InterCountry Meeting of National Malaria Programme Managers

1
Inter-Country Meeting of National Malaria
Programme Managers

• Ensure Access to Diagnosis and Treatment of
  Malaria
• Mohammadou Kabir Cham
• Muscat, Oman, March 24 - 28, 2002

2
Overview of Presentation

• Disease Management
• Diagnosis
• Definition of access
• Determinants of access
• Potential interventions to improve access
• Treatment Policy

3
References

• Assessment of therapeutic efficacy of
  antimalarial drugs for uncomplicated falciparum
  malaria. WHO, 1996.
• Improving access to essential drugs through
  innovative partnerships. WHO/IFPMA Action Paper.
  November 2000.
• WHO Technical Report Series 892. WHO Expert
  Committee on Malaria. Geneva 2000.

4
References

• Use of antimalarial drugs. Report of a WHO
  Informal Consultation. November 13 - 17, 2000
• Antimalarial drug combination therapy. Report of
  a WHO Technical Consultation. April 4 - 5, 2001
• Implementation of new antimalarial teatment
  policies in Africa. Discussion paper for RBM
  Partners meeting, February 26 - 28, 2002

5
Disease Management

• Early diagnosis and prompt treatment is a
  technical component of RBM
• Effectiveness is highly dependent on safe,
  effective, available, affordable and acceptable
  to the population at risk antimalarial drugs

6
Rational Use of Antimalarial Drugs

• Shortens duration of illness
• Reduces risk of severe disease and death
• Contributes to slow down development of
  resistance

7
Diagnosis

• Clinical diagnosis - low specificity
• Parasite detection
• Basic microscopy
• low direct cost, sensitive, differentiates
  between species, determines parasite density
  levels, and can be used to diagnose other
  conditions
• difficult to maintain good microscopy at the
  periphery

8
Diagnosis

• Antigen-based tests
• Histidine-rich protein II (HRPII) for asexual Pf
  (water soluble protein)
• HRPII persists after effective treatment
• Parasite specific lactate dehydrogenase (pLDH)
  produced by sexual stages
• can detect other species than P.falciparum
• not persistently positive after treatment

9
Diagnosis

• Microscopy using fluorochromes (acridine orange)
• PCR
• Antibody detection by serology

10
Definition of Access

• Timely availability, within varied
• physical and economical conditions,
• of safe, effective and assured quality
• of antimalarial drugs to those
• who need them

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Determinants of Access

• National treatment policy
• formulation, dose, regimen, potential
  side-effects
• Basic infrastructure conditions
• irregular drug supply
• ineffective distribution
• inappropriate use of drugs

12
Determinants of Access

• Economic conditions
• lack of political will to allocate fiscal
  resources
• macroeconomic constraints
• no priority within overall public budgets
• declining financial resources
• Legislative and regulatory guidance
• Global and national situations

13
Interventions to Improve Access

• Rational selection and use of drugs
• developing essential drugs lists
• capacity building
• improving availability of diagnostics
• standard treatment guidelines
• regulating pharmaceutical promotion
• monitoring and timely responding to drug
  resistance

14
Interventions to Improve Access

• Affordability
• Overcome price barriers
• Efforts to address access for the poorest
• Sustainable financing
• Increasing budget allocation to health
• Maximise efficiencies
• Insurance systems
• New financing mechanisms

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Interventions to Improve Access

• Reliable health and supply systems
• Public Sector
• Procurement based on national guidelines
• Appropriate estimate needs
• Optimising stock levels
• Commercial Sector
• Incentives to supply remote areas
• Regular quality control
• Reduce inefficiencies

16
Interventions to Improve Access

• Actions to address institutional, programmatic or
  technical constraints
• Recognition of diversity of stakeholders
• Willingness to embrace the diversity

17
Antimalarial Treatment Policy

• Set of recommendations and regulations concerning
  availability and rational use of antimalarial
  drugs
• Part of the essential drug list and national
  malaria control policy
• Provides policy-makers with evidence-based
  recommendations
• Provides health workers with clear guidelines for
  early diagnosis and prompt treatment appropriate
  to the local context

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Purpose of Treatment Policy

• Access to safe, effective, good quality and
  affordable antimalarial drugs to
• ensure a rapid and long lasting clinical cure
• produce an overall reduction in malaria
  morbidity, including anaemia
• interrupt progression of uncomplicated malaria
• reduce consequences of placental malaria
  infection and maternal malaria associated anaemia
  
• delay development and spread resistance

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Challenge

• Achieving a balance between two
• essential but at times competing
• principles
• ensuring prompt treatment of malaria, and
• ensuring that antimalarial drugs have a maximum
  useful life span

20
Key Issues

• Financing new generation of antimalarials,
  through SWAPs, PRSPs and GFATM
• Greater co-ordination at country level
• Better communication amongst the partners
• Defined modalities of operation
• Supporting and strengthening global and country
  systems for drug procurement, distribution and
  management
• Strengthening health systems