Mural outside the Redemption Hospital in Monrovia, Liberia

(Monrovia, Liberia) –  Malaria is by far the biggest killer here in Liberia. The entire country –from Monrovia city  center to the border regions—is considered malaria endemic.  Prevention and treatment of malaria is among the country’s most pressing public health challenge.

On the prevention side, the ministry of health and international partners report some progress. In 2011, they reached 100% net coverage, meaning that every household in Liberia had been given at least one insecticide treated bed net.  The scale up has been rapid. In 2005, that figure was under 10% and in 2009 about 50% of households were covered.  Between 2005 and today, the Ministry of Health reports that morbidity declined from 66% to 33% of the population. That is still a huge number, but it represents real progress.

Part of the problem is that receiving a bed net and actually using it are two different things. I visited several homes in one community and nobody had much interest in using a bed net.  You see public information and awareness campaigns everywhere, but I do wonder about the effectiveness of these campaigns.

One reason for a significant drop in Malaria deaths in Liberia since 2005 is because treatment options for malaria have become much more accessible. This is thanks in part to UNITAID financing schemes, which has helped bring down the price of Artemisan-based Control Therapy (ACTs)–the gold standard for malaria treatment.  UNITAID has raised about $2.5 billion since from small taxes imposed on airline tickets in 14 countries. This steady funding stream lets UNITAID make long term commitments to drug manufacturers which has helped to dramatically reduce the price of ACTs.

In 2006, a treatment course cost about $10, making mass purchases of the drug well beyond the reach of the public health sectors in poor countries like Liberia. UNITAID has helped bring that price down to 33 cents per treatment. As a result, the public health sector of Liberia is able to purchase ACTs in large quantities at an affordable price.

UNITAID Chair Philippe Douste-Blazy tours a drug storage facility in Monrovia

A patient who visits a public hospital for Malaria will receive the top-of-the line ACT therapy at no cost, providing the drugs are in stock. However, the national health system is weak and these hospitals’ reach are limited. So, rather than walk several hours to go to the nearest government clinic, patients often opt for the local pharmacy.

The pharmacist won’t necessarily sell the patient ACTs and perhaps opt for traditional cures. And even if the pharmacist has ACTs, the cost may be too pricey for the patient. Still, the corner pharmacy has the advantage of convenience. According to the ministry of health, the public system treats about 54% of malaria cases and the private sector treats about 46%. Encouraging the private sector to offer ACTs to patients properly diagnosed with malaria is among the most urgent treatment priority.

Malaria eradication is not some pie-in-the sky dream. According to the World Health Organization, malaria rates have been reduced by 25% globally since 2000 and by 33% in Africa. The key is keeping up the fight and the pressure in the midst of a global economic turndown. Donor funds are drying up, which is why innovative sources of global health funding like UNITAID’s airline ticket scheme are more necessary than ever.

These interventions work. They just need a little funding and a lot of political will.

  • Russ

    I taught at a high school in Liberia and asked my students if they used mosquito nets at night when they slept.  I remember they all said “no” and when I asked why it was because “it too hot” and they “can’t feel free”.  I think a better option is to cut up the bednets and use it as screening for the windows and to keep the door shut, which is what I ended up doing because it was way “too hot” at night.  Just my two cents.