Anti-malarial treatment available to millions of poor Nigerians at a fraction of its normal cost

Millions of poor Nigerians will gain access to the most effective combination treatment for malaria at a fraction of its current cost, following the successful conclusion of negotiations between the United Kingdom Department for International Development (DFID) funded Partnership for Transforming Health Systems (PATHS2) and a variety of international and national stakeholders in Nigeria this week.  

PATHS2, in collaboration with the Clinton Health Access Initiative (CHAI), will provide life-saving anti-malaria treatments to health facilities based largely in rural communities in the five Nigerian states of Lagos, Kaduna, Jigawa, Enugu and Kano, the  latter state recently driven by terrorist bomb attacks.

A course of treatment will be provided for as little as 60 Naira (approximately 25 pence in Sterling), in comparison to previous costs of nearly 20 times as much, making the drugs affordable to even the poorest Nigerians, many of whom still subsist on less than US$1 a day.

The Affordable Medicines Facility for malaria (AMFm) is an innovative financing mechanism to expand access to affordable ACTs—Artemisinin-based Combination Therapies. ACTs are the medicines recommended by the World Health Organisation (WHO) as the most effective malaria treatment.

The AMFm is hosted and managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), with key financial support provided by UNITAID, DFID and the Bill & Melinda Gates Foundation, and with technical support provided by the Clinton Health Access Initiative (CHAI).

International manufacturers of ACTs receive a subsidy directly through the AMFm initiative almost to the tune of 95% which in turn is passed on by Nigerian pharmaceutical manufacturers, the First Line Buyers of ACTs. Acting as second line buyers, PATHS2 will distribute ACTs through primary health centres in the five Nigerian states in which it currently works, which have a total population of approximately 37 million, representing around 22% of the population of Nigeria as a whole.

Artemisinin-based Combination Therapies were introduced in Nigeria in 2005 for the treatment of uncomplicated malaria due to the increased resistance to chloroquine and sulphadoxine-pyrimethamine – also known as mono-therapies - which were older malaria medicines grown less effective due to the development of resistant strains .

PATHS2 has supported the significant reduction in prices of ACTs by bringing First Line Buyers and PATHS2 states together to discuss their requirement and support the signing of annual contracts between the states and First Line Buyers. The First Line Buyers are pharmaceutical companies in Nigeria who buy directly from WHO certified manufacturers outside the country. In Nigeria, there is currently no domestic manufacturer of AMFm drugs.

The First Line Buyer supported under AMFm will sell Artemisinin/ Lumefantrin (Pack of 24) for just 50 Naira to PATHS2 States health facilities and patients will get it for about 60 Naira, compared to its previous cost, which was as much as 2,000 Naira (£8-00). This pricing makes it the cheapest price available anywhere in the country.

It is estimated that 70% of all disease incidence in Nigeria is related to malaria. The World Malaria Report of 2008 recorded 57,506,430 cases of malaria across Nigeria, causing 225,424 fatalities.

“This ground breaking agreement between the international community, state governments and Nigerian pharmaceutical manufacturers will revolutionise the treatment of malaria in the five PATHS2 states,” said Mike Egboh, PATHS2’s National Programme Manager.

“It will have a significant long term positive impact on health care service delivery as it will strengthen the treatment of malaria and save tens of thousands of lives, particularly in rural areas of the five states in which PATHS2 is operating. It will also contribute to the reduction of maternal and infant mortality, as new mothers and their babies are particularly vulnerable to this dreadful disease.”

Subsidised ACTs are expected to come on stream in PATHS2 supported public health facilities within the next month or so.

Long term, PATHS2 hopes that the model it has successfully negotiated will be rolled out nationally, making the WHO’s drug treatment of choice for malaria affordable to the entire population of Nigeria.

The Partnership for Transforming Health Systems Phase Two (PATHS2) is a six year development initiative (2008-2014) that aims to ensure Nigeria achieves important health-related Millennium Development Goals.

Funded by UKaid, through the Department of International Development (DFID), PATHS2 works in partnership with the Government of Nigeria and other stakeholders, to improve the planning, financing and delivery of sustainable health services for those in most need. 

Apart from working at a Federal level, PATHS2 is working in the five States of Enugu, Jigawa, Kano, Kaduna and Lagos.

PATHS2 follows the successful PATHS1 project, which ran from 2002 to 2008, and was also funded by UKaid.

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The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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