Friday, September 24, 2010

The Anti-Malaria Drug Policy Change Process In The Gambia

Coartem Was Introduced Into the Country In 2007
VOL:1 ISSN:13 For the benefit of our readers, we are serialising the various presentations that were delivered by different presenters at the recently concluded one-day orientation of media personnel on malaria control and prevention, organised by the National Malaria Control Programme (NMCP), at the NMCP/CIAM Conference Hall in Kanifing.
In this edition, we bring you a presentation on the Anti-Malaria Drug Policy Change Process in The Gambia, which was delivered by the Programme Officer for Malaria in Pregnancy, Mrs. Olimatou Colley.
Background Information

The First Consensus Meeting was held in October 2004 at the Atlantic Hotel in Banjul, which was organised by the Ministry of Health and partners.
The objectives of the first meeting were; to bring together key stakeholders and partner from both the private and public sector to review existing data on the status of anti-malaria drug resistance in The Gambia.
To share relevant information on the magnitudes of anti-malaria drug resistances in The Gambia with a view to reaching a decision on what steps should be taken to address the situation;
That there is evidence of Choloroquine resistances in The Gambia above WHO’s threshold of 28 per cent. There is the need to change the anti-malaria treatment policy.
The Second Consensus Meeting held in January 2005, facilitated by the World Health Organisation (WHO TA) of which the objectives of second were; to share relevant background information including morbidity and mortality, results of drug efficacy studies and treatment options; to reach a consensus on the drug of choice for the new anti-malaria treatment policy;
To develop a strategies framework for the formulation and implementation of the new anti-malaria treatment policy;
A technical review of all the available options was conducted, while the Ministry of Health and partner selected new drug to replace Choloroquine for the treatment of uncomplicated malaria.
Arthemether and Lumefantrine (Coartem) was the new drug chosen to replace Choloroquine. An interim combination treatment for uncomplicated malaria was identified, Choloroquine plus Sulphadoxine-Pyrimethamine (CQ¬+SP).
Sulphadoxine-Pyrimethamine was to be used for Intermittent Preventive Treatment (IPT), while Quinine was reserve for severe malaria and identified for treatment of malaria in pregnancy since Coartem is contraindicated in pregnancy.
But resent studies have proven that Coartem is safe during the second and third trimester. A draft framework for the implementation of the new drug was developed, out of which the transition period was said to be from January 2005 to June 2006.
Update on preparatory phase
Change was communicated to the Global Fund and CCM; a taskforce was formed and inaugurated to work on technical issues about the change process.
The taskforce member were; NMCP, CIAM, CMS, DPI, RCH, IMCI, HEU, RVTH, UTG, WHO, UNICEF, RHTs, Banjul Pharmacy, W.E.C Mission and MRC.
A Cabinet paper was prepared and sent for approval, the paper was approved in February 2007. The Malaria Case management guidelines were revised to include Artemisinin-based Combination Therapies (ACTs), EDL also revised by NPS to include ACTs.
ACT training manual was developed, IEC materials on Acts were also developed, and Radio and TV sensitisation were launched. Training of health worker on pharmacovigilance started and ACTs arrived in country in September 2007.
Next Steps
The next steps were; training of health worker on ACTs; distribution of the drugs countrywide; establishing a pharmacovigilance system; strengthening malaria diagnosis; Strengthening patients education through community sensitization and monitoring and evaluation at all levels.
High costs of ACTs, lack of a sustainability plan, high attrition of trained health staff from public health facilities, low health budgets and weak health system to adequately cope with the change.
Ways Forwards
Mobilise resources to ensure availability of drugs, develop a suitability plan, the health budget allocation should be increased in order to secure adequate anti-malaria drugs, improve on the current Health Financing Mechanism to address the issue of cost to government, individual and families.
Strengthening of the health systems to adequately cope with the change (drug quality control, pharmacovigilance, procurement and distributions systems, surveillances and research etc).
Watch out for other presentations. See our next edition on Health Concern

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