Turning back the tide on malaria

In 1998, a global partnership was formed to combat malaria.  The Roll Back Malaria (RBM) initiative set up by WHO, UNICEF, the World Bank and others, pledged in 2000 to cut malarial deaths by half before 2010.  

But we have not managed to roll back the tide on this disease. Seven years on from WHO recommendations to national governments to switch to ACT as the first-line therapy, malaria statistics still make desperate reading.

ACT: A success on paper only ?

Although 41 out of 43 countries in Africa at high risk have made the switch to ACT on paper through their national protocols, the reality is that in many places where MSF works, ACT are hardly available outside our projects.

The global need for ACT is estimated to be at 350 - 500 million treatment courses. In 2005, however, only 23 million treatments were purchased and in 2006 the figure was still under 90 million treatments worldwide.

The problem extends to diagnostics: today, diagnosing malaria based on clinical symptoms alone, and not by microscopy or rapid test, is still the norm in many places. This means mistakes are often made in diagnosis and people are given anti-malarial drugs even though they aren’t infected. This can lead to deaths from incorrect diagnosis and inappropriate treatment.

 Why has ACT not been rolled out more widely ?

A variety of factors have hindered a wider roll out of ACT treatment. These include:

• Donor money for funding malaria has increased but applications for grants from country governments are often turned down because of inadequate information provided by the applicants and administrative red tape.
• Donors are continuing to fund older and ineffective malaria drugs.
• National governments continue to order older less effective malaria drugs such as chloroquine and SP on the basis that these are familiar and are cheaper than ACT.
• WHO has failed to prequalify enough malaria drugs - there are only two prequalified ACTs at present. Similarly the WHO has yet to recommend any specific rapid diagnostic test for malaria. Without this seal of approval, many countries prefer to use older, more familiar protocols.
• Cost remains a significant hurdle to ACT access. Some countries have introduced free public health care in recent years such as Zambia and Uganda. However many countries continue to charge patients user fees even though the drugs may be provided free by donors.
• Lack of knowledge among the population on the correct drugs to treat malaria meaning many patients who get their drugs through the private sector do not know which drugs to ask for.