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  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

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    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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The Green Leaf flies high

By Carlton Cofie-Ghana

November 2012 will see a big decision at the Global Fund on whether to continue, modify, expand, suspend or terminate the Affordable Medicines Facility for Malaria (AMFm).

The facility,  currently being piloted in Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar) will have completed its first phase and become due for a review.

AMFmsubsidizesgood quality anti-malarial drugs, making it possible for the WHO-recommended malaria treatment, artemisinin-based combination therapy (ACT), to be sold at the affordable price of about one US dollar for adults and even lower for children.

AMFm was implemented to save lives and reduce the use of less-effective treatments, like chloroquine and other monotherapies, to which malaria parasites are becoming increasingly resistant.

It was not all smooth sailing because the pilot phase of AMFm brought up issues that need to be addressed in order to make key stakeholders happy.

Believing in the importance of the facility and looking ahead with confidence to its continuation, the National AMFm Co-ordinator in Ghana, Vivian N.A. Aubyn told Eyes on Malaria that the facility has justified its implementation in terms of being accessible, affordable, promoting increased use of ACTs and ultimately crowding out monotherapies.

Availability

Speaking at the National Malaria Control Programme (NMCP) offices in Accra, Ms Aubyn said stocks abound in Ghana following a delivery of over 21 million treatment dosesco-paid ACTs in the country. Availability and accessibility, as far as she was concerned, have been made possible.

She said when Ghana began the implementation of the AMFm in August 2010 the country’s first delivery of the AMFm co-paid ACTs was  over 450 thousand treatments which arrived in November 2010, but by the end of December 2011, the country had received more than 20 million treatment doses.

The AMFm Co-ordinator said in working to increase access, the NMCP/AMFmmanaged to answer the questions about whether those who need quality assured ACTs find them.

As to whether the quality-assured ACTs are within reach in all communities, Ms Aubyn said the AMFm helped to expand access by making the ACTS available in licensed chemical shops and pharmacies across the country, adding that the monitoring report shows that 95% of facilities surveyed have the subsidized ACTs in stock.

She said the AMFm has also helped to increase the knowledge of healthcare practitioners in malaria case management by training more than 1400 pharmacists in the private sector 6,400 licensed chemical sellers and 522 prescribers in the private sector.  In the public sector 4000 health workers were trained.

Affordability

The AMFm Coordinator said that when it comes to the issue of affordability, the efforts of the malaria control programme and its partners had been geared towards answering the question Can people buy ACTs with the green-leaf logo, without having to forego their daily meal or make other sacrifice?”

The NMCP and implementing partners set GHC 1.50, the equivalent of one American dollar, as the suggested maximum retail price for the adult dose of the AMFmACTs.

Initially there were profiteering chemists who sold the medicines about twice the suggested price. With intense media education and outreach programme however, suggested prices are now being largely adhered to by the private sector.

Ms Aubyn backed this claim with monitoring reports of the Pharmacy Council from April to August 2011. In these reports the modal price for the AMFmACTs over the period had remained consistent at GHC 1.50.

The April report showed that a few outliers were selling at GHC 5.00 these maximum prices dropped to GHC 3.00 and this was still for a few outliers.

Some retails outlets were said to have argued that they got them at a higher price from first line buyers.

This is shocking because in order to be eligible for co-paid ACT under the AMFm, a first line buyer must meet the criteria set out by the Global Fund and sign an undertaking with the Global Fund which sets out the conditions of purchasing ACTs under the AMFm.

Each buyer acknowledges the goals and objective of the AMFm and the operational priority to reduce the price of the quality-assured ACT for patients in all sectors 

Touching on the price of AMFm drugs, the Director of the Centre for Tropical Clinical Pharmacology & Therapeutics, Prof Alex Dodoo, called for constant monitoring to ensure prices remain as they are now - around a dollar.

Prof Dodoo, an AMFm consultant and immediate-past president of the Pharmaceutical Society of Ghana (PSOG), said “With the recent increases in the price of fuel and commodities, prices of the ACT with the green-leaf logo, will begin to creep up if not monitored constantly.”

Ghana has ensured a public-private partnership, whereby the private sector sustained the initiative by bringing in stocks until October 2011 when the public sector received its first stocks of the AMFm drugs. 

Ms Aubyn said Ghana was the first country to conduct the monitoring of the level of awareness, price, and availability of the AMFm drugs in the country and to disseminate the results.  It is continuously monitoring these indicators on a monthly basis and producing monitoring reports.

Prof Dodoo said the success of the AMFm is due largely to the huge support it enjoyed from pharmacists in the country.

He said “We pharmacists took the view that this is a national issue so let’s support it. That’s why over 40 per cent of Ghanaian pharmacists backed the AMFm from the beginning. Pharmacists are proud to say we are the only health professionals who literally carried the project forward to make it succeed.”

Prof Dodoo said however that the concerns of pharmacists about the AMFm implementation have to be addressed. He said PSOG members, have complained that their businesses have been destroyed because they are not allowed to produce the AMFm drugs and only some allowed to become first line buyers.

Increased ACT use

Using statistics to prove an increased ACT use in Ghana, the AMFm Co-ordinator emphasized that as far back as August 2011 the subsidized ACTs was enjoying about the same level of patronage as full-price ones.

And the same report of August 2011 showed that national awareness on the AMFm was over   97 per cent.

Reports indicate that as of August 2011, approved AMFm orders for just four countries (Ghana, Kenya, Nigeria and Tanzania) account for around 80 percent of the total global ACT production capacity. This overwhelmingly high demand for ACTs in just four countries threatened the availability of ACTs in all other malarial countries.

Then there are reports that 70 per cent of AMFm treatment orders are for adult doses although malaria is mainly a childhood disease.

A research will not only help to answer that question but also explain if the increased patronage of ACTs have led to a reduction of malarial deaths among pregnant women and young children for whom it all began.

Prof Dodoosaid “AMFmhas led to a crowding out of monotherapies for the simple reason of cost. People would rather buy the quality subsidized ACT for a dollar than a less potent therapy, for twice the amount. ”

“This is evident in the fact that importers are beginning to shy away from importing those drugs because it makes no sense to try importing drugs that are not legal and then struggle to sell them.”

Curiously though, Zanzibar, a country that has almost zero malaria transmission, has ordered over 240,000 AMFm ACT treatments.

In West Africa the survey revealed AMFm products being sold in non‐AMFm countries. The threat of leakage of AMFm drugs to non‐AMFm countries is real and requires urgent action.

Reports say the subsidized ACTs drugs are being traded into non-subsidized private markets, profiting peddlers and smugglers.

A non-AMFm country like Togo is said to have the subsidized green leaf ACTs in local shops. Togo is not participating in the subsidy scheme and these medicines are not supposed to be sold there. The same situation applies in Cote D’Ivoire and Benin and none of them is participating in the AMFm.

Optimism

Hopefully, these issues will be addressed to justify the expectation that AMFm will be continued come January 2013.

Prof Dodoo shares in the optimism of the AMFm Co-ordinator because of positive reports from the grapevine.

He said “With the recent donation of 750 million dollars by the Bill and Melinda Gates Foundation to the Global Fund, expectations are that the temporary financial difficulties will be overcome and allow the AMFm to be continued. Our suspicion is that there is going to be a transition period, which may be very long, as is common with global health arrangements.”

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Ninth Edition