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[e-drug] Distribution strategies for ACTs

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

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