GENEVA - April 21 - Alarmingly few African patients with malaria are getting existing effective treatment that could cure them in a few days, says Doctors Without Borders/Médecins Sans Frontières (MSF). Four years after the World Health Organization (WHO) issued a global recommendation for countries to switch from old malaria treatments to artemisinin-based combination therapies, or ACTs, and two years after the Global Fund decided to fund ACTs, MSF teams are witnessing government-run health facilities still giving patients old malaria medicines instead of a treatment that works.
In the West African country of Guinea, malaria is the leading cause of death, accounting for over 15 percent of all deaths recorded in the country's health facilities. "Here in the town of Dabola, we manage to provide ACTs and we see our patients cured after three days, but just 40 km down the road the situation is dramatically different – people aren't getting the best treatment although officially, the government changed the protocol a year ago," said Dr. Barbara Maccagno, medical coordinator for MSF in Guinea. MSF estimates that less than one percent of all malaria patients in the country are getting ACTs today.
Guinea is by no means an isolated case. In Zambia, MSF estimates that a mere 11 percent of all patients presenting with malaria are receiving ACTs. MSF teams in several African countries report similar experiences. In Sudan, Kenya, Malawi, Côte d'Ivoire, and Sierra Leone, the ministries of health are still using chloroquine or sulfadoxine-pyrimethamine, drugs known to be largely ineffective in many areas due to resistance and no longer recommended as first-line treatment.
Nearly 40 African countries or territories have adopted ACTs as their national treatment protocol for malaria to date. Of these, however, over 70 percent are either not deploying the policy at all or are implementing it very slowly. This is due to a combination of obstacles such as lack of political will and financial and human resources; lack of training for health workers and the resulting poor recognition of the benefits of ACTs among the communities; shortages of ACTs of assured quality; the fact that health workers do not have access to rapid diagnostic tests; and poor access to health care in general. Therefore malaria, a curable disease, continues to kill a child every 30 seconds.
"The lack of coordinated support to countries by WHO's malaria program, the Roll Back Malaria partnership, and by donors such as the US President's Malaria Initiative, has hampered the procurement and distribution of ACTs at country level to date," said Dr. Prudence Hamade, head of the MSF's malaria working group. "In addition, the Global Fund is a pure funding agency and has not been able to help countries with the actual ACT implementation process." Out of the $208 million allocated by the Global Fund for ACTs since 2002, only about 30 percent has actually been used for procurement of this recommended treatment.
"Without rapid steps to ensure that effective drugs actually reach the people who need them, governments' decisions remain virtual and end up having no meaning for those who were supposed to benefit from them," said Dr. Karim Laouabdia, director of MSF's Campaign for Access to Essential Medicines. "Giving patients chloroquine against malaria is as ineffective as giving them a placebo – medically and ethically. It is just wrong. We know implementing ACTs is no easy task, but noone should be allowed to drag their feet in making sure these life-saving drugs get to all those who need them."
In 2005, MSF treated approximately 1.8 million malaria patients in 40 countries in Africa, Asia and Latin America. MSF has been advocating for ACTs since 2001 and uses them consistently in its programs worldwide. Malaria is a parasitic disease that is spread by mosquitoes and kills over one million people a year, mostly in Africa.