Diversions – bumps in the road to malaria elimination

During visits to private pharmacies in 11 African cities from late 2007 to early 2010 Bate and colleagues purchased 894 samples of antimalarial medicines. Overall 6.5% of these medicines had evidence of being diverted from the public health system. This was only 4.2% of the older malaria therapies, but 27.8% of the 151 ACTs had come from the public sector.

global-fund-coartem-found-at-pharmacy-in-angola2.jpgThe ACT diversion problem was most noticeable in Nairobi, Lagos, Kampala, Luanda and Dar es Salaam.  The photo here shows ACTs we found in a small pharmacy shop down the street from a clinic in the suburbs of Luanda in 2008. Informal discussions in Luanda with donors also revealed major problems of theft from the ports. Specifically, the Boston Globe reported that, “According to an audit last year by the US President’s Malaria Initiative, about $640,000 worth of medicines sent to Angola vanished from airports and the government’s medicines warehouse.”

The authors are the first to admit that the study design is not perfect and that their sample size could have been larger, but the key issue is that they have actually documented the ‘leakage’ of these donated medicines from the people who need them. This moves the problem beyond the anecdotal level.

Medicines are not the only area where the diversion makes malaria commodities take a detour. Nets disappear, too.

Last year’s universal LLIN distribution in Kano State, Nigeria experienced some challenges in terms of reaching people and their retaining nets.  The goal was two nets per household, but a report by donors after the distribution found that 28% of households surveyed got only one. Seven percent of nets that reached households were also ‘lost’. So far there have been no mechanisms like the study by Bates and colleagues to trace nets into the private sector or elsewhere.

The main issue we see is that health systems need to be strengthened and public education needs to be improved – in this was diversions will be less likely and the public can serve as a watchdog for any malpractices and take an active role in rolling back malaria in their communities.

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08 Sep 2010 17:37:32 GMT

Source: Reuters

 

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