Salt, Sugar, and Malaria Pills
How the Affordable Medicine Facility–malaria endangers public health
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Recent progress in controlling malaria is a major development success. Thanks to external aid and domestic financing the proportion of children in sub-Saharan Africa sleeping under a bed net has increased from 2 per cent to 39 per cent in the last 10 years. This has brought down the number of malaria deaths dramatically in many countries, such as Namibia, Swaziland, Ethiopia, Senegal and Zambia, where deaths have been cut by between 25 and 50 per cent.
Yet just 40 months away from the MDGs deadline, this progress is being threatened by the support of some donors for the Affordable Medicines Facility–malaria (AMFm). This facility, hosted by the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2008, heavily subsidizes the most effective malaria drug, artemisinin combination therapy (ACT), and promotes the sale of these medicines through informal private providers – including shopkeepers and vendors. But, as the pilot phase of the AMFm draws to a close, donors now have hard evidence of the subsidy’s limitations and the risks of scaling-up, as well as better options to deliver results for poor people.
This paper reviews the limitations and failures of the AMFm, and the changes in the malaria landscape that render the AMFm obsolete. The paper also offers evidence of alternative approaches that can deliver better health outcomes for poor people. At the Global Fund and UNITAID board meetings taking place at the end of 2012, it is essential that all donors act on the evidence, and don’t continue to pursue unworkable solutions like the AMFm.
For the AMFm:
- The Global Fund should take a decision at their November board meeting to cease hosting the AMFm;
- UNITAID and the UK Department for International Development (the AMFm’s main funders) should discontinue funding beyond current commitments (the end of 2012);
- If pilot countries wish to continue providing ACT via the private sector, they should do so through normal Global Fund or other donor grants.
For scaling-up malaria treatment:
Donors should invest in a public-public partnership between community health workers and primary health care facilities, with an enhanced emphasis on training and supervision.
This approach combines the benefits of public sector and community approaches, while avoiding the risk to public health entailed by the involvement of the informal private sector. It also enables a public health approach to dealing with the majority of non-malarial fevers. Professional, regulated private sector outlets, such as pharmacies, can plug gaps where they exist – normally in cities and towns.
This approach is based on what works. It has already happened in countries including Ethiopia, Zambia, Rwanda, and others.
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