Background Affordable medicines facility-malaria (AMFm) program and subsequently Co-payment mechanism were developed to help increase access to quality assured Artemisinin Combination Therapies (ACTs) in seven countries in sub-Saharan Africa. We explored through a qualitative study, experience of healthcare personnel on Co-payment mechanism and the implication on access and availability of ACTs in private drug outlets in Uganda.

Methods In each drug outlet, data was collected from pharmacists through key informant interview. The interview covered, (i) awareness of the co-payment mechanism, (ii) Knowledge of quality assured artemisinin combination therapies (QAACT), (iii) stocking of QAACTs, (iv) dispensing price of QAACTs), and (v) determinants of dispensing price of QAACTs. Data was managed using Atlas.ti and analysed using framework methodology.

Results From 25 key informant interviews, five themes emerged, (i) considerations taken while stocking antimalarial agents, (ii) access and purchasing behaviour of clients, (iii) antimalarial dispensing, (iv) awareness of QAACT, and (v) awareness of Co-payment mechanism. None of the respondents was aware of Co-payment mechanism and QAACT (green leaf ACT). Duocotecin brand of ACTs (non-QAACT) was the most stocked antimalarial agent. Every seven in ten drug outlet clients request to purchase ACTs without a prescription and preferred buying cheaper brands. Drug outlets stocked and sold both ACT and non-ACT antimalarial agents. Most drug outlet clients cannot afford buying a full dose of an ACT. None of the respondents considered using Co-payment mechanism while stocking ACTs.

Conclusion There is lack of awareness of Co-payment mechanism and QAACT among pharmacists. There was reportedly no difference in the dispensing price between QAACT and non-QAACT. The dispensing of less than a full dose of ACTs to drug outlet clients is a common practice. The Ministry of Health needs to create awareness through public campaigns on the Co-payment mechanism in the country.