Improving access to malaria medicine through private-sector subsidies in seven African countries.
Identifieur interne : 000913 ( PubMed/Corpus ); précédent : 000912; suivant : 000914Improving access to malaria medicine through private-sector subsidies in seven African countries.
Auteurs : Sarah Tougher ; Andrea G. Mann ; Yazoume Ye ; Idrissa A. Kourgueni ; Rebecca Thomson ; John H. Amuasi ; Ruilin Ren ; Barbara A. Willey ; Daniel Ansong ; Katia Bruxvoort ; Graciela Diap ; Charles Festo ; Boniface Johanes ; Admirabilis Kalolella ; Oumarou Mallam ; Blessing Mberu ; Salif Ndiaye ; Samual Blay Nguah ; Moctar Seydou ; Mark Taylor ; Marilyn Wamukoya ; Fred Arnold ; Kara Hanson ; Catherine GoodmanSource :
- Health affairs (Project Hope) [ 1544-5208 ] ; 2014.
English descriptors
- KwdEn :
- Africa, Antimalarials (economics), Antimalarials (supply & distribution), Artemisinins (economics), Artemisinins (supply & distribution), Cluster Analysis, Commerce (economics), Developing Countries, Drug Resistance, Health Services Accessibility, Humans, Malaria (drug therapy), Quality Improvement.
- MESH :
- chemical , economics : Antimalarials, Artemisinins.
- chemical , supply & distribution : Antimalarials, Artemisinins.
- geographic : Africa.
- drug therapy : Malaria.
- economics : Commerce.
- Cluster Analysis, Developing Countries, Drug Resistance, Health Services Accessibility, Humans, Quality Improvement.
Abstract
Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.
DOI: 10.1377/hlthaff.2014.0104
PubMed: 25201662
Links to Exploration step
pubmed:25201662Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Improving access to malaria medicine through private-sector subsidies in seven African countries.</title><author><name sortKey="Tougher, Sarah" sort="Tougher, Sarah" uniqKey="Tougher S" first="Sarah" last="Tougher">Sarah Tougher</name><affiliation><nlm:affiliation>Sarah Tougher (Sarah.Tougher@lshtm.ac.uk) is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Mann, Andrea G" sort="Mann, Andrea G" uniqKey="Mann A" first="Andrea G" last="Mann">Andrea G. Mann</name><affiliation><nlm:affiliation>Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Ye, Yazoume" sort="Ye, Yazoume" uniqKey="Ye Y" first="Yazoume" last="Ye">Yazoume Ye</name><affiliation><nlm:affiliation>Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Kourgueni, Idrissa A" sort="Kourgueni, Idrissa A" uniqKey="Kourgueni I" first="Idrissa A" last="Kourgueni">Idrissa A. Kourgueni</name><affiliation><nlm:affiliation>Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Thomson, Rebecca" sort="Thomson, Rebecca" uniqKey="Thomson R" first="Rebecca" last="Thomson">Rebecca Thomson</name><affiliation><nlm:affiliation>Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Amuasi, John H" sort="Amuasi, John H" uniqKey="Amuasi J" first="John H" last="Amuasi">John H. Amuasi</name><affiliation><nlm:affiliation>John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana.</nlm:affiliation></affiliation></author><author><name sortKey="Ren, Ruilin" sort="Ren, Ruilin" uniqKey="Ren R" first="Ruilin" last="Ren">Ruilin Ren</name><affiliation><nlm:affiliation>Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Willey, Barbara A" sort="Willey, Barbara A" uniqKey="Willey B" first="Barbara A" last="Willey">Barbara A. Willey</name><affiliation><nlm:affiliation>Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Ansong, Daniel" sort="Ansong, Daniel" uniqKey="Ansong D" first="Daniel" last="Ansong">Daniel Ansong</name><affiliation><nlm:affiliation>Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH.</nlm:affiliation></affiliation></author><author><name sortKey="Bruxvoort, Katia" sort="Bruxvoort, Katia" uniqKey="Bruxvoort K" first="Katia" last="Bruxvoort">Katia Bruxvoort</name><affiliation><nlm:affiliation>Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Diap, Graciela" sort="Diap, Graciela" uniqKey="Diap G" first="Graciela" last="Diap">Graciela Diap</name><affiliation><nlm:affiliation>Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Festo, Charles" sort="Festo, Charles" uniqKey="Festo C" first="Charles" last="Festo">Charles Festo</name><affiliation><nlm:affiliation>Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania.