PHM-Exch> Malaria, aid and shopkeepers: saving lives or playing with fire?

[Claudio Schuftan]

From: Anna Marriott <amariott at oxfam.org.uk>

Global Health Check has posted a new item, Malaria, aid and shopkeepers:
saving
lives or playing with fire? by Anna Marriott and Dr Mohga Kamal Yanni

On World Malaria Day there is much to celebrate. Today’s UK Guardian cites
malaria control as ‘one of the most notable achievements of international
aid’. Dramatic reductions in malaria deaths from Ethiopia to Zambia have
been
attributed to large scale free prevention, diagnosis and treatment via
trained
health workers. But the Global Fund for HIV, TB and Malaria, one of the
major
vehicles responsible for delivering these approaches and capable of further
scale up, now faces a severe financial crisis. Meanwhile some donors are
making
the choice to invest more precious aid resources into a different unproven
and
risky scheme – the Affordable Medicine Facility for malaria (AMFm).

Recently the UK and Canadian governments as well as UNITAID decided to
inject
more funding into AMFm which actively promotes the sale of the only
effective
treatment left for malaria (Artemisinin Combination Therapy or ACT) via
unqualified shopkeepers. Not only does this go against WHO guidelines that
say
malaria must be diagnosed, it also risks lives because:

Paying for treatment excludes poor people. Inability to pay for a full
course
renders patients vulnerable to buying an incomplete course of treatment or
going
without treatment altogether
Using unqualified shopkeepers to deliver medicines creates a real danger of
widespread misdiagnosis and mistreatment. If shopkeepers treat all fevers as
malaria other killer diseases are missed and the already alarming detection
of
drug resistance to malaria treatment grows
Even when shopkeepers have access to Rapid Diagnostic Tests (RDTs), poor
people
cannot afford to pay for the test and there is no provision to treat people
who
test negative for malaria
Last year, uncontrolled ordering by AMFm buyers also threatened to
destabilise
the market for Artemisinin Combination Therapy (ACTs) and led to a funding
gap
in the AMFm of $120m. For example, buyers in Zanzibar, a country where
malaria
has almost been eliminated, have ordered over 240,000 treatments when the
number
of malaria cases is around 10,000 per year. These cases of unnecessary
over-ordering constitute a massive waste of aid.

The AMFm experiment presents a great risk of repeating the sad story of
chloroquine – an effective drug rendered useless in Africa because of
resistance. Despite being cheap, poor people could not afford a full
treatment
course allowing resistance to develop. A few years ago the first cases of
resistance to ACTs were identified along the Thai-Cambodia border – where
resistance to chloroquine first emerged. Alarmingly, recent research has
found
more cases of ACT resistance on the Thai-Burmese border.

The threat of growing resistance to ACT cannot be taken lightly and
containing
it must be a global priority if the world is to avoid losing the battle
against
the malaria parasite. As well as specific measures in the regions affected,
that
means using aid to scale up proven approaches of diagnosing and treating
patients free of charge via trained community health workers or primary
health
care units. Instead, with donor support, UNITAID (the international drug
purchasing facility) has made the recent decision to invest $34 million
over 3
years in the sale of RDTs by shopkeepers. The decision could result in RDTs
flooding the private-sector market without prescribers being qualified to
use
the tests, without the drugs necessarily there to accompany them, and
without
addressing the treatment of those who test negative for malaria.

Supporting the AMFm is not only a risk to public health it is also a waste
of
precious resources. With donors including the UK government ever more
focussed
on ‘results’ it makes sense to rethink support for the AMFm and instead
focus limited aid resources on scaling up evidence-based approaches that
have
already worked to save so many lives. That means fully financing the Global
Fund
to deliver free malaria prevention, diagnosis and treatment by trained
health
workers.

This blog was co-authored by Dr Mohga Kamal-Yanni, Senior Health and HIV
Policy
Advisor for Oxfam GB

To view the latest post or submit comments please visit
http://www.globalhealthcheck.org/?p=837
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