In 2000, the Abuja Declaration issued by the African Summit on Roll Back Malaria, called on African countries to "Make appropriate treatment [of malaria] available and accessible to the poorest groups in the community." With increasing problems of resistance, this means ensuring access not only to 1st-, 2nd-, and 3rd-line antimalarial treatments, but also to the new, and hence more expensive, artemisinin-derived antimalarials.
But in order to devise effective strategies to improve access to anti-malarials, a clear picture must first be drawn of their current availability, funding for procurement, capacity for medicines regulation and control, and mechanisms for ensuring rational selection and use. While some of the related data are available within the ministries of health of malaria-endemic countries, they are often not disaggregated, which means that they cannot be used optimally in planning, budgeting or reporting.
To tackle this problem, a survey tool was developed and pilot-tested in Kenya. The tool incorporated elements of a drug pricing methodology already developed by Health Action International and WHO (see Working Out the Cost of Medicines on page 14). Survey results showed that:
• resources for procuring antimalarials are limited
• shortcomings exist in the quality of prescribing, but dispensing of antimalarials is often appropriate
• antimalarials are widely available
• antimalarial prices in private health facilities vary considerably
• post-marketing surveillance for quality assessment of antimalarials is sporadic
• patients who suspect that they have malaria mainly consult public health facilities
• 83% of those seeking medical care for malaria were diagnosed as having malaria
• 86% of patients diagnosed with malaria obtained the medicines they were prescribed
• 77% of those who obtained medicines took them as prescribed.
A similar survey will be carried out in 2003 in Ghana, Tanzania, Uganda and Zambia.
Price (US$) of 8 artemisinin antimalarial products varied widely in the private sector in Kenya in 2002
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