</nlm:affiliation></affiliation></author><author><name sortKey="Johanes, Boniface" sort="Johanes, Boniface" uniqKey="Johanes B" first="Boniface" last="Johanes">Boniface Johanes</name><affiliation><nlm:affiliation>Boniface Johanes is a researcher at the Ifakara Health Institute.</nlm:affiliation></affiliation></author><author><name sortKey="Kalolella, Admirabilis" sort="Kalolella, Admirabilis" uniqKey="Kalolella A" first="Admirabilis" last="Kalolella">Admirabilis Kalolella</name><affiliation><nlm:affiliation>Admirabilis Kalolella a researcher at the Ifakara Health Institute.</nlm:affiliation></affiliation></author><author><name sortKey="Mallam, Oumarou" sort="Mallam, Oumarou" uniqKey="Mallam O" first="Oumarou" last="Mallam">Oumarou Mallam</name><affiliation><nlm:affiliation>Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Mberu, Blessing" sort="Mberu, Blessing" uniqKey="Mberu B" first="Blessing" last="Mberu">Blessing Mberu</name><affiliation><nlm:affiliation>Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Ndiaye, Salif" sort="Ndiaye, Salif" uniqKey="Ndiaye S" first="Salif" last="Ndiaye">Salif Ndiaye</name><affiliation><nlm:affiliation>Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal.</nlm:affiliation></affiliation></author><author><name sortKey="Nguah, Samual Blay" sort="Nguah, Samual Blay" uniqKey="Nguah S" first="Samual Blay" last="Nguah">Samual Blay Nguah</name><affiliation><nlm:affiliation>Samual Blay Nguah is a researcher at the research and development unit at KATH.</nlm:affiliation></affiliation></author><author><name sortKey="Seydou, Moctar" sort="Seydou, Moctar" uniqKey="Seydou M" first="Moctar" last="Seydou">Moctar Seydou</name><affiliation><nlm:affiliation>Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Taylor, Mark" sort="Taylor, Mark" uniqKey="Taylor M" first="Mark" last="Taylor">Mark Taylor</name><affiliation><nlm:affiliation>Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia.</nlm:affiliation></affiliation></author><author><name sortKey="Wamukoya, Marilyn" sort="Wamukoya, Marilyn" uniqKey="Wamukoya M" first="Marilyn" last="Wamukoya">Marilyn Wamukoya</name><affiliation><nlm:affiliation>Marilyn Wamukoya is a researcher at APHRC.</nlm:affiliation></affiliation></author><author><name sortKey="Arnold, Fred" sort="Arnold, Fred" uniqKey="Arnold F" first="Fred" last="Arnold">Fred Arnold</name><affiliation><nlm:affiliation>Fred Arnold is a senior fellow at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Hanson, Kara" sort="Hanson, Kara" uniqKey="Hanson K" first="Kara" last="Hanson">Kara Hanson</name><affiliation><nlm:affiliation>Kara Hanson is a professor of health systems economics and head of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Goodman, Catherine" sort="Goodman, Catherine" uniqKey="Goodman C" first="Catherine" last="Goodman">Catherine Goodman</name><affiliation><nlm:affiliation>Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:25201662</idno><idno type="pmid">25201662</idno><idno type="doi">10.1377/hlthaff.2014.0104</idno><idno type="wicri:Area/PubMed/Corpus">000913</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000913</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Improving access to malaria medicine through private-sector subsidies in seven African countries.</title><author><name sortKey="Tougher, Sarah" sort="Tougher, Sarah" uniqKey="Tougher S" first="Sarah" last="Tougher">Sarah Tougher</name><affiliation><nlm:affiliation>Sarah Tougher (Sarah.Tougher@lshtm.ac.uk) is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom.