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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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Treating without “Sacrificing a Meal”

As the Global Fund Board looks to assess and possibly continue its Affordable Medicines Facility – Malaria (AMFm), some key players have advised that it takes into account the sacrifices and discomforts through which they supported the project to survive and succeed.

A recent meeting in Accra organized by the AMFm Coordinator’s Office of the National Malaria Control Programme (NMCP) in collaboration with the Malaria Voices Advocacy Project (MVAP), created the atmosphere for first-line and second-line buyers to showcase the role they played and continue to play in the AMFm and its impact on the pilot implementation in Ghana.

The Global Fund’s co-paid subsidy arrangement has expanded access to artemisinin-based combination therapies (ACTs), the most effective treatment for malaria and obviously helped communities to avoid less-effective treatments, like chloroquine and other monotherapies, to which malaria parasites are becoming increasingly resistant.
On the strength of its potency and efficacy in curing uncomplicated malaria, the AMFm-subsidized ACT drug has enjoyed an increased patronage.

It is yet to be shown however if the increased use of the potent drug has led to a corresponding drop in malaria deaths among pregnant women and children under- 5, as envisaged.

The idea is brilliant but it relied heavily on the goodwill of first-line and second-line buyers who buy in bulk from WHO-approved drug manufacturers. These drug firms invest heavily in large orders for the benefit of retailers and the consumers.

Indeed the first-line and second-line buyers are more than happy to be associated with a project as noble as AMFm which has given people in endemic communities the option of buying a potent therapy for malaria without having to “sacrifice a meal.”

The whole idea, according to AMFm Co-ordinator Vivian Aubyn, “is premised on the fact that you need to have a meal before taking your anti-malarial drug.”

In the days before AMFm, a quality ACT cost nearly ten dollars, which was not acceptable given that most malaria victims live on less than a dollar a day.

Today, the recommended price of the drug with the green leaf logo is just a dollar for adults and even less for children.

Among the high points of the 2-year pilot of AMFm is a demonstration of the workability of a partnership of public and private sectors with a common goal to bring malaria under control.

Ms Aubyn said “Way back in December 2011 the AMFm caused the subsidized ACTs to be at par with the non-subsidized ones in terms of patronage, which is an achievement of the initial objective to generate increased access to quality ACTs to help in the fight against malaria.”

“By March 2012, over 28 million doses of ACTs with the green leaf logo had been received in Ghana mainly through the proactive performance of the private sector.”

The AMFm Co-ordinator said another feather in the cup of Ghana is that the sense of purpose of the public-private sector collaboration has become a template on which neighbours on the continent have fashioned their project implementation.

She said independent evaluation and monitoring reports indicate that in Kenya for example, AMFm ACTs procurements had been carried out mainly by the public sector, giving the state direct control of the prices of the subsidized ACTs and thus showing one of the lowest prices among the phase I pilot countries.

 Therefore, for Ghana to be able to maintain a modal price of approximately US$ 1 throughout the 18 months of implementation with the private sector taking the lead in bringing in the co-paid ACTs especially in the absence of price controls, shows how much the private sector is committed to contributing to the well-being of Ghanaians.

First Line Buyers and wholesale buyers say their willing participation in the project is purely for motives of love, sacrifice and social responsibility.  They said this came with lost opportunities and their businesses had to endure some jolts.

The first-line buyers complained that on many occasions their capital was locked up during the long wait for supplies to arrive. And sometimes when the orders came some treatments had been substituted with others. An order for adult doses often brought a supply of children’s doses instead, and sometimes also not in the requested quantity.

They argue that this led not only to a reduction and sometimes loss of returns on investment but also loss of credibility to their distributors whom they had promised large quantities of the subsidized ACTs.  They describe the situation as so challenging that out of the registered 31 first-line buyers, only about a dozen are still participating in the programme.

The inability to develop their own brands of ACTS also griped the first line buyers, many of whom are full-fledged drug manufacturers.

The first-line and second-line buyers say their hands are tied by the recommended price arrangement which prevented them from increasing prices to cater for increasing costs of operation and inflation.

They also said that in sticking to the recommended price they are making huge sacrifices especially in the face of currency depreciation. But they also said that they were part of the process of deciding a suggested maximum retail price for the co-paid ACTs and are committed to ensuring that the programme succeeds.  
Looking ahead
In view of the realities faced by these importers and wholesalers, they believe that if AMFm continues as usual without any consideration for their concerns, it might experience problems and its goal to make ACTs accessible would not materialise.
Among the suggestions proffered by these stakeholders is an echo of the call by well-meaning stakeholders for an immediate abolition of all taxes and tariffs on commodities used to fight malaria, especially ACTs.

When the time comes to decide the fate of the AMFm, the options available to the Global Fund include Continuation, Expansion, Modification or Termination.

Termination is out of the question because it will defeat the whole idea to increase the use of quality ACTs and crowd out the use of monotherapies to which the malaria parasites have shown increasing resistance.

The first and second-line buyers believe the solution lies in the modification of the project to check bottlenecks which sometimes cause gaps in the supply chain.

They also feel strongly that the AMFm registration fee for first-line buyers should be reduced from USD three thousand ($3000) to about a fifth of that amount.

These and other concerns are expected to be addressed to ensure that the popularity enjoyed by the AMFm moves from the current 95 per cent to one hundred per cent.

This is crucial, because maintaining the gains in malaria control requires that programmes like AMFm, are not merely maintained but in fact scaled up to show the commitment of stakeholders to stop people dying from this disease.

By Carlton Cofie

Special Edition