E-Drug: Distribution strategies for ACTs (5)
An ideal ACT distribution strategy should meet the following four basic
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
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.
Mr T A Chizanga
BPharm; M Pharm
Private Pharmacy Practice