</nlm:affiliation></affiliation></author><author><name sortKey="Mann, Andrea G" sort="Mann, Andrea G" uniqKey="Mann A" first="Andrea G" last="Mann">Andrea G. Mann</name><affiliation><nlm:affiliation>Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Ye, Yazoume" sort="Ye, Yazoume" uniqKey="Ye Y" first="Yazoume" last="Ye">Yazoume Ye</name><affiliation><nlm:affiliation>Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Kourgueni, Idrissa A" sort="Kourgueni, Idrissa A" uniqKey="Kourgueni I" first="Idrissa A" last="Kourgueni">Idrissa A. Kourgueni</name><affiliation><nlm:affiliation>Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Thomson, Rebecca" sort="Thomson, Rebecca" uniqKey="Thomson R" first="Rebecca" last="Thomson">Rebecca Thomson</name><affiliation><nlm:affiliation>Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Amuasi, John H" sort="Amuasi, John H" uniqKey="Amuasi J" first="John H" last="Amuasi">John H. Amuasi</name><affiliation><nlm:affiliation>John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana.</nlm:affiliation></affiliation></author><author><name sortKey="Ren, Ruilin" sort="Ren, Ruilin" uniqKey="Ren R" first="Ruilin" last="Ren">Ruilin Ren</name><affiliation><nlm:affiliation>Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Willey, Barbara A" sort="Willey, Barbara A" uniqKey="Willey B" first="Barbara A" last="Willey">Barbara A. Willey</name><affiliation><nlm:affiliation>Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Ansong, Daniel" sort="Ansong, Daniel" uniqKey="Ansong D" first="Daniel" last="Ansong">Daniel Ansong</name><affiliation><nlm:affiliation>Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH.</nlm:affiliation></affiliation></author><author><name sortKey="Bruxvoort, Katia" sort="Bruxvoort, Katia" uniqKey="Bruxvoort K" first="Katia" last="Bruxvoort">Katia Bruxvoort</name><affiliation><nlm:affiliation>Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Diap, Graciela" sort="Diap, Graciela" uniqKey="Diap G" first="Graciela" last="Diap">Graciela Diap</name><affiliation><nlm:affiliation>Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland.</nlm:affiliation></affiliation></author><author><name sortKey="Festo, Charles" sort="Festo, Charles" uniqKey="Festo C" first="Charles" last="Festo">Charles Festo</name><affiliation><nlm:affiliation>Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania.</nlm:affiliation></affiliation></author><author><name sortKey="Johanes, Boniface" sort="Johanes, Boniface" uniqKey="Johanes B" first="Boniface" last="Johanes">Boniface Johanes</name><affiliation><nlm:affiliation>Boniface Johanes is a researcher at the Ifakara Health Institute.</nlm:affiliation></affiliation></author><author><name sortKey="Kalolella, Admirabilis" sort="Kalolella, Admirabilis" uniqKey="Kalolella A" first="Admirabilis" last="Kalolella">Admirabilis Kalolella</name><affiliation><nlm:affiliation>Admirabilis Kalolella a researcher at the Ifakara Health Institute.</nlm:affiliation></affiliation></author><author><name sortKey="Mallam, Oumarou" sort="Mallam, Oumarou" uniqKey="Mallam O" first="Oumarou" last="Mallam">Oumarou Mallam</name><affiliation><nlm:affiliation>Oumarou Mallam is head of central services at the Institut National de la Statistique du Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Mberu, Blessing" sort="Mberu, Blessing" uniqKey="Mberu B" first="Blessing" last="Mberu">Blessing Mberu</name><affiliation><nlm:affiliation>Blessing Mberu is a research scientist at the African Population and Health Research Centre (APHRC), in Nairobi, Kenya.</nlm:affiliation></affiliation></author><author><name sortKey="Ndiaye, Salif" sort="Ndiaye, Salif" uniqKey="Ndiaye S" first="Salif" last="Ndiaye">Salif Ndiaye</name><affiliation><nlm:affiliation>Salif Ndiaye is director of the Centre de Recherche pour le Développment Humain, in Dakar, Senegal.</nlm:affiliation></affiliation></author><author><name sortKey="Nguah, Samual Blay" sort="Nguah, Samual Blay" uniqKey="Nguah S" first="Samual Blay" last="Nguah">Samual Blay Nguah</name><affiliation><nlm:affiliation>Samual Blay Nguah is a researcher at the research and development unit at KATH.</nlm:affiliation></affiliation></author><author><name sortKey="Seydou, Moctar" sort="Seydou, Moctar" uniqKey="Seydou M" first="Moctar" last="Seydou">Moctar Seydou</name><affiliation><nlm:affiliation>Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger.</nlm:affiliation></affiliation></author><author><name sortKey="Taylor, Mark" sort="Taylor, Mark" uniqKey="Taylor M" first="Mark" last="Taylor">Mark Taylor</name><affiliation><nlm:affiliation>Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia.