[afro-nets] Malaria ... about Rapid Diagnosis Kits

General afro-nets
1

Dear Colleagues

I am an experienced accountant but not an MD or medical scientist. As a cost accountant, I cannot understand why the WHO and the world's health planners are planning on spending around 75 cents US per unit for rapid diagnosis kits for malaria. I am told that a reasonable trained Africa health worker could handle a large number of blood smears each day at a unit cost that is an order of magnitude lower than the rapid diagnosis kits.

What explains this? What am I missing?

If a health worker ... nurse ... is being paid $50,000 a year, and a doctor is being paid $200,000 a year, and there is a shortage of nurses and doctors, then having a 75 cents rapid diagnostic kit makes economic sense ... but does it make the same economic sense for public health in Africa. Yet these rapid diagnosis kits are in the cost projections being discussed by WHO and Roll Back Malaria and their community of experts. I don't get it.

If these rapid diagnosis kits were 2 cents US each ... then it would be different. But at 2 cents there would be no profit in selling these kits. At 75 cents there is profit ... and it would appear that there has been some pretty aggressive marketing by the owners of this technology. Typically aggressive marketing includes significant inappropriate disbursements that nobody wants to talk about, including, but not limited to the funding of studies to demonstrate the effectiveness of the technology.

I only know a small bit about this aspect of malaria control costing ... and I would very much like to learn more. On the face of it, there is a nasty problem here based merely on my modest knowledge of cost accounting .. but maybe there is stuff that I don't know and should know.

If anyone can help my understanding please let me know. Thanks.

Sincerely

Peter Burgess

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Peter Burgess
The Transparency and Accountability Network: Tr-Ac-Net in New York
http://www.tr-ac-net.org
Community Accountancy
Integrated Malaria Management Consortium (IMMC)
+1 917 432 1191 or +1 212 772 6918
mailto:peterbnyc@gmail.com

2

Hi Peter

I am also missing something from your statement. There is shortage of both nurses and doctors not only in the US but also in Africa. Most of the nurses and doctors trained in Africa now reside and work in Europe/USA for better economic opportunities. The ratio of doctor/nurse to the population is very high. The fact that you have been told that a well trained health worker can handle a large number of blood smears each day does not necessarily translate to cost-efficiency and cost-effectiveness. You may wish to factor into your cost analysis the burden of over-loading these health workers and the burnt-out rate if it continues. Also factor in the bribes that patients must pay to some of these healthcare workers in order to get their lab results in a timely manner because of the inadequate number of trained personnel. The rapid diagnosis kit makes sense especially rural Africa where most of the population resides and again where most of the clinics,/hospitals and healthcare facilities are without doctors and nurses.. Let's not discourage the production and use of these kits.

If there is inappropriate disbursements that is the duty of trained auditors and they bring such people before the law courts. In any case aggressive marketing as you defined it has always been part of new services/technologies. It is not limited to these kits. Otherwise how else will new services/technologies be marketed? Regulatory bodies/NGOs as well as the general public have a duty to monitor this demonstrations and point out the deficiencies

S. Nana Osei-Bonsu
+1 212-361-0668
mailto:oseibonsu@aol.com

3

Hi Peter,

The jury is still out concerning the feasibility of RDTs in malaria i.e. financial and otherwise. According to Zurovac et al what we have is a mixed bag of results depending on level of transmission (at least for Kenya). Check out their paper, whose abstract I've copy pasted below.