Policy brief on improving access to artemisinin-based combination therapies for malaria in the east african community

International Journal of Technology Assessment in Health Care, 26:2 (2010), 255–259.
Policy brief on improving access
to artemisinin-based combination
therapies for malaria in the East
African community
Harriet Nabudere
Makerere University
Gabriel L. Upunda
East African Community
Malick Juma
Ministry of Health, Zanzibar
Keywords: Antimalarials, Care access, Health policy, East African Community, Tanzania,
Kenya, Uganda, Rwanda, Burundi
THE PROBLEM
WHO reports show that more than 90 percent of the annual global malaria cases and deaths are reported from the The World Health Organization (WHO) since June 1998 African region (20). Children under the age of 5 years and has advocated for the use of artemisinin-based combination pregnant mothers are the most vulnerable groups affected therapies (ACTs) in countries where Plasmodium falciparum by the disease. Malarias’ annual contribution to deaths in malaria is resistant to traditional antimalarial therapies such under-5 year olds is as high as 39,000 in Uganda, 31,000 in as chloroquine, sulfadoxine-pyrimethamine, and amodi- aquine (19;22). In 2006, WHO released evidence-based Community health workers (CHWs) have successfully guidelines for the treatment of malaria backed by findings contributed to public health services in the fight against from various scientific studies (21). During the period malaria. The CHW kits for home-based management of fever between 2002 and 2006, all the five East African states at present still contain older antimalarials in Uganda and Tanzania, Kenya, Uganda, Rwanda, and Burundi changed Tanzania. Rwanda does not have a CHW network, whereas their national antimalarial treatment policies to use ACTs as Kenya has incorporated ACTs to be used at community level first-line treatments for uncomplicated falciparum malaria and commenced with deployment of the drugs in the The private sector provides health services to a large state-managed health facilities (12–15). To scale up the use proportion of the population in East Africa through faith- of ACTs in the East African region to combat malaria and based organizations and other not-for-profit organizations, speed up progress toward the sixth Millennium Development as well as for-profit facilities (6). The cost of ACTs at these Goal, a combination of delivery, financial, and governance outlets is still quite high (between US$5 and US$15 per adult arrangements tailored to national or subnational contexts treatment course) compared with the free ACTs provided by public facilities. Samarasekera highlights the need fora stronger regulatory framework by government to oversee The authors thank the Swiss Agency for Development through the Research the private sector in provision of health-related services and Table 1. Policy Options
protect against catastrophichealth expenditures (2;4;10;16) would subscribe making thescheme financially untenable (10) POLICY OPTIONS
nity Health Workers (CHWs). CHWs are normally recruitedfrom members of the community, such as mothers, farmers, The policy options described in this policy brief are not teachers, and others. CHWs are much more accessible than mutually exclusive interventions; they are complementary healthcare professionals, particularly in rural areas where strategies in the fight against malaria. The policy brief does there are fewer and poorly equipped healthcare facilities; (ii) not recommend any one option over another, but highlights Engage the private sector in distributing ACTs in accordance existing research evidence in support of the included inter- with standard treatment guidelines, and ban importation ventions. The three options are the following: (i) Include and prescribing of artemisinin monotherapies; (iii) Improve ACTs in the home-based management provided by Commu- health sector financing and universal access to healthcare by INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 26:2, 2010 Malaria treatment policy brief for the East African community Table 2. Implementation of the Policy Options
mandatory, therefore, the sick aremore likely to subscribe, makingthe schemes untenable •Use of mass media for public awareness and education for all three options • Use of a “suggested retail price” bicycles for transportation, smallcommissions on each ACT packdispensed, small sustainableallowances for CHWs In a high quality systematic review, Grilli and colleagues (7) found that health messages in the mass media can promote desirable health behaviors among healthcare practitioners as well as the general public. Higher incomegroups have better access to media such as television, radio, and the Internet, and are more likely to benefit fromthis exposure than lower income groups. This could increase inequities. This strategy is well accepted, but theremay be considerable financial cost for sustained campaigns INTL. J. OF TECHNOLOGY ASSESSMENT IN HEALTH CARE 26:2, 2010 Table 2. Continued
shifting from out-of-pocket payments to prepayment and tration Building, 2nd floor, New Mulago Hospital Complex, pooling of funds using a combination of social health in- surance and community-based health insurance. These three Gabriel L. Upunda, MD, MMED, MPH (glupunda@gmail.
com), Executive Director, Regional East African CommunityHealth Policy Initiative, East African Community, ArushaInternational Conference Centre, Arusha, United Republic IMPLEMENTATION OF THE POLICY
Malick Juma, MD, MMED (malickjuma@yahoo.co.uk),
Director, General Health Services, Ministry of Health, Zanz-
Obstacles to implementing the three policy options and ibar, P.O Box 236, Zanzibar, United Republic of Tanzania strategies for addressing these are described in Table 2.
REFERENCES
DISCUSSION
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