"Saving Lives and Buying Time": Lessons in good subsidy design from the Affordable Medicines Facility - malaria (AMFm)

Malaria is one of the world's leading health problems. In 2008, an estimated 243 million people fell sick, and nearly 900,000 people died from the disease, 85 per cent of them children under five years of age. In response, over the last 15 years, the global health community has ramped up its fight against malaria. But the arsenal of options to treat the disease has declined over time, as old treatments have become increasingly ineffective due to growing resistance by malaria parasites.

In 2004 the Institute of Medicine published a report that called for subsidization of treatments that are more effective ("saving lives") and stave off resistance to the active ingredient ("buying time"). A rigorous process ensued to establish a well-designed subsidy scheme: the Affordable Medicines Facility - malaria (AMFm).

This policy brief draws lessons from the process of establishing the AMFm and provides recommendations for policy-makers on the elements of good subsidy design, including analysis and research, stakeholder consultations, supporting interventions to mitigate risks and unintended consequences, and a mechanism for monitoring and evaluation.