E-Drug: Distribution strategies for ACTs (5)
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Dear E-Druggers
An ideal ACT distribution strategy should meet the following four basic
criteria:
a) promote rational use of medicines,
b) ensure mass population coverage,
c) ensure that the medicine can be used safely by the patients, and
d) prevent/delay the emergence of drug resistance.
The challenge is to find a balance among these competing interests. Below, are my personal views regarding the Zimbabwe’s experiences with ACTs.
a) In an effort to promote rational drug use, numerous public awareness and patient education campaigns have been carried out over the past two years using mass media such as radio, television, and the print media. On the health policy front, the country’s medicines regulatory body is in the process of changing the category of distribution of ACTs so that only the artemether and lumefantrine combination will be available for general use by the public whereas purchasing other ACTs (e.g. Duo-Cotecxin) will require a prescription from a specialist. This measure is intended to curb irrational use of *all* ACTs and to prevent the emergence of drug resistance.
b) In an effort to ensure wider public access to ACTs, the Ministry of Health and Child welfare has (in addition to existing clinics) recently embarked on an ambitious campaign to train Village Health workers (VHW) about how to use Malaria Rapid Diagnostic Tests (RDTs) and ACTs to diagnose and treat malaria. This is born out of the recognition that some degree of skill is required to deliver ACTs. Using VHWs is, in my view, is an elegant way of improving access while promoting rational drug use. Malaria diagnosis using RDTs is critical in preventing haphazard use of ACTs. Since VHW live within the communities and their catchment area often comprises approximately few hundred families, this means that patients don’t have travel long distances in order to access treatment. What’s more, outbreaks of malaria often occur during the rainy season when poor roads and brimming rivers preclude travelling to distant clinics.
Past experiences with chloroquine have taught us that a “mass distribution approach using self-treatment and social marketing” to ensure mass population coverage might not necessarily be the best approach because of potential irrational drug use and concerns about drug resistance. In view of the prohibitive costs (time and money) required to develop new drugs, I believe that using VHW might provide a viable alternative to the self-treatment and social marketing approach by ensuring mass population coverage whilst promoting rational drug use thereby delaying the emergence of drug resistance.
c) In an effort to ensure that ACTs are safe and efficacious, the country recently conducted a study called Cohort Event Monitoring for Artemether/Lumefantrine. The safety and efficacy of ACTs, and emerging drug resistance was assessed in several sentinel sites across the country.
In spite of these measures, access to affordable ACTs in urban areas, which are mainly dependent on the private sector, remains a mammoth challenge. I agree with Mwemezi Elnathan Ngemera “six points plan” especially the suggestion that Public-Private partnerships are needed to address these challenges.
Regards
Mr T A Chizanga
BPharm; M Pharm
Private Pharmacy Practice
Harare, Zimbabwe