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Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania

Author

Listed:
  • Oliver J Sabot
  • Alex Mwita
  • Justin M Cohen
  • Yahya Ipuge
  • Megumi Gordon
  • David Bishop
  • Moses Odhiambo
  • Lorrayne Ward
  • Catherine Goodman

Abstract

Background: WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. Methods/Principal Findings: Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. Conclusions: A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. Trial Registration: Controlled-Trials.com ISRCTN39125414.

Suggested Citation

  • Oliver J Sabot & Alex Mwita & Justin M Cohen & Yahya Ipuge & Megumi Gordon & David Bishop & Moses Odhiambo & Lorrayne Ward & Catherine Goodman, 2009. "Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania," PLOS ONE, Public Library of Science, vol. 4(9), pages 1-7, September.
    • Handle: RePEc:plo:pone00:0006857
    DOI: 10.1371/journal.pone.0006857
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    References listed on IDEAS

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    1. McCombie, S. C., 1996. "Treatment seeking for malaria: A review of recent research," Social Science & Medicine, Elsevier, vol. 43(6), pages 933-945, September.
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    1. Kristian Schultz Hansen & Siân E Clarke & Sham Lal & Pascal Magnussen & Anthony K Mbonye, 2017. "Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-18, December.
    2. Jessica L Cohen & Prashant Yadav & Corrina Moucheraud & Sarah Alphs & Peter S Larson & Jean Arkedis & Julius Massaga & Oliver Sabot, 2013. "Do Price Subsidies on Artemisinin Combination Therapy for Malaria Increase Household Use?: Evidence from a Repeated Cross-Sectional Study in Remote Regions of Tanzania," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-10, July.
    3. Kamat, Vinay R. & Nyato, Daniel J., 2010. "Soft targets or partners in health? Retail pharmacies and their role in Tanzania's malaria control program," Social Science & Medicine, Elsevier, vol. 71(3), pages 626-633, August.
    4. Saji S Gopalan & Varatharajan Durairaj, 2012. "Addressing Women's Non-Maternal Healthcare Financing in Developing Countries: What Can We Learn from the Experiences of Rural Indian Women?," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-8, January.
    5. Sarah V Kedenge & Beth P Kangwana & Evelyn W Waweru & Andrew J Nyandigisi & Jayesh Pandit & Simon J Brooker & Robert W Snow & Catherine A Goodman, 2013. "Understanding the Impact of Subsidizing Artemisinin-Based Combination Therapies (ACTs) in the Retail Sector – Results from Focus Group Discussions in Rural Kenya," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-10, January.
    6. Sarah Tougher & Kara Hanson & Catherine A. Goodman, 2021. "Does subsidizing the private for‐profit sector benefit the poor? Evidence from national antimalarial subsidies in Nigeria and Uganda," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2510-2530, September.
    7. Brigit Obrist & Iddy Mayumana & Flora Kessy, 2010. "Livelihood, malaria and resilience," Progress in Development Studies, , vol. 10(4), pages 325-343, October.
    8. Jacqueline Fiore, 2017. "The Impact of Subsidized Antimalarials on Treatment Seeking Behavior," Working Papers 1717, Tulane University, Department of Economics, revised Mar 2018.

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