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ACT Provides New Hope for Malaria Treatment in Uganda | Published 09.29.09

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Biryeri Rehema recounts the
dramatic story of three of her
children coming down with malaria
at the same time, while PSI/Uganda
Community Mobilization Coordinator
Rebecca Babirye listens. “Life is
precious, and I pray that the shops
will not run out of this product, which
has been brought nearer to me,"
said Biryeri.

NAMWIRA, Kaliro District, Uganda, Oct. 29, 2008 – Biryeri Rehema, a mother of eight living in eastern Uganda, recently faced an agonizing decision no parent should have to face — which of her children should get malaria treatment.

Her three youngest – four, six, and eight years old – had come down with malaria at the same time. She applied a local herb with no result, and decided to take them to a hospital that offered free treatment 60 kilometers away. But she could only raise enough money to take one child and had to choose; she chose the youngest and they set off for the hospital. The child went into convulsions during the trip. Upon arrival, the child was put on free Coartem malaria treatment which would have cost between 10,000 and 15,000 Ugandan shillings (US $6.10-9.15) in the private sector.

However, she worried about the other two children, and went back to get them. Friends and family helped her transport them to the same hospital where they received treatment.

This nightmare has a happy ending, with all three children recovering from malaria after a week and a half in the hospital, but many stories do not end so well. This area of Uganda – an ecotourism center with spectacular whitewater rafting and the source of the Nile — is also endemic with malaria: The Ministry of Health estimates it kills 320 people in Uganda every day. I visited a district health center near here where 36% of inpatients are there for malaria.

But Biryeri is confident she will not find herself in this situation again.

The reason for her optimisim is an effort launched in September that puts a highly subsidized and repackaged version of Coartem in the private sector, including several small drug shops just a few feet away from Biryeri’s house. And the prices are affordable, with the cost of four different products ranging from 200 shillings (US$0.12) for children under three to 800 shillings (US$0.50) for children over 12. These are prices that even Biryeri — a single mother of eight who sells bread, millet and vegetables for a living — can afford.

Dubbed the Consortium for ACTs in the Private Sector Subsidy (CAPSS), the initiative was launched in the four districts of Kaliro, Kamuli, Budaka and Pallisa, the result of the Ministry of Health’s decision in 2006 to adopt Artemisinin Combination Therapy (ACT) Coartem as the first-line treatment for malaria. The consortium includes the Ministry of Health (with overall responsibility), PSI (repackaging and marketing), Surgipharm, a private commercial sector (distribution) and the Malaria Consortium (provider training). The project is funded by the Medicine for Malaria Venture (MMV), a non-profit organization based in Switzerland that was created to discover, develop and deliver new anti-malarial drugs.

“The issue here is affordability of drugs,” said ChrisHentschel, the president of MMV. “No parent should ever have to choose between food and medicine for their children.”

This project is special because PSI is testing delivery mechanisms in a high profile way to inform the Affordable Medicines for Malaria mechanism (previously known as the Global Subsidy for ACTs). If proven effective here in Kaliro, it will be rolled out in other malaria endemic countries of Africa.

Dr. Susan Mukasa, PSI/Uganda country representative, attended the launch which she described as the best she has seen in her seven-year PSI career. It was inaugurated by Prime Minister Apollo Nsibambi, who gave a stirring speech and expressed strong support for CAPSS, urging people to look out for the “ACT-with-the-leaf” logo emblazoned on all registered sales outlets. Minister of Health Dr. Stephen Mallinga was also there, as were about 5,000 people. PSI/Uganda is creating demand for ACT through radio, mobile film units, community and school mobilization, district-level advocacy and the ACT Cup. PSI/Uganda Community Mobilization Coordinator Rebecca Babirye is based in Kaliro to make sure those things happen.

In the first three weeks following the launch, PSI has packaged and distributed 100,800 combined doses for all age groups. The demand is strong: When I visited the area the week following the launch several outlets were already sold out, but Dr. Mukasa said the supply problem has been resolved.

“PSI did a very wonderful job in terms of building awareness of ACTs,” said Kaliro District Health Officer Dr. Shaban Mugerwa.

Biryeri said she was very excited when she heard that she would be able to buy ACT at shops near her home at a price that she can afford. In fact, she has already availed herself of the opportunity: One of her children recently came down with malaria and she bought ACT easily and treated her child quickly.

“Life is precious, and I pray that the shops will not run out of this product, which has been brought nearer to me,” she said. “That is my appeal to the supplier.”

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