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Anti-Malarial Efforts Challenged

Sleeping under a mosquito bednet is the most effective way to protect against contracting malaria . Illicit sale of over priced anti malarial products, like bednets and ACTs, threaten PMI’s efforts to combat malaria in Benin. (Photo USAID)

The permanent availability of anti-malarial drugs and other products is a key element of success in the fight against malaria. In Benin, an important challenge for the health system is to ensure that supplies of anti-malarial products are uninterrupted so that every citizen has access to products whenever s/he needs it, regardless of where s/he lives.

As part of the President’s Malaria Initiative (PMI), USAID has helped Benin’s National Malaria Control Program (NMCP) with the acquisition of health commodities for the treatment and prevention of malaria. Since October 2007, PMI has made available 1.1 million artemisinine-based combination treatments (ACT), 2.3 million tablets of sulfadoxine-pyrimethamine (SP) for the preventive treatment of pregnant women, 650,000 mosquito bed nets impregnated with long-acting insecticides (ITNs), and 30 kits of microscopes and laboratory consumables for the accurate and rapid diagnosis of malaria.

In July 2008, the Benin Ministry of Health issued new directives instructing health providers to prescribe ACT -- which is most effective for the treatment of uncomplicated cases of malaria -- and banning chloroquine and other medication that are proven ineffective in Benin against malaria. However, barriers to malaria treatment in the form of stock outs or the illicit sale of over priced anti malarial products threaten PMI’s efforts to combat malaria in Benin. These barriers also discourage vulnerable populations from seeking treatment from the public health system.

A USAID and Integrated Family Health Project (PISAF) team visited Zou-Collines health facilities and communities in Savalou, Glazoué, Paouignian, and Banamé to verify that the anti-malarial treatment and prevention products prescribed by the Ministry of Health of Benin were available and that the communities are informed and have access to them.

The team met and talked with the Regional Health Director (DDS), Health Zone Coordinators, boards of community health insurance mutuals, midwives, and community health promoters (Relais communautaires), as well as local radio stations that partner with PISAF to broadcast messages on child and maternal health topics, including malaria.

As the USAID / PISAF team observed in Lahotan and Paouignan, stock outs of anti-malarial treatments and the prescription of ineffective drugs are common occurrences in public health facilities, while inventories of medical supplies donated by the international community lay idle in central medical stores, or find their way into the black market where they are sold at inflated prices.

The visit to Zou-Collines shed light on the many challenges to getting anti-malaria products into the hands of those who need it. Among the barriers the USAID/PISAF team identified with health facility personnel are:

Anti-malarial treatments in a day pharmacy at a communal health facility. Uninterrupted access to anti-malarial ACT treatments donated under PMI is a top priority of USAID’s support to Benin. (Photo USAID)

The continued availability and prescription of obsolete and ineffectual anti-malarial medicines. A pricing policy for ACTs, which does not generate a profit margin sufficient to enable community health centers to cover the costs for re-stocking anti-malaria products. An unclear system for handling the proceeds of anti-malaria product sales and crediting them back to the health centers. A Management Information System that is not functional. Removing these obstacles is crucial to ensuring uninterrupted access to malaria treatment and prevention products by the most vulnerable populations of Benin. USAID and other donor efforts, notably the World Bank’s Booster program, are assisting Benin to remove these barriers and strengthen its health system, a necessary step in the PMI goal of reducing the number of malaria-related sickness and death by 50 percent by 2010.

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