Drug procurement, the Global Fund and misguided competition policies
Artemisinin-combination therapies (ACTs) provide an effective treatment for most cases of malaria but these life-saving drugs are still not reaching the majority of the people who need them. This is particularly the case in Africa, where frequent “stock outs” of ACTs and other drugs threaten to make a mockery of official treatment guidelines.
The factors that lead to stock outs clearly need – but seldom receive – detailed scrutiny. A commentary article in Malaria Journal has now examined the situation in Kenya and Uganda with regard to the drug procurement policies of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).
The GFATM now plays a key role in financing the purchasing treatments for malaria, TB and AIDS in developing countries, but the authors of the article allege that its policies, “...encourage grant recipients to procure products based largely on price alone has placed less value on quality and reliability of supply. This has led to stock-outs and a questionable tenders that may cost malaria control programmes more than is saved through open tenders”.
In Kenya, GFATM required that 75% of the country’s annual order for the recommended first-line treatment for uncomplicated malaria should be made through an international open tender. Accordingly, in May 2008 the Kenya Medical Supplies Agency, which receives GFATM funding, awarded a $12.3 million tender to the lowest bidder, Ajanta Pharma in India, which had quoted around 40% below other potential suppliers.
However, the company was subsequently unable to supply the drug on time and in the agreed quantities and – despite emergency measures – this led to serious stock-out problems. Also, in 2009, WHO issued a notice of concern (NOC) against Ajanta Pharma following an inspection of the company’s production plant, which revealed several major deviations from good manufacturing practices. (More recently the NOC has been withdrawn).
Uganda, in March 2009, while aware of the problems in Kenya, chose Ajanta as its “best evaluated bidder”, even though another potential supplier was in fact slightly cheaper. Again this led to greater shortages of the first-line treatment for malaria.
The authors of the article acknowledge that, “GFATM is one of the most successful mechanisms for supporting malaria control programmes and is more open and transparent than almost any other multilateral or bilateral programme”. They also agree that c competition among suppliers will lower prices and may raise quality. Nevertheless, minimum standards must be set. The authors allege that GFATM has “pushed competition ahead of drug quality or consistency of supply” and they call for a reform of GFATM policies.
GFATM has yet to respond to the publication of the article. Meanwhile, Kenya’s acute shortage of malaria drugs continues – see report in the Daily Nation.
The authors of the article are no strangers to controversy. Richard Tren and Kimberly Hess work for Africa Fighting Malaria, a lobby group with offices in New York and Cape Town that has been criticised for its links to right-wing political think tanks. Initially focused on campaigning for the increased use of DDT, the group has gone on to criticise much of the currently received wisdom concerning malaria treatment and control, including home-based treatment and the Affordable Medicine Facility for malaria (AMFm). Author Roger Bate is a Resident Fellow of the American Enterprise Institute, which says its purposes are “to defend the principles and improve the institutions of American freedom and democratic capitalism”. His published articles have had provocative titles such as “How Environmentalism Kills the Poor”.
Citation: Tren R, Hess K, Bate R (2009). Drug procurement, the Global Fund and misguided competition policies. Malar J; 8(1):305.
from Paul Chinnock, TropIKA.net