The private commercial sector distribution chain for antimalarial drugs in Cambodia - Findings from a rapid survey
Year: 2016
Type: book
Abstract: In November 2008, the Global Fund to Fight AIDS, Tuberculosis and Malaria launched the first phase\nof a new global subsidy on ACT, known as the Affordable Medicines Facility‐malaria (AMFm). The\nprimary objectives of the AMFm are:\n1) To make ACT available and affordable to all patients through both the public and private\nsectors, and \n2) To delay the onset of artemisinin resistance by displacing artemisinin monotherapies from\nthe market.\nThrough a co‐payment applied at the manufacturer level, the AMFm will enable public and private\n(both for profit and not‐for‐profit) suppliers in approved countries to purchase high‐quality ACTs at a\nfraction of current prices. As a result, it is expected that ACT will be sold through private shops at a\nprice similar to that of older and less effective drugs, thereby dramatically increasing patients’\ncapacity to purchase and use ACT. \nThe AMFm has been designed to ensure that primary suppliers – who operate at the top of the\ndistribution chain and are the first point of entry for drugs into the country ‐ maintain any pre‐\nexisting purchasing relationships with manufacturers, and to minimize disruption to the operation of\nthe distribution chain. Gaining a comprehensive understanding of public and private sector ACT\ndistribution channels is therefore needed to ensure successful implementation of the AMFm, and\nultimately to maximize ACT access in each country.\nCambodia is one of the 11 countries eligible to apply for the first phase of the AMFm that will\noperate for 18 months. The AMFm country application form requests a description of the current\ndistribution chain for antimalarials across the public and private sectors. The description will serve as\na key input into the selection and design of supporting interventions to ensure safe and effective\ndistribution of co‐paid ACTs under the AMFm. While there is information available on the public and\nNGO distribution chains, little is currently known and understood about the actors and operations of\nthe private commercial sector distribution chain. \nThe objective of the rapid distribution chain survey was therefore to assist Cambodia in the\ndevelopment of an effective AMFm implementation plan, by providing an understanding of the\ncurrent private commercial sector distribution chain for antimalarials. This report presents the\nfindings of a series of semi‐structured interviews conducted with government officials and private\nimporters and wholesalers of malaria treatment. \nFour private commercial importers were identified to regularly serve the private commercial sector\ndistribution chain for malaria treatment. There was some indication that their number may have\nbeen higher, notably from looking at the range of antimalarial drugs available in the retail market. In\nCambodia, there is no legal distinction between retail and wholesale pharmacies and a total of 1213\nbusinesses are registered to stock pharmaceutical drugs in general. Estimates of the number of\nwholesale pharmacies operating in the distribution chain for malaria treatment were not available at\nII\nthe time of this rapid survey, a knowledge gap that will be addressed by the ACTwatch Supply Chain\nStudy report which is due at the beginning of 2010.\nIn the relatively highly concentrated import market for malaria treatment, each company supplied\nmost provinces, with wide‐reaching and well‐organised distribution and promotion systems. In the\ncapital city, wholesalers always purchased antimalarials from local importers and in turn also served\nthe provincial market. \nWholesale suppliers reported applying between 3% and 45% mark‐up, with importers adding\nsomewhat higher markups than wholesalers in the capital city or provincial towns. This situation\nmight have reflected their limited number as well as the relatively higher distribution and promotion\ncosts they reported facing. Yet in the retail sector where more numerous medicines sellers are\nexpected to operate, mark ups could be higher, ranging from 26% to 88%. \nUptake of co‐paid ACT was discussed with respondents who all welcomed the AMFm initiative.\nBarriers to the distribution of ACT have also been identified, mainly around the regulatory\nenvironment, the costs of distributing and promoting antimalarials and the risk associated with\nentering a relatively small and concentrated antimalarial market reported to be, in some instances,\ndominated by cheaper substandard or counterfeit drugs.
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2556058481