Monthly Archives: May 2011

Chase for Profit Hampers Malaria Drugs Subsidy

On the streets of Nairobi, James Odhiambo goes from one pharmacy to the next in search of anti-malarial drugs marked with the Global Fund’s logo of a green leaf. He is looking for this specific brand because he understands that it is more than 10 times cheaper than the same drug produced by different manufacturers.

He finally buys it from Nila Pharmacies along Accra Road – the sixth outlet he has visited this morning.

“My brother was yesterday evening diagnosed with malaria at a private clinic in Dandora suburb upon his arrival from a two week holiday in the lakeside city of Kisumu. That is why I have come to town to search for drugs,” says Odhiambo holding a prescription from the Samaritan Health Clinic – where his brother was diagnosed.

However, Odhiambo says his brother could not buy anti-malarial drugs from the clinic where he was tested because the available drugs were expensive costing Sh400 (five dollars). This is the average price of anti-malaria drugs in Kenya.

“We have always seen these subsidised drugs being advertised all over in the media. We were not going to waste the entire Sh400–equivalent to two days’ wages – on a similar dose,” said Odhiambo, who works as a casual labourer in the city.

The drugs Odhiambo is referring to are subsidised through the Affordable Medicines Facility – malaria (AMFm). All drugs manufactured under the scheme have the logo of a green leaf. It is managed by the Global Fund with support from the United Nations, the UK Department for International Development and related donors.

Kenya was one of the very first countries in Africa to implement the scheme in August 2010, where a dose for an adult was supposed to retail at 50 cents, and a dose for children under the age of five would cost Sh10 .

However, many pharmacies across the country took advantage of the subsidy to maximise profits.

“Two months ago, we requested our reporters from different parts of the country, including rural areas, to check on retailing prices of the subsidised anti-malarial drugs. As a result, we discovered that pharmacists sold them at varying prices ranging from Sh80 (one dollar), to Sh240 (three dollars),” says Gatonye Gathura, the chief science reporter at the Nation Media Group in Kenya.

A pharmacist at a private pharmacy in Buru Buru Estate in Nairobi told IPS that she had to inflate the price simply because if she sold the drugs at the recommended retail price, it would not make any economic sense to her – considering her costs of transporting it from the distributors, and other inputs.

According to Harley’s Ltd, the distributor of one of the brands recommended for subsidy, a dose for an adult should be sold to retailers for Sh26 to be sold to consumers at the recommended price of Sh40 (50 cents).

But like many other pharmacists, Linda Atieno’s pharmacy did not stock the subsidised drugs. “If I sold a dose of unsubsidised Coartem drugs for example, I make a profit of up to Sh200 (over two dollars). This compares poorly with the profit I would make from a dose of the subsidised version of Coartem – which is Sh14,” she says.

Inflating costs

In order to reduce instances where pharmacists are inflating the cost of the subsidised drugs, the Kenyan government has embarked on awareness campaigns through the media to inform Kenyans of the availability of the drugs, and the recommended prices per dose.

According to Dr John Logedi, the deputy programme manager at the Division of Malaria Control, the awareness campaign will help consumers make an informed choice and enable them to seek outlets that sell the drugs at the right price.

Technically, the government of Kenya does not have control over drugs sold in pharmacies in the private sector because the pharmaceutical market in the country is based on “a willing seller, willing buyer” concept.

So far, the subsidised drugs in Kenya are distributed through both the public and the private sector.

However, despite difficulties in searching for pharmacies that stock the subsidised drugs and sells them at the correct prices, Odhiambo admits that the subsidy programme is a great relief to many people with a meagre income like his. “Most of us cannot afford the unsubsidised drugs that cost up to Sh600 (over seven dollars). The subsidy is therefore good news to most of us,” he said.

In marginalised rural areas such as Turkana, private pharmacies are yet to begin stocking the subsidised drugs, despite the launch of the programme several months ago.

“We have the subsidised drugs in public health centres within Turkana Central. But not in private pharmacies,” said Dr Gilchrist Lokoel, the Turkana Central Medical Officer of Health at the Lodwar District Hospital.

Phase one of AMFm is already under implementation in nine pilots in eight countries. They include Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar) and Uganda.

