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Salt, pepper, and some malaria tablets

Posted by Ian Sullivan Digital Campaigner

26th Oct 2012

Local shop selling basic malaria medicines, Kilifi, Kenya. Credit: Caroline Penn / Panos

Good investment in community healthcare is needed to fight malaria, argues Ian Sullivan, rather than putting people's health in the hands of untrained shopkeepers.

If I've got a fever and need urgent medical care, I don't want to be heading down to my local grocers to discuss my symptoms. I definitely don't want to get treatment based on this advice. If that's true in the UK, why should people in poorer countries be expected to take this course, especially when they suspect that they have malaria?

Unfortunately, that's the reality for millions. People buy medicines from shops, with the danger of misdiagnosis and irrational treatment, this should not be condoned by donors. Efforts should be made to change the practice and instead invest in community health workers who have proven effective in both diagnosis and treatment

In our new report, Salt, Sugar and Malaria Pills, we're shining a critical light on the mechanism that has been set up to support selling sophisticated malaria medicines in shops. The scheme, piloted in 7 countries, the Affordable Medicine Facility for malaria (AMFm) has shown no concrete evidence that it has been effective at saving the lives of the most vulnerable, or in delaying drug resistance because medicines are being distributed by unqualified shopkeepers and hawkers rather than trained health workers.

Using untrained and unsupervised drug sellers poses a very high risk of misdiagnosis. Studies show that malaria cases are decreasing and thus it is more likely that a child with a fever will have pneumonia rather than malaria. One of my colleagues, Dr Mohga Kamal Yanni, a senior health policy adviser, said: "It is dangerous to put the lives of sick children in the hands of a shopkeeper with no medical training. A shopkeeper selling salt, pepper and malaria medicines cannot diagnose or treat a child with pneumonia." There is also a risk of increased drug resistance if people who do have malaria do not take the full course of treatment.

As well as the potential risks to public health, this paper concludes that this is a dangerous distraction, skewing investment away from more effective solutions like investing in community health workers and primary health care facilities. For instance, aid money helped to fund investment in an additional 30,000 health extension workers in Ethiopia (in addition to treatment and bed nets), because of which the number of deaths from malaria have halved in just three years.  

In April 2010, with the support of UK government aid, Sierra Leone made healthcare free for pregnant women and children under 5. Within the first year of free healthcare being introduced the number of children being treated for malaria tripled and the fatality rate for malaria in hospitals reduced dramatically, by approximately 90 per cent.

A recent evaluation described the AMFm as a 'game changer' that had increased availability and decreased price, but gave no evidence of how many confirmed cases of malaria had been treated. It failed to measure whether medicines were reaching those that really needed it, and it ignored evidence from countries like Ethiopia where malaria deaths have halved in the last three years thanks to investment in community health workers.

Oxfam is calling for the AMFm to be brought to an end at the next big meeting of the Global Fund and solutions that look at ways of ensuring the poorest people get proper treatment from trained health workers when they're ill. That's what I want for myself and my family, and  the poorest people should expect the same.

Read the full report Salt, sugar, and malaria pills

Blog post written by Ian Sullivan

Digital Campaigner

More by Ian Sullivan

Ian Sullivan