President Clinton Launches Pilot ACT Subsidy to Improve Malaria Treatment in Tanzania

Pilot Subsidy Will Decrease Price of ACT Treatment in Private Shops

Will Test Model for Proposed Global Effort

July 22, 2007
Dar Es Salaam, Tanzania

President Clinton and Tanzanian Minister of Health, David Mwakyusa, announced today a pilot ACT subsidy to substantially increase the availability of the most effective malaria medicines through commonly-used drug shops in two rural areas of Tanzania. This pilot program is designed to test a comprehensive set of interventions to improve ACT access to help facilitate the launch of similar efforts at a national or global scale. The program is a joint effort of the Clinton Foundation HIV/AIDS Initiative (CHAI), the Government of Tanzania, and Population Services International (PSI) and is supported by the Bill and Melinda Gates Foundation.

Access to the most effective medicines, so-called artemisinin-based combination therapies or ACTs, through private channels is a critical, under addressed issue in the fight against malaria throughout Africa. Half of patients with malaria in Tanzania seek treatment for their illness through private drug shops instead of public health facilities. Due to prices as high as $8-10 per treatment, most patients are unable to access ACTs through these shops, usually purchasing medicines that have been rendered ineffective by drug resistance.

The pilot program will implement several interrelated strategies for increasing access to and appropriate use of ACTs by the roughly 450,000 people that seek malaria treatment from private shops in the pilot areas each year. First, it will dramatically lower the price patients pay for the drugs through a simple subsidy. The Clinton Foundation will make the recommended ACT (a combination of artemether and lumefantrine) available at 90 percent less than the current market price to a national drug wholesaler, which will then distribute the drugs through the existing system to rural shops.

Second, the program will provide patients with information they need to obtain the correct drugs and use them appropriately. A targeted marketing campaign led by PSI will inform patients of the availability and recommended price of ACTs, while specially designed packaging with simplified instructions in the local language of Kiswahili will help patients take the drugs properly.

The third component of the program will improve the quality of services provided by drug sellers. The program will provide drug shop employees in the target areas with training on the diagnosis and treatment of malaria. In addition, the Tanzanian Food and Drug Authority (TFDA) recently took the bold step of banning the sale of oral artemisinin monotherapies, which can rapidly lead to devastating drug resistance.

A comprehensive data collection effort accompanying the program will enable CHAI to analyze the impact of these strategies. This information will be used to refine the approach and facilitate the design and launch of national and global efforts. The international malaria community, through a Roll Back Malaria Partnership task force chaired by Minister Mwakyusa, is currently discussing a potential global subsidy of ACTs. It is expected that the lessons learned from this pilot program will help inform the structure and scope of that subsidy.

Malaria is one of the greatest public health challenges in Tanzania. Every year, 15-18 million people in Tanzania fall ill with malaria. More than 100,000, 80 percent children under the age of five, die. With support from the Global Fund, the Tanzanian Government has been able to increase ACT treatment in the public sector. But in the private sector, few patients currently access ACTs due to prices that are 20-30 times that of less effective medicines (i.e., $8-10 per dose). At this price, ACTs are inaccessible to most people in Tanzania – 60 percent of Tanzanians live on less than $2 per day.

CHAI is also partnering with the Government of Tanzania in other efforts to improve treatment through the private sector. This includes helping the TFDA to expand the Accredited Drug Dispensing Outlet (ADDO) initiative, which has proven highly effective at increasing the quality of drug shops and the services they provide to patients.

About the Clinton Foundation HIV/AIDS Initiative

Since 2002, the Clinton Foundation HIV/AIDS Initiative (CHAI) has assisted countries in implementing large-scale, integrated care, treatment and prevention programs. CHAI partners with 25 countries in Africa, the Caribbean and Asia. Individual governments take the lead, and the Foundation provides technical assistance, mobilizes human and financial resources, and facilitates the sharing of best practices across projects. CHAI also provides access to reduced prices for antiretorival (ARV) HIV/AIDS drugs and diagnostics to a total of 69 countries, which together represent more than 90 percent of people living with HIV/AIDS in developing countries. Today, 750,000 people are receiving ARVs purchased under agreements negotiated by the Clinton Foundation.

In January 2007, with the support of the Bill & Melinda Gates Foundation, CHAI expanded its efforts to include malaria. It has sought to apply the model which it has successfully used in its efforts on HIV/AIDS, engaging with both manufacturers and affected countries to increase access to effective treatment. To date, it has provided direct support to three countries, including Liberia and Tanzania.