Can Countries Cope with ‘Donor Coordination’ on ACTs?

A team of researchers from Burkina Faso and Germany have accused donors of lacking coordination in meeting the malaria drug needs of low income countries in endemic regions. They believe this lack of coordination between donors and international health agencies is leading to the needless deaths of too many African children from malaria, according to Medical News Today.

Kouate et al. go on to point out that donors, in fact are very coordinated when it comes to decisions to promote ACTS. ACTS, in particular the Coartem brand of artemether-lumefantrin, is the drug of choice approved through WHO’s prequalification program. All donors ranging from Global Fund and World Bank to USAID/President’s Malaria Initiative are on board with this decision.

pnlp-burkina-sm.JPGThe clearly articulated challenge is actually finance, not questions of efficacy. This is a similar concern raised by pharmacists in Kenya as mentioned in one of our recent blogs, and creates a sense of resentment in endemic countries. The Kenya example also shows that countries put in a lot of work and effort to make the transition from monotherapy antimalarial drugs to the recommended ACT drug policy. In fact it took Kenya 32 months to finalize the decision, but once having been made, new drug policies do not guarantee that the newer, safer and more effective drugs will be available, as seen in Burkina Faso.

Dr. Uwem Inyang who has worked with malaria and global fund programming in Nigeria shares similar concerns. He observed that countries, “adopt their policies without any in-depth consideration of its availability and alternatives through economic analysis.”

The challenges of changing the policy in Kenya reflects the same challenges including, “lack of clarity on sustainable financing of an expensive therapeutic for a common disease, a delay in release of funding, a lack of comparative efficacy data between AL and amodiaquine-based alternatives, a poor dialogue with pharmaceutical companies with a national interest in antimalarial drug supply versus the single sourcing of AL and complex drug ordering, tendering and procurement procedures. Need careful attention to myriad of financial, political and legislative issues that might limit the rapid translation of drug policy change into action,” according to Abdinasir Amin and colleagues in Malaria Journal.

Dr. Inyang stressed that, “We can not go back on this policy change but we can begin to take stock on how to treat malaria and thus reduce the economic burden arising from it.” Hopefully donors like those in the G8 Industrialized Nations will also realize that we live in an era of ACTs and make good on promises to fund malaria control in Burkina Faso, Kenya, Nigeria and other endemic countries.

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