Anti-malaria drugs in private sector crossing borders

By Esther Nakkazi

Subsidized anti-malarial drugs sold through private sector outlets are now crossing borders and getting repackaged to retail at prices far above the target of making them easily accessible to the public.

In 2010, the Global Fund started the Affordable Medicines Facility for malaria (AMFm) project with a financing model that would make Artemisinin-based Combination Therapies (ACTs) affordable and accessible to the public within 24 hours.

It was envisaged that the initiative would save at least 70,000 lives and lead to savings of about $65 per household annually, the amount an average family in Uganda spends on ACT for malaria treatment per year according to the Global Fund.

The project-financing model subsidized ACTs by 95 percent so that the consumer would pay a price over 1,000 percent lower than the usual price through the private sector outlets where about 60 percent of Ugandans go when they fall sick.

But the price has failed to be translated to the consumer as the ACTs are repackaged and resold to markets in Kenya, southern Sudan and DR Congo. The project has also been slow in taking off.

In Uganda, one of the nine pilot countries under the project, the ACTs cost up to Ush 20,000 ($8.5) although the targeted price after subsidizing them by the Global Fund was meant to be only Ush 1,200 ($0.5).

“We are now recovering more anti-malarials that are supposed to be sold through the private sector and they cost so much more,” said Dr. Diane Atwine head of the Medicines and Health Services Monitoring Unit (MHSMU).

The monitoring unit set up in 2009 to investigate the theft of drugs from government facilities so far has no records of the quantities of ACTs recovered but estimated that anti-malarials and antibiotics worth $ 2.5 million have been intercepted since November 2011. 

Artemisinin-based combination therapy is the World Health Organization (WHO) recommended first line treatment for malaria in public and private facilities.

Stakeholders have blamed the illicit ACTs trade by the private sector on the weak packaging, in blisters, which makes them susceptible to retailers. They remove the outer cover and put them in tins. However, its not only those that are prone but even those that are not repackaged.

The Global Fund ACTs packages do not bear the official price, which would inform consumers of the price. They only bear a green leaf as a logo, which apparently signifies affordability and effectiveness of the antimalarials, said Dr. Atwine.

The logo was also meant to distinguish the subsidized ACTs from others sold through the private sector and guide consumer choice. But there is no awareness by the public on their availability.

“It is also a mindset problem. People consider cheap things to be of low quality. Until there is enough awareness created, the skeptical public might take time to buy these drugs,” said Dennis Kibira, the medicines advisor at HEPS-Uganda.

According to Kibira, this would require a strong behavior change campaign, which has not taken place. While the project kicked off early 2010, the medicines arrived in April last year and the awareness campaign only starts next month.

Secondly, it was anticipated that the under the project ACTs would flood the market, in a sense of supply outstripping demand within a price regulated market but this has not happened.

“We thought drugs would flood the market but it has been slow. We now have funds for creating awareness through a national campaign so that the public can know that the ACTs are available at a subsidized rate,” said Dr. Peter Albert Okui, at the National Malaria control programme.

Research shows that ACTs are not readily available in Uganda and are only in as few as 1 in 25 private sector drug outlets. And only 6 percent of children access ACTs in 24 hours although it kills mostly pregnant women and children below 5 years old.

As close to homes as they can get, access to antimalarials within 24 hours would improve Ugandans health to reach the Abuja revised Roll back Malaria (RBM) target of 80 percent populations with no malaria.

Ends.