PHM-Exch> The biggest faith-based initiative in the world of malaria: OXFAM

[Claudio Schuftan]

From: AMarriott at oxfam.org.uk

 As part of Oxfam’s work collecting evidence on the role of the public and
private sector in scaling up access to health care in poor countries we have
been closely following the developments of the recently launched Affordable
Medicines Facility for Malaria (AMFm) (http://www.theglobalfund.org/en/amfm/).
Backed by the UK government, the World Bank and the Bill and Melinda Gates
Foundation, AMFm will subsidize the cost of malaria treatment.



Oxfam applauds the overall goal of the AMFm to reduce prices of Artemisinin
Combination Therapies (ACTs). However, we have expressed serious concerns
about the initiative because of its objective to use largely unregulated
shops to deliver the last effective treatment available for malaria. The
sale of drugs through shops risks misdiagnosis and mistreatment. This means
that lives could be put at risk, and it means that families could go without
food to pay for malaria treatment for a child who is actually dying of
pneumonia.



Not only does misdiagnosis risk lives, it also increases the threat of drug
resistance.



The AMFm aims to target poor people but charging poor people for drugs also
risks drug resistant strains of malaria developing and spreading. The world
has already lost chloroquine, which was a very effective and cheap drug,
partly because poor people could not buy a full course of treatment from
shops. We now risk repeating the same story through the AMFm. Already there
is worrying evidence of resistance to ACTs in Cambodia and large-scale
distribution of ACTs through unqualified shopkeepers has been blamed (
http://news.bbc.co.uk/1/hi/world/asia-pacific/8072742.stm).



Charging for drugs also runs counter to the AMFm’s objective to expand
overall access to effective malaria treatment. Poor people cannot afford
treatment, subsidized or not. Recent research by Médecins Sans Frontiéres in
Africa found that numbers of people diagnosed and treated for malaria
significantly increase only when services are provided free of charge (
http://www.msf.org/source/medical/malaria/2008/MSF_malaria_2008.pdf).



Without treatment cerebral malaria can kill a child in just 24 hours.
Urgently expanding access to effective malaria treatment to all children is
a global responsibility. Given this urgency Oxfam questions why more is not
being done to learn from and invest in the proven large scale successes of
expanding access to effective prevention and ACTs through the public sector.
This includes recruiting and training large numbers of community based
health workers to distribute bed nets and to safely diagnose and treat
patients free of charge, in addition to indoor spraying. For instance, this
approach has reduced malaria deaths by a staggering 66% in Zambia over the
last 6 years and halved malaria deaths in Ethiopia in just 3 years (
http://www.who.int/mediacentre/news/releases/2009/malaria_deaths_zambia_20090423/en/index.html

http://www.theglobalfund.org/en/savinglives/ethiopia/ma1/).



Unfortunately although the AMFm initiative is open to supporting pubic
sector distribution, it remains weighted in favour of commercial sales of
ACTs. A requirement for successful country applicants to the AMFm is a focus
on increasing accessibility to ACTs through the private sector. Does this
mean that malaria endemic countries, who lack the capacity to safeguard ACT
delivered by shops, and who choose instead to focus on scaling up to
universal access through the public sector, will be denied support from the
AMFm?



The AMFm is still going ahead without evidence to support the approach it
will take, and despite the fact that this approach is in some respects
contrary to the evidence.  Oxfam agrees with Dr. Bernard Nahlen, the deputy
co-ordinator of the US President’s Malaria Initiative, that the AFMm
constitutes ‘the biggest faith-based initiative in the world of malaria’ (
http://www.nytimes.com/2009/04/18/world/18malaria.html).  We’d like to see
more interventions based on the evidence of what works.
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