The Novartis Malaria Initiative: lessons from a
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Still, challenges remain. Only one in three patients currently treated for malaria has access to ACTs. Even as availability of effective treatment has increased in countries with a strong public health system, a larger pool of patients lack access because they live either in rural areas with scant healthcare infrastructure, or in countries with weak public health systems. Many poor Africans lack immediate access to public health facilities and usually buy antimalarial drugs at local market stalls and drug shops that offer older, ineffective medicines because of their lower price.
Novartis Foundation for Sustainable Development
The Novartis Foundation for Sustainable Development (NFSD) is also active in the fight against malaria.
A groundbreaking program called the Affordable Medicines Facility – malaria (AMFm) has been launched to bring effective and affordable medicines within the reach of these patients forced to rely primarily on private, self-pay outlets. AMFm is an international collaboration that will use financial subsidies to lower the price of Coartem and other ACTs at retail outlets in a limited number of countries during its first phase.
The program is operating in eight pilot countries during an initial two-year trial period. Estimated costs of subsidies will be shared by the government of the United Kingdom and UNITAID, a drug purchasing facility funded by a surtax on airline tickets that is supported by 29 countries. In April 2010, Novartis made the initial delivery of Coartem to a customer in Nigeria participating in the AMFm initiative followed by deliveries to other participating countries. AMFm is just the latest example of a dramatic hike in donor funding for malaria that has accelerated scale-up of prevention and treatment. Influential donors leading the campaign to roll back malaria range from the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNITAID, to the US President’s Malaria Initiative and the World Bank. Importantly, the emergence of new donors has led to innovative, risk-sharing agreements that are helping to mitigate financial risk previously borne solely by Novartis and other product suppliers.
For example, some procurement agencies place firm orders with long lead times for Coartem and in exchange benefit from supplemental price discounts from Novartis. This new model facilitates procurement of raw materials and production planning for Novartis. In a related approach, funding for the subsidy element of the AMFm program is guaranteed by the Global Fund, again sharing financial risk with suppliers.
Advances in malaria control promise broader benefits for public health across malaria endemic countries. Robert W. Snow, Professor of Tropical Public Health at the University of Oxford, sees an opportunity "to use Coartem as an entry point for making the whole government healthcare sector work better. This could have a knock-on effect for all the diseases that are managed at local clinics and healthcare facilities," he adds.
One example is the expanding use of rapid diagnostic tests to confirm diagnoses of malaria prior to treatment of adults with ACTs. In 2004, 75% of fever cases in Africa could be attributed to malaria and were treated preventively with antimalarial drugs. By 2009, that proportion of fevers attributed to malaria had declined to about 40% – reflecting lower malaria transmission and reductions in the total number of cases in many countries.
A large study deploying diagnostic tests in Ethiopia showed that initial clinical diagnoses of malaria were confirmed in only 10% of patients. The study found that the cost of rapid diagnostic tests was more than offset by money saved by avoiding inappropriate use of Coartem in patients who wouldn’t benefit. "The major finding here is that use of rapid diagnostic tests pays," says Gebre Ab Barnabas, former Head of the Health Bureau in Tigray, Ethiopia’s northernmost region. The WHO now recommends diagnostic testing for all suspected cases of malaria before initiating treatment.
With effective medicines now readily available in most urban centers, leading countries are turning their attention to improving access in remote rural areas as well. Because of the limited number of healthcare professionals, however, community health workers are spearheading improved access to malaria treatment in rural areas.
In both Zambia and the Tigray region, community health workers have been trained to use diagnostic tests and then dispense Coartem if the diagnosis confirms malaria. "We found these tests could be used easily by voluntary community health workers, many of whom are illiterate," Dr. Gebre says.
Through educational materials earmarked for patients and caregivers, training materials for healthcare professionals, the SMS for Life system and our Best Practice Sharing workshops, Novartis has made a significant contribution to capacity building and we will continue to do so in the future.