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In October and November 2007, antimalarial medicines were collected from six cities in Africa with the intent of performing a basic quality assessment of medicines available in the private sector, following the protocol established by the Global Pharma Health Fund e.V. Minilab®, which has been adopted by branches of the United States and Nigerian Governments, amongst others. However, in preparing the resulting publication, an unexpected observation was made: some public sector medicines had been diverted to private markets. That is, medicines intended to be dispensed free of charge in public health facilities, which may have been donated by countries or manufacturers as part of aid programs, or sold at heavy discounts, were bought by researchers at varying market rates in the private sector.
The presence of illegally diverted medicines occurs in many markets where government health workers illegally sell "public sector drugs to retail shops". Indeed, diversion of antimalarial medicines has been seen across numerous African markets, including Nigeria, Central African Republic, Senegal, Zambia, and Tanzania.
Medicine diversion can lead to stock-outs in the public sector, which can have devastating effects in countries with high burdens of disease. In 2008, two years after Kenya adopted artemisinin-based combination therapy (ACT) as its first-line malaria treatment, it experienced wide stock-outs requiring intervention by the President's Malaria Initiative (PMI). In 2009, the Global Fund's Office of the Inspector General (OIG) reported stock-outs of ACTs for adults in Tanzania. Uganda has also experienced stock-outs of ACTs. The successful procurement and distribution of antimalarial medicines is a matter of life and death, and in countries with perennial malaria transmission, medicines must always be available.
The goal of this study was to assess the numbers of diverted antimalarial medicines from several samplings, which took place from late 2007 to early 2010 in 11 African cities, and to discuss possible causes.
Roger Bate is the Legatum Fellow in Global Prosperity at AEI. Kimberly Hess is a researcher and editor at Africa Fighting Malaria. Lorraine Mooney is a researcher, editor, economist, and medical demographer at Africa Fighting Malaria.
Bate R, Coticelli P, Tren R, Attaran A. Antimalarial drug quality in the most severely malarious parts of Africa --a six country study. PLoS One. 2008;3(5):e2132.
Patouillard E, Hanson K, Goodman C. Retail sector distribution chains for malaria treatment in the developing world: a review of the literature. Malar J. 2010;9:50.
President’s Malaria Initiative. Malaria Operational Plan (MOP) Kenya FY2009. Available from: http://www.fightingmalaria.gov/countries/ mops/fy09/kenya_mop-fy09.pdf. Accessed Jul 2, 2010.
The Global Fund to Fight AIDS, Tuberculosis and Malaria. The Office of the Inspector General, Audit Report on Global Fund Grants to Tanzania. Issue Date: 10 June 2009. Available from: http://www.theglobalfund.org/documents/oig/Tanzania_Country_Audit_Final_Report.pdf. Accessed Jul 2, 2010.
Zurovac D, Tibenderana J, Nankabirwa J, et al. Malaria case-management under artemether-lumefantrine treatment policy in Uganda. Malar J. 2008;7:181.