dear sir – response to AMFm article in the economist

on 24 novemberthis article was published in the economist on AMFm and the Global Fund. below is the response i would have liked to have published because a few things in the article were maddening. particularly frustrating are those celebrating the end of AMFm as though ending a subsidy on ACTs in the private sector are the same thing as removing ACTs from the private sector. it’s not. so far as i know, we have not yet heard whether pharmaceutical companies intend to keep their ACT prices low, in order to tap into the non-premium market uncovered in AMFm. in any case, malaria programs moving forward need to address the reality of treatment-seeking behavior and expectations for fever in the wake of AMFm. 

‘Sir – At least two things on the horizon for malaria treatment – for both the Global Fund and the larger global health community – are not cloudy in the dust of the Affordable Medicines Facility–malaria (AMFm). Yet these points remain under-discussed.

First, the end of the AMFm subsidy for malaria treatment does not eliminate the obligation to scale-up malaria and broader fever diagnosis in both the private and public sectors. The globally recommended treatment for malaria – ACTs – are legally available over-the-counter in three of the seven countries that piloted AMFm. This includes Nigeria, which accounts for one-quarter of global malaria deaths. It also includes Ghana and Uganda.

Even where citizens cannot legally access ACTs over-the-counter, they can often obtain these treatments as easily as if the laws supported such access. Unless the global discussion shifts to changing and enforcing national drug regulations – which it has not – we need to continue talking about scaling-up diagnosis at the gamut of fever-treatment points. This remains the case with or without a subsidy.

Second, it is a false dichotomy that aid money be directed to either a drug subsidy or a community health worker (CHW) effort. Instead, we need to discuss how to apply lessons from successful CHW programs to the variety of workers on the front-lines of treating fevers. Again, those in both the private and public sectors who are, in reality, treating fevers. Researchers working with community health workers suggest that, where in place, CHWs can appropriately distinguish and treat fevers, as well as encourage their charges to complete treatment. However, the CHW model has not proved viable in each context it has been tried. As such, not every malaria-burdened country has trained, scaled-up, and maintained CHWs, despite attempts since the late 1970s. We need to discuss the current realities of safely treating fevers in countries shouldering malaria burdens in order to develop both short- and long-term plans.

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