s AMFm proposal which was among the

10 proposals which was approved by the GF Board in November 2009. The
Ugandan proposal covers a two-year period with a net contribution of US$
4,270, 305 from the AMFm. The AMFm offers an opportunity for Uganda to
meet its national targets to close the critical “access gap" and make ACTs
more accessible in the private sector and hence contribute to the National
Malaria Control Strategic Plan, the Roll Back Malaria (RBM) 2010 targets for
achieving universal access of key interventions and the 2015 Millennium DR. FLAVIA MPANGA KAGGWA, HEALTH SPECIALIST, UNICEF
Development Goals. The overall AMFm proposal is to contribute to the re- UGANDA. PHOTO: UNICEF/UGDA2009/SEKANDI
duction of malaria mortality and morbidity in Uganda
What is the Malaria situation in Uganda?
What is The Affordable Medicines Facility – malaria (AMFm)?
Uganda has the third highest burden of malaria in Africa, with an
estimated 11.5 million malaria cases in 2008 (Uganda Bureau of
The Affordable Medicines Facility – malaria is an innovative financing
mechanism designed to expand access to the most effective treatment for Statistics (UBOS), 2009). Malaria is responsible for 21% of under
malaria, artemisinin-based combination therapies (ACTs). fives deaths and remains the biggest killer of children. Artemether
-Lumefantrine (AL), a very efficacious Arteminisin Combination
The Affordable Medicines Facility – malaria aims to enable countries to in- Therapy (ACT) is the first-line anti-malarial treatment in Uganda.
crease the provision of affordable ACTs through the public, private and NGO
sectors. This will save lives and reduce the use of less-effective treatments Although AL is free of charge in the public sector (but is often
to which malaria parasites are becoming increasingly resistant. It also aims stocked out because of erratic funding), it costs between US$6-
at reducing the use of artemisinin as a single treatment or monotherapy, US$10per dose for an under five dose in the private sector. A
thereby delaying the onset of resistance to ACTs and preserving their effec- study by WHO et al 2008 showed that over 60% of Ugandans
tiveness. seek anti-malarial treatment in the private sector, where ACTs
are rarely available due to their exorbitant costs.
To achieve this aim, the Global Fund will reduce the manufacturer sales Funding for malaria control in Uganda exceeded US$ 75 million
price of ACTs to public, private and not-for-profit sector buyers. The Global in 2006, supported by the government, the Global Fund, UN
Fund will do this by negotiating a lower price for ACTs and then paying a agencies and other external donors.
large proportion of this directly to manufacturers on behalf of buyers (a buyer
“co-payment”). This means that buyers will only pay approximately US$0.05 Nonetheless, access to ACTs has been severely impaired since
October 2008 up till now due to the freezing of disbursement of
for each course of ACTs. For patients who currently pay for treatment, this is
Global Fund Round 4 Phase 2 funding. The government there-
expected to result in a significant reduction in the price of ACTs from about
US$6-10 per treatment to about US$0.20-0.50. fore applied for the Affordable Medicines Facility to help subsidize
the cost of AL in the private sector from the current US$ 6-10 to
Uganda to get funding from the Affordable Medicines’ Facility For ma- US$ 0.25-0.5. The AMFm offers an opportunity for Uganda to
laria (AMFm) meet its national targets to close the critical “access gap" and
make ACTs more accessible in the private sector and hence
In November 2009, the Global Fund Board approved 10 proposals under contribute to the National Malaria Control Strategic Plan, the Roll
Phase 1 of the "Affordable Medicines Facility - Malaria" (AMFm). Uganda’s Back Malaria (RBM) 2010 targets for achieving universal access
proposal was among the 10 proposals which was approved by the GF Board. of key interventions and the 2015 Millennium Development
The Ugandan proposal covers a two-year period. A total of US$ 12, 485, Goals. The overall AMFm proposal is to contribute to the reduc-
998 will be disbursed under the AMFm facility. U$8,214,693.38 of this tion of malaria mortality and morbidity in Uganda.
amount will be re-programmed from Global Fund round 4 resources which
were already approved by the Global Fund Board leaving the net addition of What will be achieved with the AMFm?
US$ 4,270, 305 from the AMFm.
The funding from the AMFm will facilitate an increase in access to
and use of life-saving ACTs for uncomplicated malaria in public
and private health facilities largely funded through Global Fund
Round 4 by:

Making effective and affordable anti-malarials accessible to

VILLAGE HEALTH TEAM (VHT) MEMBERS IN KOTIDO SHOW A WOMAN HOW TO USE
A MOSQUITO NET TO PREVENT MALARIA. PHOTO: UNICEF/UGDA2009/SEKANDI
all, and thereby substituting ineffective drugs. This will be
achieved partly by subsidizing the cost of ACTs in the pri-
vate sector from of US$ 6-10 to US$0.25-0.5 per dose
Ensuring prompt and appropriate health-seeking behavior
for malaria treatment and good compliance with treatment
schedules by providers, patients and caregivers.
Scaling up the training of private sector health care provid-
ers across the country. Private sector clinicians and staff
from licensed drug shops will be trained on the use of ACTs,
the importance of and methods for reporting adverse events,
and procurement and supply management of ACTs.
Creating a supportive environment to facilitate the rapid
scale up of malaria diagnosis using Rapid Diagnostic Tests .