</nlm:affiliation></affiliation></author><author><name sortKey="Wamukoya, Marilyn" sort="Wamukoya, Marilyn" uniqKey="Wamukoya M" first="Marilyn" last="Wamukoya">Marilyn Wamukoya</name><affiliation><nlm:affiliation>Marilyn Wamukoya is a researcher at APHRC.</nlm:affiliation></affiliation></author><author><name sortKey="Arnold, Fred" sort="Arnold, Fred" uniqKey="Arnold F" first="Fred" last="Arnold">Fred Arnold</name><affiliation><nlm:affiliation>Fred Arnold is a senior fellow at ICF International in Rockville, Maryland.</nlm:affiliation></affiliation></author><author><name sortKey="Hanson, Kara" sort="Hanson, Kara" uniqKey="Hanson K" first="Kara" last="Hanson">Kara Hanson</name><affiliation><nlm:affiliation>Kara Hanson is a professor of health systems economics and head of the Department of Global Health and Development at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author><author><name sortKey="Goodman, Catherine" sort="Goodman, Catherine" uniqKey="Goodman C" first="Catherine" last="Goodman">Catherine Goodman</name><affiliation><nlm:affiliation>Catherine Goodman is a senior lecturer in health economics and policy at the London School of Hygiene and Tropical Medicine.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Health affairs (Project Hope)</title><idno type="eISSN">1544-5208</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Africa</term><term>Antimalarials (economics)</term><term>Antimalarials (supply & distribution)</term><term>Artemisinins (economics)</term><term>Artemisinins (supply & distribution)</term><term>Cluster Analysis</term><term>Commerce (economics)</term><term>Developing Countries</term><term>Drug Resistance</term><term>Health Services Accessibility</term><term>Humans</term><term>Malaria (drug therapy)</term><term>Quality Improvement</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Antimalarials</term><term>Artemisinins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="supply & distribution" xml:lang="en"><term>Antimalarials</term><term>Artemisinins</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Africa</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Malaria</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Commerce</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Cluster Analysis</term><term>Developing Countries</term><term>Drug Resistance</term><term>Health Services Accessibility</term><term>Humans</term><term>Quality Improvement</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">25201662</PMID><DateCreated><Year>2014</Year><Month>09</Month><Day>09</Day></DateCreated><DateCompleted><Year>2016</Year><Month>09</Month><Day>08</Day></DateCompleted><DateRevised><Year>2014</Year><Month>09</Month><Day>09</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1544-5208</ISSN><JournalIssue CitedMedium="Internet"><Volume>33</Volume><Issue>9</Issue><PubDate><Year>2014</Year><Month>Sep</Month></PubDate></JournalIssue><Title>Health affairs (Project Hope)</Title><ISOAbbreviation>Health Aff (Millwood)</ISOAbbreviation></Journal><ArticleTitle>Improving access to malaria medicine through private-sector subsidies in seven African countries.</ArticleTitle><Pagination><MedlinePgn>1576-85</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1377/hlthaff.2014.0104</ELocationID><Abstract><AbstractText>Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers.</AbstractText><CopyrightInformation>Project HOPE—The People-to-People Health Foundation, Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Tougher</LastName><ForeName>Sarah</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Sarah Tougher (Sarah.Tougher@lshtm.ac.uk) is a research fellow in the Department of Global Health and Development, London School of Hygiene and Tropical Medicine, in the United Kingdom.