AFRICA: Drug Subsidy Key to Anti-Malaria Effort

  • by Susan Anyangu (nairobi)
  • Inter Press Service

Nine hundred thousand people die worldwide every year as a result of malaria, 90 percent of them in Africa.

A survey done by Population Services International (PSI) and the London School of Hygiene and Tropical Medicine reveals that only three percent of children access effective malaria treatment within 24 hours.

Speaking to IPS at the Fifth Multilateral Initiative on Malaria Pan-African Malaria Conference, Dr Desmond Chavasse, vice president malaria control and child survival at PSI (a global health organisation with programmes targeting malaria, child survival, HIV and reproductive health), equates the lack of access to effective malaria drugs to being tantamount to a death sentence for African children who are under five.

'Artemisinin-based Combination Therapies (ACTs) are currently the most effective form of treatment against malaria and over 80 countries have adopted these as first-line treatment, as recommended by WHO. However, a survey done by PSI and London School of Hygiene and Tropical Medicine reveals that despite being effective, ACTs are not being sold in the market,' Chavasse says.

The stumbling block is simple: the cost of ACT is far beyond the means of a typical family in Sub-Saharan Africa.

'In the last six weeks I have had to send money to my husband three times to buy medicines for our four-year-old son who consistently gets malaria episodes. I am the sole bread winner in my family since my husband is a casual labourer. My family relies on my salary which is 3,500 Kenya shillings (around 46 U.S. dollars) a month and thus going to hospital is simply not an option for us,' Lillian Ngaira recounts with a forlorn look.

And so when Ngaira's son falls sick, they buy medication from a local pharmacy. A little probing reveals that the malaria diagnosis is not based on clinical test, but rather an assumption by Ngaira and her husband.

'The boy always runs a high fever and I know this is malaria. So we rely upon a local chemist where we purchase medicine. A dose for malaria costs approximately 60 Ksh ($0.80),' she recounts.

From Ngaira’s description, the medicine they give their son is not among the recommended ACTs, raising questions about its effectiveness especially if he catches a resistant strain of malaria.

According to Chavasse, Ngaira's case depicts the scenario in most of Sub-Saharan Africa where evidence reveals that mothers go to shops rather than hospitals to buy malaria medicines.

'It is clear majority of people rely on the private sector to access malaria treatment. However, the majority of the funding targeting malaria treatment is directed at the public sector, where only 40 percent seek treatment. Thus it means we have no data on what kind of treatment people are receiving and what this could be doing to them. This poses a serious challenge for the work being done to reduce malaria deaths,' says Dr Peter Olumese, WHO’s global malaria program medical officer.

The cost of a complete dose of ACTs is between six and 11 dollars depending on where one purchases it. For Ngaira's household, meeting all its expenses out of 46 dollars a month, finding $11 to cover one child's treatment is simply not a viable option.

'I understand what you are telling me, that these drugs are effective. But the reality is they are expensive so I will not bother asking for them. There are cheaper alternatives available, and if that is what I can afford, I will buy that to offer my child relief,' Ngaira says.

ACTs may be the most effective medicine at 99.5 percent efficacy, but they account for at most 15 percent of the total volume of anti-malarials in use.

'This is because the ACTs are 10 to 20 percent more expensive in the private sector than the most commonly purchased anti-malarials... which are ineffective. This is encouraging the use of mono-therapy treatment which heightens the likelihood of developing resistance,' says Chavasse.

The effectiveness of ACTs is because the drug contains two different anti-malarials, almost eliminating the possibility of the parasite developing resistance to both at the same time.

To respond to the pricing challenge, the Global Health Fund, with financial support from The Clinton Foundation and Medicines for Malaria Venture, will soon launch a project to subsidize ACTs and make them available through the private sector.

'It is clear that people rely on the private sector to get medicines thus we must find innovative financing to make the effective drugs available at an affordable rate,' says Oliver Sabot, director of the Clinton Foundation's malaria control team.

Two pilot projects in Uganda and Tanzania provide subsidized ACTs through private sector clinics and chemists. The results have shown that a 95 percent subsidy to first-line buyers significantly increases uptake of the ACT, displacing ineffective anti-malarials such as chloroquine.

The Global Health Fund has invited 10 African countries as well as Cambodia to apply to participate in a wider drug subsidy programme. Benin, Niger, Senegal, Nigeria, Ghana, Kenya, Uganda, Tanzania, Rwanda and Madagascar have applied to take part. It remains unclear how many countries will be selected; the announcement will soon be made when the board meets in Addis Ababa Ethiopia in November.

'In a few days, the Global Health Fund board will meet in Addis Ababa where they will announce which countries will be selected to participate in the programme. What will happen is that with funds from partners, the Global Health Fund will direct monies into these countries to subsidize the purchase of ACTs to make them cheaper for the patient,' says Dr Olusoji Adeyi, director of affordable medicines facility, Global Fund.

Under the subsidy programme, the cost of a course of ACTs will fall from 11 dollars to $0.25 cents. And if the results are similar to those in the pilot projects in Uganda and Tanzania, the intention is to seek more funding to expand the coverage of the subsidy programme.

If the price of ACTs is brought down, researches argue the onus will thus be on governments to institute stringent regulatory measures and ban ineffective treatments. Governments will also need to ensure the public sector health facilities always have adequate stock of ACTs.

Chavasse says if made accessible ACTs will provide one of the most important missing links to the fight against malaria.

'Access to ACTs has been the weak link in the fight against malaria. The use of ACTs alongside other malaria preventative measures such as use of insecticide treated mosquito nets and indoor residual spraying will help reduce the disease burden caused by malaria both in children and adults,' Chavasse says.

© Inter Press Service (2009) — All Rights ReservedOriginal source: Inter Press Service