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The Affordable Medicines Facility-malaria (AMFm) is a financing mechanism intended to expand access to affordable and effective antimalarial medication (artemisinin-based combination therapies, ACTs). It works primarily through the commercial private sector, in addition to the public and non-governmental organization sectors which are the more traditional routes for development assistance in malaria control. Its goal is to drive down the price of the most effective malaria medicines so that millions of people can afford to buy them. The program has been called "one of the most important recent advances in fighting malaria" and "a triumph of international cooperation."〔 The AMFm is hosted and managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria in Geneva, Switzerland.〔(【引用サイトリンク】url=http://www.theglobalfund.org/en/amfm )〕 The premise of the AMFm is that a factory-gate global subsidy, with measures to support its implementation, will save lives and reduce malaria-related mortality by increasing access to ACTs, and delay the onset of widespread resistance to the artemisinin in ACTs. It includes three elements: (i) price reductions through negotiations with ACT manufacturers, (ii) a buyer subsidy through a 'co-payment' at the top of the global supply chain and (iii) supporting interventions at the country level to promote the appropriate use of ACTs. AMFm Phase 1 was formally launched in April 2009〔 and began operations in July 2010.〔(【引用サイトリンク】url=http://www.theglobalfund.org/documents/amfm/AMFm_AffordableMedicinesFacilityMalaria_FAQ_en )〕 AMFm Phase 1 is being implemented through nine pilot programs in eight countries: Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar) and Uganda.〔 There are early signs AMFm Phase 1 is effectively increasing availability and decreasing prices of ACTs; however the Global Fund Board will only take a decision on the future of AMFm at the end of 2012 on the basis of an independent evaluation.〔 As part of the Copenhagen Consensus 2012, a panel of leading economists concluded that the AMFm was "one of the best returns on health that could be made globally" and ranked it two of 16 priority solutions to advance global welfare.〔(【引用サイトリンク】url=http://www.copenhagenconsensus.com/Projects/CC12/Outcome.aspx )〕 In November 2012 the Global Fund Board decided to modify the existing AMFm business line by integrating lessons learned from Phase 1 into Global Fund core grant management and financial processes. The AMFm was subsequently renamed the Private Sector Co-payment Mechanism. ==Background== Malaria is a life-threatening disease caused by parasites that are transmitted to humans through the bites of infected mosquitoes. ''Plasmodium falciparum'' is the species of the malaria parasite that causes the vast majority of severe disease and death. In 2010, there were about 216 million cases of malaria globally, and about 655,000 deaths – mostly among children in Africa.〔(【引用サイトリンク】url=http://www.who.int/malaria/world_malaria_report_2011/en/ )〕 Yet, malaria is preventable and treatable. The most effective treatment for malaria are ACTs which combine artemisinin with another antimalarial medication.〔(【引用サイトリンク】url=http://www.rbm.who.int/cmc_upload/0/000/015/364/RBMInfosheet_9.htm )〕 ACTs are recommended by the World Health Organization (WHO) as first-line treatment for uncomplicated ''P. falciparum'' malaria and, in 2004, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest global funding source for malaria control,〔(【引用サイトリンク】url=http://www.fightingmalaria.org/issues.aspx?issue=34 )〕 began reprogramming all approved grants to procure ACTs in areas with high levels of drug resistance. However, ACTs account for only one in five antimalarial treatments taken and, until the advent of the Affordable Medicines Facility-malaria (AMFm), were provided almost entirely by the public sector. Over 60 percent of patients in malaria endemic areas access anti-malarial treatment through the private sector but, before the AMFm, the private sector only accounted for about 5 percent of all ACTs provided.〔 ACTs are more expensive than the less-effective first-line malaria treatments, such as chloroquine (CQ), sulfadoxine/pyrimethamine (SP) and amodiaquine (AQ), which usually cost less than US$1.〔(【引用サイトリンク】url=http://www.actwatch.info/results/overview.asp )〕 Therefore, unsubsidized, quality-assured ACTs are not affordable by many of the people who need them in malaria-endemic countries. This leads to avoidable complications or death, since people either do not receive treatment or use cheaper, less effective antimalarials. Further, if patients use artemisinin monotherapies, this increases the risk of widespread resistance to artemisinin. The challenges noted above have been compounded by a mismatch between country realities and the channels through which ACTs financed by development aid were routed.〔 Whereas the commercial private sector plays a significant, sometimes dominant, role in many countries, donor-funded ACTs have been traditionally channeled mostly through the public sector and not-for-profit private sector. These factors, combined with an insufficiency of ACTs relative to the burden of malaria, resulted in poor access to ACTs at country level and persistent use of inappropriate alternatives.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Affordable Medicines Facility-malaria」の詳細全文を読む スポンサード リンク
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