“We abandoned chloroquine when it failed to cure one in four patients and was available everywhere,”…..“We now have a drug that cures 100% of patients but is not available in one in four clinics.”
That is a quote taken from a recent Editorial by the Editors of the PLoS Medicine journal who are calling for what they call a “third wave” in malaria treatment advocacy.
According to the authors of this editorial, the first wave of malaria activism brought to global attention the disparity between the burden of malaria and the amount of money spent on the disease by the international community. Successes during this period include the establishment of the Global Fund and other major new fund raising mechanisms for the disease.
The second wave highlighted the fact that although money was rushing it, much of it was not being spent on the most efficacious malaria treatments, namely ACTs. We have now seen the establishment of the Affordable Medicines Facility for Malaria (AMFm) and much more attention to this issue globally.
Now the big problem, they argue, is that despite the fact that there is money available for treatments and commitment to spend them on the best drugs, the medicines are still not always making it to the patients who need them, largely due to stock-outs of medicines in facilities. They see this as perhaps the biggest barrier to expanded treatment coverage.
This finding should not be terribly surprising, big global solutions tend to start at the top and only when they realize that things are not working do they look one level down to see why the solution did not work (parallels can be drawn with HIV and health human resources). But how is this nitty gritty operational problem going to be solved? It will all depend on health systems, and solutions are likely country specific, but will need to be resolved if global targets are to be met.
A friend of mine, Jeremie Gallien, a brilliant operations researchers at MIT, who normally devotes his energy to figuring out how to get parcels from warehouses to people’s doors or how to get the latest fashions on store shelves as fast as possible, is now working on this problem in Zambia, and I can’t wait to find out what he has learned.
I know that there are lots of other really smart folks out there also working on this important problem, it is just too bad we always have to start at the wrong end of a problem to identify the most important barriers or to foresee them in advance. Perhaps an operations researcher would have said that all along!Share on Facebook