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    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.


    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.


    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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Success amid corruption

As the trial by the Global Fund to provide subsidised anti-malarial drugs to selected African countries takes a new turn, evidence has emerged that such life-saving projects can easily fall prey to corruption.
In 2010, the Global Fund began subsidising the cost of the most effective anti-malarial drugs, artemisinin-based combination therapy (ACT) in eight countries through a co-paid project known as the Affordable Medicine Facility – Malaria (AMFm).

However, the live-saving drugs found their way to countries where the Global Fund was not running the subsidy programme.

“Global Fund takes the diversion of the subsidised anti-malarial drugs very seriously, and has put in place several measures to minimise the risk,” Emmanuel Yuniwo Nfor, Acting Head of the AMFm at the Global Fund, told Eyes on Malaria.

The goal of the pilot subsidy program was to radically reduce deaths from the life-threatening disease, especially among children below the age of five, by making drugs affordable in poor communities.

According to the World malaria report 2011, there were about 216 million cases of malaria. In Africa, the World Health Organisation reports that the disease kills at least one child every minute.
Changes to the AMFm mean that although the pilot phase of the programme ended in December 2012,  people in eight countries -- Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (including Zanzibar) and Uganda – should still be able to buy the highly effective drugs for as low as half a dollar.

This has been made possible by what is known as the transition arrangement, which started in January 2013. This transition stage will run till 2014, when the new integrated model commences.

AMFm subsidized good quality anti-malarial drugs, making it possible for the WHO-recommended malaria treatment, 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.

However, in Kenya for example, the subsidised drugs are currently unavailable in most of the private pharmacies particularly in Nairobi, leading to those who have stocks to inflate the prices in the face of high demand.
 “The main reason for the shortage is that the demand is very high, yet the supply of the drugs has not been consistent,” said Dr David Soti, the Head of the Division of Malaria Control under Kenya’s Ministry of Public Health and Sanitation.

He attributes further shortage to unscrupulous traders who buy the subsidized drugs and sell them elsewhere.

However, the Global Fund is quick to point out that there is no evidence to suggest that there are large-scale organized diversions of the subsidised drugs.  

“If you have had reports of a shortage of AMFm drugs in Kenya, it is probably caused by the limited funding available for co-payments during the pilot phase of AMFm, known as Phase-1. We are working with donors to secure sufficient funding to continue the AMFm in 2013,” said Nfor.

He points out that cross-border arbitrage is common where there are large differences in prices across borders.

 “For example, many US citizens purchase medicines from Canada online or by crossing the border in person because prescription drugs in Canada are much lower than prescription drug prices in the US.  This cross-border arbitrage has been estimated at US$1 billion annually,” he said.

“Through our surveillance, we have found out that the subsidised drugs have found their way to South Sudan and Somalia, where they are being sold at more than six dollars per dose” said Dr Kamamia WaMurichu, the Chairman of Kenya

Pharmaceutical Distributors Association. The two countries are net importers of medicine from Kenya.

 “Unscrupulous traders are making a ‘kill’ out of drugs that were meant to save the poor,” he said.
He notes that since there is no limit to how many doses a retail pharmacist should buy at a time, unscrupulous traders place orders for thousands of doses, which they later export to different countries where prices for such drugs are not subsidised.
According to Nfor, the ultimate solution to the diversion of such drugs to unintended countries through porous borders would be to roll out the subsidy programme to all malaria-endemic countries that need the drugs.
An independent evaluation led by a consortium of ICF International, and the London School of Hygiene and Tropical Medicine reports that the AMFm has been very effective in providing access to the most effective treatment, ACT, particularly for the low income earners.

 “With the subsidy programme and campaigns through the mass media, we have seen the uptake of the ACTs increase substantially, bringing down the disease burden in the past three years,” said Dr John Logedi, the Deputy Director at the Division of Malaria Control in Kenya.
However, Dr WaMurichu feels that countries need to strengthen surveillance at the ports of entry; a practice he says may not be easy particularly when the drugs are transported by road.

“It may not be practical to offload the entire truck to check whether or not it contains the subsidised drugs,” he said.
So far, any pharmacist in the participating countries can buy and sell the drugs under the AMFm scheme at the subsidised rate.

In the private sector, the drugs are identified by the green leaf logo on the packet. At the same time, the AMFm drugs are supposed to be available in public health institutions free of charge.

- By Isaiah Esipisu - Kenya

Tenth Edition