Uganda

Uganda: Hope looms in fight against malaria

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Evelyn Lirri

Despite a decision by many countries including Uganda to switch to artemisinin-based combination therapies (ACTs) to treat malaria, stock-outs and high costs of the drugs are still prohibitive for many Ugandans.

ACTs are widely recommended by the government and the World Health Organisation and have been found to be effective. But as a new report, "Understanding the Antimalarials Market: Uganda 2007," jointly published by the Ministry of Health and Medicines for Malaria Venture (MMV), a public-private partnership venture to develop effective and affordable anti malarial drugs finds that the drug is widely unavailable in the rural areas, especially outside government health facilities.

Though they are supposed to be free in government health facilities, because of the stock outs, patients are forced to turn to the private health facilities to access these drugs. But even in the private sector, they are either not available or too expensive.

ACTs like Coertem typically cost between Shs12,000 for children and Shs18,000 for adults a doze at private clinics. This is far beyond the reach of the 31 percent - about 8.4 million people who live below the poverty line or on less than a dollar a day.

In the accompanying press statement issued on the same the report was released on November 6, State Minister for Health, Dr Emmanuel Otaala said that plans are underway, to increase availability of ACTs by reducing their costs through subsidies to Shs200 and Shs400 a doze for children and adults, respectively, in private health facilities. This, he said, is because most people prefer seeking treatment from private health facilities.

Indeed the report found that 71% of outlets providing antimalarial medicines are private sector facilities.

"ACTs can cost up to 60 times the price of ineffective medicines like chloroquine," the report reveals.

Up until recently, monotherapy drugs like chloroquine and fansidar were used to treat malaria but have over the years developed resistance. Now, health experts say drug combinations, rather than monotherapy are the best solution with artemisinin-based drug combinations such as Coartem recording cure rates similar to that of chloroquine 30 years ago.

In Uganda, malaria is a leading cause of death; killing close to 320 people everyday -mostly pregnant women and children under the age of five.

According to statistics from the Ministry of Health, malaria is also responsible for the high poverty levels in the country, with at least 25 percent of Ugandan households spending their incomes to treat malaria alone

"This study provides powerful evidence to policy-makers and donors to build a case for greater accessibility of effective antimalarials via all channels, public or private," said Mr Chris Hentschel, the president and chief executive officer of MMV in the November 6 statement.

Commenting on the report, Health Minister, Dr Stephen Malinga said it provides clear evidence on how to make life-saving ACTs available to the most vulnerable population.

"Governments and donors will not win the fight against malaria and poverty unless they continue to strengthen the public health system. However, the study leaves us in no doubt that ACTs must also be made available in the private sector at a price that people can afford," said Prof. Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership.

Uganda is one of the countries that will benefit from a new $3 billion Global Action Plan launched in September 2008 to reduce deaths from malaria to near zero by 2015 that is being championed by the Roll Back Malaria Partnership.

Part of the plan is to increase access to insecticide-treated bed nets and undertake indoor residual spraying in malaria endemic areas.