 

Progress Against Malaria in Africa Is Real but Fragile

Ellen Johnson Sirleaf and Robert B. Zoellick

On this past Monday, April 25 — World Malaria Day — the news from Africa was good.

Over the past decade, 11 African countries have seen the number of confirmed malaria cases, malaria-related hospital admissions or deaths drop by more than 50%, according to 2009 data. When 2010 figures become available we expect to see similar progress in even more countries.

The good news stems in part from the fact that approximately three-quarters of the people at risk of contracting malaria in Africa, which bears the disease’s heaviest burden of death and debilitating illness, were using insecticide-treated mosquito nets by the end of 2010. That suggests that the goal of protecting the whole of Africa’s population with bed nets and effectively preventing the fevers and crushing headaches of malaria appears within reach. (See how malaria has crippled one town in Uganda.)

More welcome news: global deaths from malaria have fallen from nearly a million a year in 2000 to 781,000 in 2009. But even while we mark what may be a turning point in our effort to eradicate the disease, we cannot overestimate our progress. It is fragile.

Malaria continues to exact a great toll, killing three-quarters of a million people a year, more than 90% in Africa, which accounts for about one in six child deaths. The consequences of losing our focus now would be deadly. Mosquito bed nets last about three years, and a failure to replace the more than 300 million nets blanketing Africa over the coming three years could lead to resurgent malaria illness and deaths. Just this past year, Zambia faced a resurgence of malaria in a few provinces when mosquito nets were not replaced in time. Deaths and illness increased within months. Rapid action to address this increase has since been taken by the Zambian government, together with the World Bank, U.N. Foundation, Bill and Melinda Gates Foundation, Stanbic Bank, the African Leaders Malaria Alliance (ALMA), and the U.N. Special Envoy’s Office. (See photos of the most malarial town on Earth.)

While funding is important, it is really the partnerships that have been built with citizens, governments, and health-care providers as well as the increasing reliance on and use of science, technology and the body of medical evidence that can accelerate progress in this area. For instance, beyond the wide distribution of mosquito nets, ending malaria deaths will require making sure that effective diagnosis and timely treatment become available to every patient. Health authorities need to keep better track of where malaria still exists and which drugs produce the best health outcomes. We want funding to be targeted and effective, not a simple throwing of money at the problem.

In the wake of the global financial crisis, we face difficult choices with limited resources. Liberia, for one, has made it a priority to end deaths from malaria above many other pressing needs, for both health and economic reasons. As a result, Liberia is on track to protect its entire population by year’s end. But Liberia is not alone. Thirty-nine African countries have united against the disease under ALMA, chaired by Tanzanian President Jakaya Kikwete. This cooperation is the only way we can overcome the disease. No country is an island when it comes to malaria; mosquitoes do not respect borders.

In mobilizing the money, the bed nets and the treatment, and in strengthening supply chains for lifesaving medicines, our bedrock guiding principle must be stronger accountability. ALMA’s flagship accountability initiative is a simple tool, commonly employed in the private sector: a scorecard. (See TIME’s special report on the battle for global health.)

Currently under development with our partners in the Roll Back Malaria Partnership, the scorecard will track progress, identify what is working and what is not and highlight where intervention is required. We will further expand the use of new technology platforms, such as texting and Twitter, to reach hundreds of millions of people to create positive pressure at all levels, and to encourage demand for transparency, accountability and results by citizens.

Africa’s partners, including the World Bank, are committed to ending deaths from malaria. In 2010, the Bank pledged $200 million to anti-malaria efforts in Africa, largely to provide bed nets to families in the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Mozambique, Sierra Leone and Zambia. This helped to close emergency gaps. Consistent with the priorities of African countries, we expect new financing, mobilized from the latest replenishment of the International Development Association, the Bank’s fund for the poorest countries, to be committed to the fight against malaria, including through our work on helping African countries build stronger health systems.

So as we take inspiration this week from African countries that now have malaria in retreat, we also need to recommit to finish the job. Allowing hard-won gains to be reversed cannot be an option.

Zoellick is president of the World Bank Group. Sirleaf is President of Liberia and the incoming chair of the African Leaders Malaria Alliance, whose members — African heads of state and government — are working to end malaria-related deaths in Africa.