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mann</LastName><ForeName>Andrea G</ForeName><Initials>AG</Initials><AffiliationInfo><Affiliation>Andrea G. Mann is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><CollectiveName>ACTwatch Group</CollectiveName></Author><Author ValidYN="Y"><LastName>Ye</LastName><ForeName>Yazoume</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Yazoume Ye is a fellow and technical director at ICF International in Rockville, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kourgueni</LastName><ForeName>Idrissa A</ForeName><Initials>IA</Initials><AffiliationInfo><Affiliation>Idrissa A. Kourgueni is general director of the Centre International d'Etudes et de Recherches sur les Populations Africaines and of the Institut National de la Statistique de Niger, both in Niamey, Niger.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Thomson</LastName><ForeName>Rebecca</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Rebecca Thomson is a research fellow at the London School of Hygiene and Tropical Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Amuasi</LastName><ForeName>John H</ForeName><Initials>JH</Initials><AffiliationInfo><Affiliation>John H. Amuasi is a doctoral candidate in the School of Public Health, University of Minnesota, in Minneapolis, and a researcher at the Komfo Anokye Teaching Hospital (KATH), in Kumasi, Ghana.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ren</LastName><ForeName>Ruilin</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Ruilin Ren is a senior technical specialist at ICF International in Rockville, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Willey</LastName><ForeName>Barbara A</ForeName><Initials>BA</Initials><AffiliationInfo><Affiliation>Barbara A. Willey is a lecturer in the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ansong</LastName><ForeName>Daniel</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Daniel Ansong is a senior lecturer in the Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, and deputy director of the Research and Development Unit, KATH.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bruxvoort</LastName><ForeName>Katia</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Katia Bruxvoort is a research fellow at the London School of Hygiene and Tropical Medicine.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Diap</LastName><ForeName>Graciela</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Graciela Diap is a medical coordinator at the Drugs for Neglected Diseases initiative, in Geneva, Switzerland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Festo</LastName><ForeName>Charles</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Charles Festo is a researcher at the Ifakara Health Institute, in Dar es Salaam, Tanzania.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Johanes</LastName><ForeName>Boniface</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Boniface Johanes is a researcher at the Ifakara Health Institute.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kalolella</LastName><ForeName>Admirabilis</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Admirabilis Kalolella a researcher at the Ifakara Health Institute.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mallam</LastName><ForeName>Oumarou</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Oumarou Mallam is head of central services at the 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ValidYN="Y"><LastName>Seydou</LastName><ForeName>Moctar</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Moctar Seydou is a specialist statistician at the Institut National de la Statistique du Niger.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Taylor</LastName><ForeName>Mark</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Mark Taylor is a Slovak Academic Information Agency (SAIA)-sponsored public health scholar at the University of Trnava, in Slovakia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wamukoya</LastName><ForeName>Marilyn</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Marilyn Wamukoya is a researcher at APHRC.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Arnold</LastName><ForeName>Fred</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Fred Arnold is a senior fellow at ICF International in Rockville, 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