Kenya is not only facing increased budget demands to treat malaria using the newer effective antimalarial drugs, it also must deal with expanding habitats for the malaria carrying anopheles mosquitoes.
The East African media organization reported, “The money used last year for malaria was the largest amount ever spent in one year in Kenya on a single disease other than HIV/Aids, and analysts say this reflects both the growing commitment of donors and the government to combat the country’s leading killer.” While donor support such as that from the Global Fund to Fight AIDS, TB and Malaria, can make child doses of Coartem available to the country at cost – about one US dollar – the country must cope with market pricing to meet its total malaria drug needs. This may range upwards to $US 8 per treatment for the consumer. If countries do not forecast and fund their total antimalarial drug needs for both children and adults, cheaper medicines from donor funds may be misused for adult clients who have malaria.
The article also implied that countries may feel resentment because they perceive that that WHO and other donors have forced their hand in adopting new drug policies that favor Coartem among other combination therapies.Â Apparently the Pharmaceutical Society of Kenya (PSK) protested that the drug was too expensive. The PSK was worried that this decision to promote Coartem could not be sustained when donor funds wound down.Â If countries decide to return to cheaper but less effective alternatives, the small headway made in recent years will be lost. Clearly this should be a wakeup call to donors and the pharmaceutical industry to find cheaper AND effective alternatives.
If the $US 58 price tag for antimalarials in one year was not enough of a challenge, Kenya is also faced with expanding mosquito habitats.Â According to The Standard “The discovery of malaria-causing mosquito (Anopheles gambiae) in the Central highlands may have been a surprise to many, but not to climate change experts.” People living in these new malaria territories do not have the acquired immunity that those in endemic areas have, and hence the impact will be great.Â While Kenya itself cannot control global climate change, being the home of the UN Environmental Agency, it should be a major advocate for encouraging global cooperation on the issue. In the meantime Kenya will have to budget even more scarce funds for malaria drugs, insecticide treated nets and IRS.
Finally, a third challenge is program management. Although one can empathize about the dilemmas facing Kenya, one needs to draw attention to the fact that the Global Fund does have concerns about how Kenya is managing the support it is receiving to provice malaria treatment. According to the Round 2 Malaria Grant Score Card (2005) which states: “The Program has failed to meet targets inseveral important service delivery areas (SDAs) including distributionof insecticide-treatednets (ITNs) (0% of target) and no data is available for number of people receiving treatment for Malaria, pregnant women receiving IPT (Intermittent Preventive treatment) or Case fatality rate.” the progress report of November 2006 shows some progress on IPT, but not nets and treatments received.
A concerted donor-country effort is needed to meet these triple challenges in a timely manner.