By Theresa Owusu-Ako - Ghana

Ghana has shifted the fight against malaria into high gear with the launch of the Affordable Medicines Facility for Malaria (AMFm) a brilliant idea to expand access to the most effective treatment for malaria ­- artemisinin-based combination therapies (ACTs).

The timeliness of AMFm is commendable at a time the world is struggling to cope with the disturbing news of resistance to the most efficacious treatment for malaria. The great expectation being that AMFm will lead to a reduction in the use of artemisinin as a single treatment or monotherapy, thereby delaying the onset of resistance to the drug and preserving its effectiveness.

The subsidized anti-malaria drug, ACT with the Green Leaf logo is being rolled out by the Ghana Health Service through its agency, National Malaria Control Programme (NMCP).

Some Africans refer to malaria as common but it is a serious ailment and a leading cause of economic loss to the nation. It also contributes to school absenteeism. Therefore the initiative to subsidise ACTs by making them as cheap as Chloroquine, or even cheaper, is a well-thought-out plan to ensure that malaria, which accounts for 38 percent of total Out Patients Department attendance in public health institutions, is checked.

                              ACT drug

The initiative is a co-financed intervention hosted and managed by the Global Fund, with a view to increasing the provision of affordable ACTs through the public, private and non-governmental organisations (NGOs). It will save lives and reduce the use of less-effective treatments, like chloroquine, to which malaria parasites are becoming increasingly resistant.

Evidence of the noble idea behind AMFm is in the fact that the subsidised Green-Leaf-Logo ACTs is selling at $1 compared to other ACTs which sell up to seven times that amount.

Given that many associate low-priced commodities with inferiority, health experts have quite a task convincing buyers that the Green Leaf Logo ACTs have the same efficacy as other ACTs on the market. These ones have only been subsidized to make them affordable and within the reach of all for the quick and effective treatment of malaria. 

AMFm is being implemented through pilots in eight countries: Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, Uganda, and Cambodia where there is reported resistance to ACT treatment.

It is up to patients in these countries to adhere to the correct dosage and not to abuse it. Abusing these artemisinin based combination therapies will deal a big blow to efforts aimed at eradicating malaria. 

Though research is on-going for other anti-malarials none has been rolled out yet so it is important to protect what is available now. 

It is absurd that doctors are still prescribing monotherapies for the treatment of malaria and describing every feverish condition as malaria even with the availability of Rapid Diagnostic Test Kits.  

For fear of losing out on ACTs, the WHO and partners have developed the Global Plan for Artemisinin Resistance Containment which has specific strategies to protest artemisinin:

• stopping the spread of resistant parasites,
• increasing monitoring and surveillance to evaluate the threat of arteminsinin resistance
• improving access to diagnostic and irrational treatment with ACTs and

• investing in artemisinin resistance-related research. 

There is the need for National Malaria Control Programmes and those who have been trained and equipped with knowledge on the ACTs to do an effective campaign on malaria treatment especially with ACTs.  

It is not enough to advise patients to complete their doses. It is essential also to explain the benefit of taking the two tablets in the blister as the doctor ordered.

Perhaps, the fixed dose will be more acceptable. That way, patients do not have the option to pick and choose.

Health workers and pharmacists should be able to explain issues well to patients since they are the frontliners in drug administration.

National Malaria Control Programmes should carry their education campaigns to public places such as the markets, churches, and community durbars to boost the campaign and bring knowledge of ACTs to the door step of people. 

Since Ghana has just rolled out the initiative and the programme is just for two years in it is absolutely necessary that every effort is made to meet its objectives. This is a prerequisite for further assistance. 

It is important for buyers to insist on the right price and get the treatment right. 

What is commendable is the involvement of the private sector in the marketing of the Green Leaf Logo ACTs.  However they have expressed concern about WHO not giving them the pre-qualification bid to be able to manufacture the drugs in Ghana.  

About 2.2 million doses of the Green Leaf ACTs have arrived in the country so far and are available in pharmacies and licensed chemical shops.   Another issue is how the programme can be sustained with effective monitoring and not allowing the drugs to be faked. 

 By so doing the drugs will be protected and together with other interventions the high malaria burden will be ameliorated for effective resource mobilisation and socio-economic advancement.