Access to anti-malaria drugs remains elusive as retailers in privately owned health facilities continue to charge exorbitant prices in spite of government subsidies, a new study has revealed.

A report on monitoring availability and prices for-co-paid artemisinin combination therapies (ACTs) in the private sector in Uganda revealed that while 87 per cent of co-paid malaria drugs are available in the market, however, the final retail price is prohibitive for the rural population.

For instance, while the manufacturers charge a median price of UShs900 ($0.25) for a six by four pack, which is a complete dosage, wholesalers’ offer it at median cost of Ush2,000 ($0.55) and the prices double to a median of Ushs4,000 ($1.11) at retail. The six-by-four pack is the most preferred malaria treatment. 

“We have already paid 70 per cent of the costs of the drugs to the manufacturers, so we do not expect the prices to be too high at retail. The public should report facilities that are charging high prices for branded ACT,” said Jimmy Opigo, programme manager at the Ministry of Health.

“Half of our population gets malaria treatment from private facilities, but they are faced with price barriers. Yet if they delay treatment, the disease goes into a severe form; so, we need to bring the prices down,” added Dr Opigo.

The private sector is being subsidised with the aim of increasing access to affordable anti-malaria drugs after findings showed that half of the population gets treatment from the private sector, with the rural population paying a much higher price for co-paid ACTs.

Although the ACTs are free in public health facilities, a significant number of people are compelled to go to private facilities owing to frequent stock-outs, long queues and distance to government facilities said Denis Kibira, executive director, HEPS-Uganda, a non-governmental organisation that conducted the study.

The study was conducted in six regions — Central, Northern, West Nile, Western, South-western and Eastern Uganda — involving 477 private for profit facilities. The study was done between November and December 2016.

Exorbitant prices are one of the factors that prompted the government to shift malaria treatment from chloroquine and fansidar to ACTs, Dr Opigo added.

Currently, the subsidised ACT bears a green leaf brand where the Ministry of Health expects all private facilities irrespective of location not to charge more than a $1 per dose.

The government will spend $12 million on subsidising the private sector for the next three years while an additional $3.2million will be spent on monitoring drug supply from the manufacturers to the retailers and training stakeholders to improve health workers’ knowledge of the subsidised drugs. The money will be provided by the Global Fund.  

“The recommended prices should be displayed on the packs and ‘For Uganda only’ written clearly because we have information that some medicines are being leaked out of Uganda,” said Mr Kibira.

Ministry of Health statistics show that between 23 and 40 per cent of all outpatient clinic visitors and 50 per cent of all inpatient admissions are for malaria. Malaria management alone takes 10 per cent of the ministry’s budget.