A Major Failure to Provide Access to Effective Treatment

Abstract A key bench mark of successful therapeutic policy implementation, and thus effectiveness, is thatthe recommended drugs are available at the point of care. Two years after artemether-lumefathrine(AL) was introduced for the management of uncomplicated malaria in Kenya, we carried out across-sectional survey to investigate AL availability in government facilities in seven malaria-endemic districts. One of four of the surveyed facilities had none of the four AL weight-specifictreatment packs in stock; three of four facilities were out of stock of at least one weight-specificAL pack, leading health workers to prescribe a range of inappropriate alternatives. The shortagewas in large part caused by a delayed procurement process. National ministries of health and theinternational community must address the current shortcomings facing antimalarial drug supply tothe public sector.The widespread failure of chloroquine and sulfadoxine pyrimethamine (SP) in the treatmentof malaria in Africa during the late 1990s resulted in a turbulent public health debate, whichled to universal acceptance that mono-therapies that failed to cure up to one in four patientsshould be replaced by highly efficacious artemisinin-based combination therapy (ACT).1-3More than 40 countries in Africa have now adopted ACT as their first line treatmentrecommendation for uncomplicated malaria.4 Beyond the difficulties of changing nationaltreatment policies, a key bench mark of successful policy implementation, and thuseffectiveness, is that the recommended drugs are available at the point of care.5-7 In mostcountries, ACTs are supplied only to the public, formal health sector managed by thegovernment and its mission sector partners. In 2006, Kenya implemented a change inmalaria treatment policy in all public facilities from SP to the ACT artemether-lumefantrine