Malaria still kills needlessly in Africa - effective drugs are not reaching patients
MSF: Geneva - Alarmingly few African patients with malaria are getting existing effective treatment that could cure them in a few days, says Médecins Sans Frontières.
Four years after the World Health Organization issued a global recommendation for countries to switch from old malaria treatments to artemisinin-based combination therapies, or ACTs, and two years after the Global Fund decided to fund ACTs, MSF teams witness government-run health facilities still giving patients old malaria medicines instead of a treatment that works.
"Here in Dabola, we manage to provide ACTs and see our patients cured after three days, but just 40 km down the road the situation is dramatically different: people aren't getting the best treatment although officially, the government changed the protocol a year ago already," said Dr Barbara Maccagno, medical coordinator for MSF in Guinea Conakry. MSF estimates that less than 1% of all malaria patients in the country are getting ACTs today. Malaria is the leading cause of death in Guinea, accounting for over 15% of all deaths recorded in the country's health facilities.
Guinea is by no means an isolated case. In Zambia, MSF estimates that a mere 11% of all patients presenting with malaria are receiving ACTs. MSF teams in several African countries report similar experiences: for example in Sudan, Kenya, Malawi, Côte d'Ivoire and Sierra Leone, the ministries of health are still using chloroquine or sulfadoxine-pyrimethamine, even though these drugs are known to be largely ineffective and are no longer recommended as first-line treatment.
Nearly 40 African countries or territories have adopted ACTs as their national treatment protocol for malaria to date. But out of these, over 70% are either not deploying the policy at all, or are implementing it very slowly. This is due to a combination of obstacles such as lack of political will and financial and human resources; lack of training for health workers and the resulting poor recognition of the benefits of ACTs among the communities; shortages of ACTs of assured quality; the fact that health workers do not have access to rapid diagnostic tests; and poor access to health care in general. So malaria, a curable disease, continues to kill a child every 30 seconds.
"The lack of coordinated support to countries by WHO's malaria programme, the Roll Back Malaria partnership and donors such as the US President's Malaria Initiative has hampered the procurement and distribution of ACTs at country level to date," said Dr Prudence Hamade, head of the MSF malaria working group.
"In addition, the Global Fund is a pure funding agency and has not been able to help countries with the actual ACT implementation process."
Out of the $208 million allocated by the Global Fund for ACTs since 2002, only about 30% has actually been used for procurement of this recommended treatment.
"Without rapid steps to ensure that effective drugs actually reach the people who need them, governments' decisions remain virtual and end up having no meaning for those who were supposed to benefit from them," said Dr Karim Laouabdia, Director of MSF's Campaign for Access to Essential Medicines.
"Giving patients chloroquine against malaria is about as effective as giving them a bag of sugar - medically and ethically, it is just wrong. We know implementing ACTs is no easy task, but no-one should be allowed to drag their feet in making sure these life-saving drugs get to all those who need them."
After some supply problems, companies are now producing ACTs. New fixed-dose combination treatments will be available by the end of 2006, with clear benefits to patients, such as a smaller pill count. There is no excuse not to act now.
In 2005, MSF treated approximately 1.8 million malaria patients in 40 countries in Africa, Asia and Latin America. MSF has been advocating for ACTs since 2001 and uses them consistently in its programmes worldwide. Malaria is a parasitic disease that is spread by mosquitoes and kills over one million people a year, mostly in Africa.