It was pathetic watching little Kemi writhe in pain. Her body temperature was very high and she had lost her appetite for food. The mother, a pepper trader at Oje, a fruit and vegetable market in the centre of Ibadan city, had bought drugs from a patent medicine vendor (PMV) next to her stall to treat her daughter’s fever.

Her mother could not understand why she should keep complaining of body aches with a temperature after the medicine seller had said her ailment was malaria and which she had treated with chloroquine.
It was with this thought that she took Kemi to a primary health care centre where the medical officer in charge asked that Kemi should take a different medication that she found too expensive.
“I had bought drugs worth over N200 and this new one you are asking me to buy for her is sold for N1, 500. This is rather too expensive. Are there no alternative medications that will do the same work of healing her? I am a trader and do not even make enough from my pepper trade,” retorted Kemi’s mother.
Kemi’s mother is not the only one who faces this sought of predicament by making a choice between cheap and expensive medications for the treatment of malaria. Years before the change in the Federal government’s policy on malaria treatment, many people resorted to drugs like chloroquine for the treatment of malaria. For a drug that is readily available and cheap, it is the choice for many people in the local communities.
However, it is not without its attendant problems. Unlike when it was initially introduced for malaria treatment, it has lost its potency in curing malaria. Above all, it has also compounded the issue of preventing deaths and disabilities that may arise when malaria becomes severe and deadly.
Ensuring that malaria is properly treated to prevent its recurrence is one problem that Professor Oladimeji Oladepo, a Public Health expert and Country Coordinator of Future System (FHS), an international research programme consortium, said is suggestive of a national malaria policy that was formulated by a top to bottom approach.
“Stakeholders at the Federal Government level, more on less, dumped the policy at the doorstep of the common man. Though the community people never had any substantial role to play in its formulation, they were, however, expected to embrace this policy and run along with it. It does not work,” says
Prof. Oladepo, who doubles as Dean of Faculty of Public Health, University of Ibadan.
“The Artemisinin-Combination- Therapy (ACT) which is now the choice drug and is now being promoted is facing challenges because the government did not consider its economic implications for the poor. They said ACT should be used for malaria treatment in the current policy. It is easy to say that, but if people at the community level had been involved, they would have been told how much it costs to treat one episode of malaria. It is between N1500 and N2000. They would have been told it was not realistic and that would have led to thinking of a mechanism such as subsiding the cost of this medication to ensure it works”, says Prof Oladepo.
According to Prof. Oladepo the disconnection between the national malaria policy and what is going on in the field, is a big problem.
“Through research we tried to find out what drug people used in malaria treatment. Many still use chloroquine, the same drug found not to be effective in malaria treatment because it is almost 15 fold cheaper than the ACT, stipulated by the policy. In fact, 70 per cent of people who have fevers, symptomatic of malaria, will visit the patent medicine vendor first and they would want to buy chloroquine, the cheapest drug to treat the malaria”.
He stated that people who use chloroquine are likely to have their malaria not cured.
So when they have malaria, it may now progress from the simple malaria to the severe form and then to cerebral malaria.
“In Cerebral malaria, seven out of 10, even with the best treatment, are likely to die. What this means is that poor people, who are disproportionately affected in the first place with malaria infection, are also disappointedly affected by the policy in terms of getting effective treatment because of poverty. So we should bring out innovative approaches to deal with that”. Professor Oladepo asserts.
But what is the way out? First is the issue of training the patent medicine vendors, the most common and widespread drug suppliers at the community level, about combining appropriate malaria treatment and the potential role of insecticide treated nets in malaria preventions based on the fact that they have limited knowledge on malaria treatment.
Though the government is already involved in the standardisation of malaria medications and ensuring provisions of quality anti malarial drugs, Prof. Oladepo says another important step would involve making the patient medicine vendors monitor compliance to set standards.
“So part of what we want to do is to combine government regulation with patent medicine vendor’s owned- internal regulatory mechanism for drugs. It works better than that of government and with PMV members playing a leading role, their members will comply with agreed standards. We have actually gone far by actually discussing this with the PMV; in fact they have written letters stating that they want to see this type of regulatory partnership”. Oladepo says. 
Professor Oladepo says that using information communication technology such as mobile phones to build an information network between the Ministry of Health and other drug regulatory bodies can also ensure early notification of fake and substandard medications.
According to Oladepo, there is the need to translate the policy on malaria treatment into the three major Nigerian languages so that people can understand the policy better even if they are not involved in its development as well as to subsidise the cost of ACT to ensure that poor people can have their malaria properly cured.