CONTAINMENT

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Affordable ACTs For All Cambodians

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Dr. Kheng Sim, Vice-Director of Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) speaks to CONTAINMENT on efforts to make vital anti-malarial drugs available to Cambodians at affordable prices.

Dr. Kheng Sim, Vice-Director of CNM. Pix by WHO/Sonny Krishnan

 

Cambodia has been chosen for the Affordable Medicines Facility – Malaria (AMFm) Phase 1. The lessons learnt from AMFm’s Phase 1 will be used for Phase 2. Can you tell us how programs have been put in place, in Cambodia, to subsidize the cost of Artemisinin Combination Therapies (ACTs) and make them widely available for a lower cost, which should help eliminate the black market for counterfeit drugs.

Firstly I have to state that Cambodia’s application to AMFm was approved this year. CNM, together with other licensed importers, is now eligible to access ACTs at a greatly reduced price through subsidies from the Global Fund. When all parties agree on the ACT that is to be used nationally, one that also meets the requirement of the Global Fund quality standard, CNM and the private importers can procure these products at approximately 5% of the manufacturer’s sale price.

However the actual ACT co-payment is determined through negotiations between the Global Fund appointed agent and the manufacturer. Nonetheless due to the unique situation of emerging artemisinin resistance in Cambodia, there have been challenges to identify an appropriate ACT that is also eligible to be subsidized.

An important component is our engagement with the private sector. Without private sector cooperation we will find it hard to completely eradicate monotherapies.

CNM is working closely with our partner [WHO] to assess and transition to a new ACT. In April 2010 at the national drug policy-making workshop, CNM recommended Dihydroartemisinin (DHA)-Piperaquine as the ideal first line treatment for plasmodium falciparum. We hope to enter into an agreement with the Global Fund to ensure that cost savings are passed on to the customer, for this ACT.

Cambodia has been successful in nearly eliminating the black market for monotherapies. Artemisinin monotherapy is a serious worry for the development of drug resistance. The recent ACT Watch’s Cambodia Outlet Survey 2009 indicated that only 8.3 % of 7,523 drug outlets surveyed sold monotherapies. The current trends indicate that this figure is declining and, obviously, enforcement in the country is working. Can you tell us how the Cambodian authorities are enforcing the ban on monotherapies,

The National Malaria Control Program by its own cannot enforce the ban on monotherapies. For that reason the National Malaria Program involves other partners into our program. An important component is the training of police officers to enforce the ban on monotherapies and carry out inspections of private drug outlets to curb the sales of fake or substandard anti-malarials. CNM is also working with the Ministry of Health in the training of the Justice Police, who are also empowered to enforce the ban on monotherapies and prosecute violators.

Another important component is our engagement with the private sector. Without private sector cooperation we will find it hard to completely eradicate monotherapies.

How difficult is it to translate policy into practice for the AMFm Phase 1? The supply side of ACTs can be a problem.

The AMFm is an innovative financing mechanism designed to reduce the price of ACTs in the public and private sector. It is not a new policy on malaria diagnosis and treatment but rather a mechanism to increase public access to low cost, high quality ACT. AMFm supporting interventions are aligned with CNM’s existing efforts to improve supply and strengthen the public sector.

But we do have challenges. As I said earlier that at the national workshop we selected DHA-Piperaquine  as the first-line treatment for falciparum malaria. But this first-line treatment is not yet prequalified by WHO. But we are confident it will be approved soon, so that we can move forward in negotiations with the Global Fund for its procurement.

We hope that the new ACT will be available soon.

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Written by malariacontainment

November 14, 2010 at 9:50 am

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