A colleague in Bamako – home of the famous Bamako Initiative – shared an experience with one of the staff members in her organization who sought malaria treatment for a sick 3 and 1/2 year old child at a front line community health clinic.Â On the first visit the child was prescribed quinine injection for that cost about US 28 cents.Â After three days the child was still sick and returned to receive ACTs at a cost of $10.07.
This raised a few questions. Why were RDTs not used? Why were ACTs not the first line of treatment? Why did the family have to pay for the medicines?
One can answer the first question with the concern that children under 5 years can benefit from prompt and presumptive treatment as a life saving measure.Â When the presumptive treatment is NOT the first line drug, one senses that the value of prompt treatment may be negated. Even though the Ministry of Health has printed and circulated malaria treatment guidelines, when one looks at the cost differences, one can get an idea of what the health worker might have been thinking – and it was unlikely to be the guidelines.
The Bamako Initiative is a community based and community managed cost recovery mechanism. The program has been working in Mali for over 15 years. This makes sense for inexpensive essential drugs. So why was the family charged what appears to be the cost of an adult dose for a small child? The ultimate answer may be that the community health service has had to buy ACTs for resale because Mali is what one might call “in between grants”.
Fortunately the child ultimately got the correct ‘presumptive’ treatment, and also fortunately the parents could afford it.Â This scenario may repeat itself in other countries. Therefore all partners must coordinate their efforts in a country and work together to close the “ACT gap.”