Ghana, like other countries in the region, is reported to be revising its national malaria strategy. Most countries developed a new strategy document around 2001, at the beginning of the Roll Back Malaria Partnership, that reflected the goals of achieving 60% coverage of the core interventions (ITNs, IPT and appropriate and timely case management).Â This level was supposed to have been achieved by 2005, and then new targets of 80% coverage took effect for the 5-year period starting 2006. Â Many changes occurred between 2001 and 2006 including the availability of artemisinin-based combination therapy (ACT), long-lasting insecticide treated nets (LLINs), and the re-emergence of indoor residual spraying (IRS).
Some shifts in policy have occurred, and it is natural for a new strategy to be developed to account for these. The Global Fund for Fighting AIDS, TB and Malaria (GFATM) noted that Ghana switched to ACTs, and now the country needs to embody this in their malaria strategy. Ghana was given permission to use artesunate-amodiaquine as its ACT rather than the pre-qualified drug artemether-lumefantrine.Â Drug quality issues resulted in serious side effects that eroded the public trust. The Food and Drugs Board took action, and as the GFATM noted, the PR worked hard â€œto overcome the bad publicity around the launch of ACTs.â€ Therefore the new malaria strategy needs a strong health education component to overcome and remaining public skepticism about the intentions and quality of the national malaria control effort.
Another challenge of the new malaria strategy will be to prevent the diversion of nets into the private sector. This problem likely arose in part due to the fact that cost was a major issue that prohibited net ownership before the start of the GFATM grant.
Ghana is also considering IRS, which is possible now that Ghana has been designated a PMI country. The challenge with IRS is determining the appropriate insecticide because of varying resistance of vectors in different regions of the country.
Overall the biggest challenge in revising the malaria strategy is determining Ghanaâ€™s own national malaria control needs and then coordinating the input of donors to meet those needs rather than developing a strategy based solely on what the donors expect.