Malaria continues to be one of the most pressing global health issues, particularly in sub-Saharan Africa, where the disease affects mostly children under five, despite the availability of prevention and treatment approaches. The unequal access to anti-malaria medications maintains the unequal burden of this deadly disease. Until we address disparities through inclusion, children will continue to face unequal lives. A child born in a disadvantaged region may not receive essential antimalarial treatment. In many respects, the hopes outlined in the 1963 Declaration of Belgrade remain unfulfilled.
Understanding Malaria and Its Impact
Malaria occurs when Plasmodium parasites are transmitted to humans through the bite of the female Anopheles mosquito, making it the most medically severe parasitic disease known to humanity. The Plasmodium parasites, which cause malaria, include two common human pathogens: Plasmodium falciparum and Plasmodium vivax. The symptoms and complications caused by malaria affect millions of people around the globe – ranging from mosquito-induced fever, chills, and flu-like illness, to severe complications including death, if the disease goes untreated.
It causes many complications; a serious problem in children younger than five is that their immune systems haven’t fully matured yet, and malaria still bugs (if you’ll pardon the expression) them quite a lot. It’s responsible for quite a lot of childhood deaths.
The Importance of Anti-Malaria Medications
Antimalarial medications serve both to treat and prevent malaria. Healthcare providers administer antimalarial treatments, primarily artemisinin-based combination therapies (ACTs), to individuals with suspected malaria, quickly clearing the parasites from the blood and reducing mortality rates. In high-transmission areas, preventive measures like intermittent preventive treatment (IPT) for pregnant women and young children, as well as seasonal malaria chemoprevention (SMC), are widely used.
And yet, those same drugs are useless if they are not getting to those who need them. Here lies the question of equity.
Barriers to Access
- Physical distance to health facilities: many areas, especially those remote and rural, have poor health infrastructure. Health facilities might be far apart and families might have difficulties getting to clinics with anti-malaria medicines due to a lack of transportation.
- Economic Barriers: Many low-income families struggle to afford certain medications. While some antimalarial drugs are widely distributed through public health programs and subsidies, gaps still exist in access.
- Supply Chain Problems: Repeated disruptions and stockouts can delay treatment for women. Since women often face worse health outcomes, as seen with Véronique, these challenges are further exacerbated by logistical issues and inefficiencies within the health system.
- Poor Awareness: In some places, no one knows that anti-malaria drugs are available and these drugs are critical. When someone suffers from malaria, they might delay seeking treatment and allow the condition to get worse.
- Cultural and Social Factors: Cultural norms around the significance of fevers and the final stages of life can impact how malaria is perceived and treated. Also, communitarian attitudes and culturally informed beliefs about a particular village could make residents hesitant to provide information to a Westernised stranger about the disease or disease prevalence. Moreover, traditional medical practitioners often earn more trust than those with formal medical training. The stigma surrounding healthcare professionals can deter individuals from seeking help. Additionally, accessibility issues—such as poor transportation networks or challenging geographic locations, like villages deep in hard-to-reach valleys—can prevent people from receiving timely medical attention.
Inclusive Approaches to Improve Access
This suggests that addressing these barriers to access should be part of a multipronged strategy that emphasizes equity and inclusion. Some key stakeholders and strategies for ensuring equal access to antimalarial medications for children include the following:
Strengthening Health Systems
Improving health infrastructure will also help to give people with malaria equal access to treatment. That means building and supplying health facilities throughout the country, reaching those in the remotest and most disenfranchised communities. Mobile clinics and community health workers can be vital as well.
Subsidizing Medication Costs
Anti-malarial medications must be affordable: governments and global health organizations can collectively subsidize the cost of treatments and provide them free of charge at the point of care for those who need them, through programs such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
Enhancing Supply Chain Management
Efficient supply chain management, with particular emphasis on the logistics of transporting drugs, forecasting demand, and mitigating any bottlenecks that result in stockouts, is critical. Networks, including those with international partners and the private sector, can assist such efforts.
Increasing Awareness and Education
It is important to create public awareness of using correct and preventive medicine against malaria and to reach them with the necessary information. Therefore, it is the responsibility of local health authorities, health centers, and NGOs to regularly plan and conduct community education programs to raise awareness among these families and tell them about the symptoms of malaria, its early treatment, and pharmacies where they can buy cheap medicines.
Addressing Cultural and Social Factors
It is only through talking to local communities that we can find out what cultural practices we need to accommodate to provide better healthcare and to understand how we might work with traditional healers and community leaders in our efforts to close the reported gaps, by encouraging modern treatment alongside traditional treatment.
Promoting Research and Innovation
This money can be invested in research to improve existing antimalarials, or even to develop entirely new ones, and also to develop better delivery systems for existing therapies. Research on parasite and vector ecology, disease patterns, and treatment protocols should lead to even more refined approaches.
Fostering Partnerships
Governments and national agencies must work with NGOs, multilateral institutions, and private industry to ensure that the response to malaria is coherent and coordinated. Partnerships help to mobilize more funding and to share expertise and best practices while leveraging collective action to make medicines more accessible to those who need them.
Case Studies of Successful Inclusive Approaches
Several countries and organizations have implemented successful strategies to improve access to anti-malaria medications:
- Rwanda: following the conflict, several strategies including free distribution of insecticide-treated nets, hospital reinforcement and drugs’ availability, and community-based healthcare have resulted in a reduction of malaria morbidity and mortality. The country’s universal healthcare coverage and a well-designed distribution system have played a key role.
- Kenya: The National Malaria Control Programme in Kenya has prioritized access by integrating malaria services with primary healthcare facilities, and using community health workers, as well as providing free or subsidized drugs.
- The Global Fund: Donor cooperation through the Global Fund has helped countries to give more people protection against and access to treatment for malaria. Funding procurement of medicines, strengthening health systems, and funding research are critical to help tackle malaria.
Implementing inclusive approaches to address inequity in access to antimalarial treatments for all children, especially those most marginalized, is a complex process. However, these strategies can successfully reduce mortality and morbidity from malaria in areas where the disease persists. Strategies that ensure strong health systems, working and effective supply chains, subsidized costs, and appropriate community engagement can enhance children’s ability to access treatment promptly from a variety of sources to maximize the chances of a successful outcome.
Moving forward, the participation of governments, international organizations, and local societies will be paramount for providing even access to therapeutic anti-malaria drugs. With concerted effort and determination, we can create a world free from this scourge so that no child will suffer its consequences, be it due to poverty
