A program designed as a "silver bullet" to fight malaria could actually be endangering lives, says Oxfam, because medicines are being distributed by unqualified shopkeepers and hawkers rather than trained health workers.
In a new report, Salt, Sugar and Malaria Pills, published today, the international agency says the Affordable Medicine Facility for malaria (AMFm) has shown no concrete evidence that it has been effective at saving the lives of the most vulnerable, or in delaying drug resistance. Despite backing by the Global Fund, Oxfam believes the AMFm, which is currently being piloted in seven countries, is skewing investment away from more effective solutions.
Dr Mohga Kamal Yanni, Oxfam's senior health policy advisor, said: "It is dangerous to put the lives of sick children in the hands of a shopkeeper with no medical training and to pursue a program that doesn't help those people who need it the most."
High risk of misdiagnosis
The AMFm was created to tackle malaria by subsidizing the cost of Artemisinin Combination Therapy (ACT), currently the most effective anti-malarial treatment, and promoting their sale through the private sector. But using untrained and unsupervised drug sellers poses a very high risk of misdiagnosis, given that malaria incidence is decreasing and therefore fevers are likely to be due to other causes. Some studies show that 60 per cent of fevers are not malarial.
Kamal Yanni said: "A shopkeeper selling salt, pepper and malaria medicines cannot diagnose or treat a child with pneumonia."
A recent evaluation described the AMFm as a 'game changer' that had increased availability and market share and decreased price, but gave no evidence of how many confirmed cases of malaria had been treated. It failed to concretely measure whether medicines were reaching the most vulnerable populations, like children living in poor and remote areas, and it ignored evidence from countries like Ethiopia where malaria deaths have halved in the last three years thanks to investment in community health workers.
"A dangerous distraction"
The AMFm has also caused excessive orders of ACT based on commercial interest rather than clinical needs. In Zanzibar, for example, the private sector ordered 150,000 treatments, in a country where less than 2,500 cases of malaria were reported in a year.
Oxfam is calling for the AMFm to be brought to an end at the Board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria on November 14th & 15th.
Kamal Yanni said: "There is no cheap option or short cut to combat malaria. The AMFm is a dangerous distraction from genuine solutions like investing in community health workers, who have slashed the number of malarial deaths in countries such as Zambia and Ethiopia. The Global Fund board must act on the evidence and put a stop to the AMFm now."