 

Educating the Local Child

A recent survey, which shows that some Nigerian children have never attended school, is true but totally unacceptable, particularly when it has been established that literacy is a vital instrument for national development.

Results of the survey released in Abuja recently, which looked at the situation in different geo-political zones and states revealed that 72 per cent of children aged between 6 and 16 years in Borno State, for instance, have never been in school.

According to the chairman of the National Population Commission (NPC), Mr. Samaila Makama, who presented the key findings of the Nigeria Education Data Survey (NEDS) 2010, states in the northern part of the country have the lowest rate of basic school attendance across Nigeria, with states in the North-West and the North-East geo-political zones being the worst hit.

From the survey, Borno State is closely followed by Yobe State, which has 58 per cent and Bauchi State, which has 52 per cent.

In the North West zone, Zamfara State leads the pack with 68 per cent, followed by Sokoto State – with 66 per cent, while Kebbi came third with 60 per cent.

The result for the North-Central zone shows Niger State having the highest rate of non-attendance with 47 per cent, followed by Kwara, Benue and Nasarawa states all tied at 12 per cent each.

Other revelations by the report included trends in Secondary Net Attendance Ratio, indicating participation in schooling among those of official school age (12-17 years). The report shows that secondary school attendance by students within the official school age range has increased over the years from 24 per cent in 1990 to 44 per cent in 2010.

The survey clearly shows that the northern part of the country has continued to lose the race to meet the target in the education component of the 2015 Millennium Development Goals (MDGs).

The results of the survey notwithstanding, the fact remains that over the last decade, and according to a United Nations Children’s Fund (UNICEF) report, Nigeria’s exponential growth in population and bad governance, have combined to put immense pressure on the country’s resources and on already overstretched public services and infrastructure.

The result of this sad situation is that across the country, a good number of children are living on the streets, under bridges, in motor parks, market stalls or with other families sometimes in slave- like conditions.

Most of these children, whose ages range from 5-17, are involved in different types of work without any clear pattern and are prone to illnesses, malnourishment, drug abuse, sexual abuse, crimes, accidents, arrest and harassment by law enforcement agents, and are also at risk of being trafficked.

It is estimated that about 4.7 million children of primary school age are still not in school and despite a significant increase in net enrolment rates in recent years, particularly in the southern part of the country, most of those in school study under very unhealthy conditions.

For a country that wants to be counted among the 20 biggest economies of the world by the year 2020, this, obviously, is not the way to go.

Indeed, there is little or nothing to celebrate in our education sector, even in those states of the country that have recorded increased enrolment rates. The increase in enrolment without commensurate improvement in infrastructure has made it more difficult to guarantee quality education and conducive learning environment.

Although the compulsory free Universal Basic Education (UBE) Act, passed into law to fight illiteracy and extend basic education opportunities to all children in the country is meant to address such situations, the number of schools, facilities and teachers available for this scheme across the country, still remain inadequate for the number of children and youths that are eligible for the programme.

Despite political commitment to trying to reverse years of neglect in the education sector and a significant increase in federal funding, a lot still needs to be done as investment in basic education in Nigeria is still low when compared to other Sub-Saharan countries.

For instance, the issue of girl-child education, particularly in Northern Nigeria, where the gender gap remains particularly wide, must be addressed.

While the authorities must double efforts to ensure that all school age children are enrolled in schools, emphasis must also be placed on provision of quality education in conducive environment with necessary infrastructure. Also efforts must be made to ensure that those who enrol in schools stay till the end of their studies. This is because it has been found that some families cannot afford the associated costs of sending their children to school such as uniforms, textbooks, transportation and feeding.

Indeed, many children do not complete the primary education cycle. According to current data from UNICEF, 30 per cent of pupils in Nigeria drop out of primary school and only 54 per cent transit to Junior Secondary Schools. Reasons for this low completion rate include economic hardship that leads to child labour and early marriage for girls.

Against this background, it is obvious that there is little or no hope of Nigeria achieving the MDG of ‘Education For All by 2015’ except something urgent and drastic is done by all stakeholders including the Federal and state governments, development partners, friendly foreign countries and non governmental organisations, because without mass literacy rapid development would continue to be elusive.

AllAfrica.com