The New Vision online (Uganda) reports that “The Government is to provide Coartem, an anti-malaria drug, to private health units at a subsidised price, the Ministry of Health announced yesterday.”Â These will be sold at ‘affordable prices‘ according to the ministry.
“Primary health care state minister Emmanuel Otaala said the ministry, in conjunction with donors, would provide the drugs at sh200 per dose for children and sh800 for adults.” Normally Coartem costs “between sh12,000 and sh18,000 in private clinics.” In approximate dollar terms this is a difference between a subsidized rate of US $0.12- 0.48 compared to $7.25 – 10.87.
For implementation the devil will be in the details in terms of procurement and supply chain management (PSM) (public vs private) as well as positioning of the subsidized drugs where existing products may offer the shop owners a greater profit margin.
Nigeria is reframing its Round 4 Global Fund Malaria Grant to include the private sector and provides some lessons about the challenges of dual districution channels for ACTs.Â The August 2008 grant progress report outlines these issues.
“There was a delay in the approval of the PSM plan because the PR wished to repackage their ACTs in a manner that would differentiate them from those given out by YGC (Yakubu Gowon Center – PR Public Sector), the other malaria PR. That is because SFH (Society for Family Health – PR private sector) is distributing ACT through the private sector with cost recovery and YGC distributes through the public sector for free. As there were no compliant factories in Nigeria, SFH had to change suppliers to one that could package the drugs according to their needs. This delayed the approval of the PSM plan which was finally approved on March 8th 2008. Procurement is now underway andimplementation can begin fully in the next quarter.”
Private sector involvement is crucial for achieving coverage for a number of reasons, least of which are the fact that in Nigeria it was estimated that a monitory of people with malaria get their treatment in medicine shops. One could never achieve 80% prompt treatment with ACTs only in the public sector.Â So while the effort is commendable, it is not something that can be embarked upon quickly.
Well thought out logistics and monitoring plans are needed to ensure the subsidized ACTs actually reach their intended population.
Please note that the World Malaria Report 2008 is now available to download from WHO’s Global Malaria Program.