Measuring the AMFm

Richard Tren & Kimberly Hess | 04 Mar 2011
The Lancet
In discussing measurement of the effectiveness of the Affordable Medicines Facility—malaria (AMFm), Olusoji Adeyi and Rifat Atun (Nov 27, p 1869)1 claim that "Expectations of attributable and rapid increases in measures of service delivery at the household level, which are neither new nor unique to AMFm, are inappropriate and unrealistic within the duration of the pilot studies." This statement conflicts with Global Fund Board decisions which call for clear evidence within the pilot phase that AMFm will achieve its four stated objectives: "(i) increased [artemisinin-based combination treatment (ACT)] affordability,(ii) increased ACT availability, (iii) increased ACT use, including among vulnerable groups, and (iv) 'crowding out' oral artemisinin monotherapies, chloroquine and sulfadoxine-pyrimethamine by gaining market share."2

The Board specified that these objectives should be achieved more cost-effectively than other financing models designed to achieve the same goals through the public sector, and noted that it could consider extending the pilot phase, if necessary. The representative for developed-country non-governmental organisations tothe Global Fund's AMFm Ad Hoc Committee asserted that failure to improve access to ACTs among the poorest and remote populations must be regarded as a "red flag" issue.3

The AMFm holds promise, but by seemingly going against Global Fund Board decisions, Adeyi and Atun appear to position it as continuing irrespective of the evidence. The AMFm has been debated and discussed for several years and is a costly intervention. Its substantial opportunity costs require far more rigorous attention to better measurement and a strict policy of acting on the evidence.

Read the authors' reply here.