The Affordable Medicines Facility malaria (AMFm) was aimed at ensuring high quality low cost medicines reached the public and saved lives. Nigeria was one of the biggest challenges for AMFm with having the highest burden of disease of any single country. Unfortunately the vastness of the problem seemed to work against the effort.
Instead of concentrating the resources on a few pilot states of local government areas, as often happens, the project was spread thinly across the nation. There was no way that enough medicine would be provided to treat the large number of cases seen annually in the country. In the states only selected medicine shops received training and supplies. Out-of-stock syndrome was common.
One can find the AMFm logo on empty boxes of medicine as seen in the attached photos from medicine shops. The shop keepers do find the boxes useful for storing other things, and then resort to selling chloroquine to their customers. When will we learn how to conduct pilot programs so that thy actually produce meaningful results and guide future policy decisions?
The AMFm Evaluation Phase 1 Report acknowledges the following among the many factors hindering the AMFm implementation in Nigeria:
- Delayed approval of ACT orders to FLBs
- Inadequate supply of ACTs
- Unstable supply of ACTs
- High transport costs to rural areas
- Inadequate ACT supply pipelines
- Inadequate distribution of ACTs to rural areas
- Re-indication of chloroquine
- Interrupted ACT supplies nationally
- Availability of chloroquine in market
These were certainly issues that could have been addressed with focus on a smaller and more clearly defined pilot area.