Uganda: Relief As Private Sector Joins in Malaria Fight

Source from:  The Monitor (Kampala) 24 September 2008 09/26/2008

When the Europeans wanted to give a final blow to malaria in Italy, the last country on the continent to have malaria, after fixing most of the physical drivers of the disease, authorities entered into partnership with the private sector. According to the President and Chief Executive Officer of Medicines for Malaria Venture, Dr Chris Hentschel, Italian authorities took the most effective malaria drugs then to tobacco shops so that the public could easily access the medicines. This was a public - private partnership aimed at enabling those with malaria rid their systems of the parasites. "Even if you killed all the mosquitoes you will not eradicate malaria. There is a population that carries the parasite. Therefore you have got to treat these people so that they don't become carriers of the disease," he said. Although Uganda is still far from fixing the physical drivers of the disease, the Consortium for ACT Private Sector Subsidy (CAPSS), a new public-private initiative similar to the Italian one, came into force on September 19. The CAPSS will see trouble-free access by the rural poor to the most effective malaria drugs which many cannot access due to the high costs. The Ministry of Health has joined hands with the Geneva based NGO Medicines for Malaria Venture in partnership with other local organisations to deliver heavily subsidised effective malaria medicines for as little as Shs200 for a treatment course of children and Shs800 for adults. The drugs are the World Health Organisation (WHO) recommended artemisinin combination therapies (ACTs), which are a blend of artemisinin with another antimalarial drug. And in this case, artemether and lumefantrine-commonly known as Coartem, Uganda's preferred first choice medicines for simple malaria. Endemic in most parts of the country, malaria kills 320 Ugandans everyday, most of them children and pregnant women. The Kaliro District Health Officer Dr Shaban Mugerwa, in whose district the initiative was launched, puts it rather dramatically in terms of the daily deaths. He says, "That is the equivalent of 23 full taxis (14 seaters) falling off a weak bridge and plunging into the river; killing everybody on board-not just today or tomorrow but every single day." Initially to be implemented in eight districts, first in Kaliro, Pallisa, Budaka, Kamuli and Soroti, then Kabarole, Kamwenge and Mubende, all covering a population of three million people, the two year project might eventually be rolled out across the country if funds can be secured. But using funds from the Global Fund to fight Aids, Tuberculosis and Malaria and other donors, the Uganda Government is already providing ACTs free of charge in almost all government health facilities across the country. So what makes this new initiative a big deal? According to the State Minister for Primary Health Care, Dr. Emmanuel Otaala, although Government is already providing ACTs in the public sector for free, CAPSS would make the medicines available to those who seek care from the private sector. "These life saving drugs are still inaccessible in the private sector largely because they are not affordable. One single dose of Coartem costs between twelve and eighteen thousand shillings in this country," said Otaala last week at the Ministry of Health. Studies by the Ministry of Health have also indicated that approximately 40 to 60 percent of Ugandans first visit the private sector when they fall sick. But because medicines in the private sector are expensive, many of the patients continue to receive ineffective drugs such as chloroquine, fansider, amodiaquine and artemisinin monotherapies, according to minister Otaala. Emphasizing the significance of public-private partnerships in the fight against malaria, the MMV President Dr. Hentschel said a soon to be published study on Uganda's antimalarial market shows that 1 in 25 private sector drug outlets even stocked ACTs. Said Hentschel, "The problem is not only that ACTs are expensive, they are in fact not available in most places where patients go to get medicine." Further highlights from the study show that it takes 11 days of an average household income to purchase a single course of ACT, for a five year old. And the cost of purchasing from the private sector, a family's annual needs for Coartem, equals the cost of over seven years of primary schooling for each child. Likewise, for a family to afford ACTs in the private sector, they would have to not eat one out of five days as it costs days of a household's basic food needs to buy the annual needs of an effective antimalarial. "The figures speak for themselves. The stuck issue here is affordability of drugs that will cure malaria," said Hentschel. "No parent should ever have to choose between food and medicine for their children." However, with the new CAPSS initiative on board, there is a lot of optimism that all those in need of treatment can be able to access it with in 24 hours. Enditem