Front line clinics in Kenya, such as the one pictured here, carry four different dosage packs of Coartem to cover all age groups. In addition, coartem is given for free to all patients, and people over five years of age are generally tested before this artesunate-based combination therapy (ACT) drug is prescribed. This comprehensive approach means that there is no discrimination in providing care.
In other countries free ACTs that have been provided through donor support are intended only for children less than five years of age. ACTs for the remainder of the population have not been bought by health authorities based on concerns for cost. Sometimes then, the free ACTs from donor programs have been used inappropriately for older patients. Kenya appears to be avoiding this problem.
The lesson is even larger than that of the need for drug forecasting and adequate procurement. The Kenyan Ministry of Health recognizes that ACT has a preventive effect as reported by Sutherland and colleagues whose â€œresults suggest that co-artemether has specific activity against immature sequestered gametocytes, and has the capacity to minimize transmission of drug-resistant parasites,â€ though this can be modest in some settings. If only a portion of the population is treated, this benefit of reducing transmission is missed.
Another benefit is economic. The Kenyan Ministry of Health also recognizes that if a parent is sick with malaria and misses work, the whole family will be affected. Just as WHO is calling for free nets for all, there also needs to be free ACTs for all who are infected with malaria. To do this we need continued donor and country support as well as a wider range of WHO pre-qualified ACTs to create competition and bring ACT prices down.