Tachi Yamada of the Gates Foundation told Discover Magazine (October 2010) that, â€œâ€¦ childhood deaths â€¦ could fall by half by 2025 if we could deliver existing vaccines, malaria treatment, and todayâ€™s other lifesaving tools with 90% penetration to those at risk.â€ During the push towards Universal Coverage, it is good to ask whether we can really reach people with our existing tools.
The INDEPTH Effectiveness and Safety Studies (INESS) offers a conceptual model as to what happens when a when efforts are made to ensure that a highly efficacious tool – malaria medicines, LLINs – actually reaches people. This ultimately impacts on the effectiveness of the tool. Thus a drug that is 95% efficacious, may be less than 50% effective if the right people do not take it at the tight time.
First people need access to the tool – in the INESS case ACTs. We must deal with all the procurement and supply chain management issues that determine whether the medicines will reach the sick people in good condition beyond the end of the tarmac road.Â Then targeting must be considered – do the right people get the medicines? Next the health workers themselves must comply with treatment guidelines, and finally, if the person with malaria gets his/her drugs, will he/she adhere to the treatment regimen?
Peter Moszynski in the British Medical Journal also expresses concern about the access and compliance issues:
Despite the widespread availability of effective new (malaria) drugs and diagnostic tools â€¦ major problems remain. Issues such as misdiagnosis and overprescription of treatments, counterfeit drugs, problems in supply and delivery, and emerging resistance to drugs “all hamper effective treatment.” A lack of awareness among donors and the public of some these basic problems “threaten the success of global malaria control efforts.â€œ
Beatrice Wasunna, et al. addressed the provider compliance issue when they found that, “In-service training and provision of job aids alone may not be adequate to improve the prescribing, dispensing and counseling tasks necessary to change malaria case-management practices and the inclusion of supervision and post-training follow-up should be considered in future clinical practice change initiatives.”
Many resources are flowing through health systems right now, especially with the pressure to achieve Universal Coverage and the enthusiasm generated by the MDG Summit. Can we ensure that the health systems in place can bring the effectiveness of these tools closer to their actual scientifically tested efficacy?