Abstract

Increased donated and subsidised medicines for malaria are saving countless lives in Africa, but there is probably increasing theft and diversion of those medicines. The impact of medicine diversion is unknown but potentially dangerous and may bolster criminal networks and increase medicine stock outs (1,2). This study demonstrates that diversion is widespread; diverted subsidised medicines were found in 11 of 14 cities investigated, and in four of those, over half the pharmacies researchers visited had diverted subsidised malaria products.

Introduction

The Affordable Medicines Facility - malaria (AMFm) is a financing mechanism run by the Global Fund to Fight AIDS TB and Malaria (GF). The AMFm is designed to expand access to the best treatments of malaria, artemisininbased combination therapies, or ACTs. AMFm donors subsidise the price of ACTs in the public and private sectors by negotiating a reduced price for ACTs with manufacturers.

Medicines are valuable, portable and widely traded, and this is often done illegally and across national borders.

Donors pay the majority of the reduced price of ACTs to manufacturers, lowering the cost to first-line buyers. Firstline buyers purchase ACTs directly from manufacturers. Since first-line buyers pay a lower price for ACTs, consumers should also pay a lower price, making ACTs more affordable. The AMFm aims to increase the availability and use of ACTs by reducing their cost and thereby driving oral artemisinin monotherapies, which should only be used as part of combination therapies, or poor-quality antimalarial drugs from the market. Additionally, the programme hopes to displace often used, but older and less effective, chloroquine and sulfadoxine-pyrimethamine (SP) treatments by making the more trustworthy ACTs equally affordable for patients (3).

Medicines are valuable, portable and widely traded, and this is often done illegally and across national borders (4,5).

One unintended consequence of all forms of malaria donation and subsidy programmes is an increase in product theft and diversion, which can lead to stock outs (6,7) and other health problems. The aim of this study was to assess

whether AMFm drugs have been stolen and diverted into other markets, since previous studies have shown that diversion of subsidised public sector products was a problem; most notably that in one study 28% of ACTs bought in the private sector had been stolen from the public sector (8).

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Roger Bate is the Legatum Fellow in Global Prosperity at AEI. 

Julissa Milligan is a research assistant at AEI.