Assuring effective malaria treatment in Africa: drug efficacy is necessary but not sufficient

Resistance of Plasmodium falciparum parasites to antimalarial drugs has fuelled an increase in malaria prevalence and malaria specific mortality during the past decade in sub-Saharan Africa.1 Promising efficacy results from field trials of artemisinin containing combination therapy (ACT) are a source of optimism and numerous African countries are considering changing first line malaria drug policy to ACT to counter high levels of resistance.2 However, demonstrated drug efficacy is not enough to guarantee effective malaria treatment in Africa.3 Delivery of effective malaria treatment will not occur unless attention is also focused on the broader socio-cultural, economic, technical, and political environments in which it will be implemented.

Malaria is associated with retarded economic development in Africa and results in annual direct and indirect costs estimated to exceed US$2 billion.4 Intersectoral competition for resources in African countries is severe and social expenditure often receives a disproportionately small budgetary allocation. Within the health sector, the AIDS pandemic has placed an additional burden on limited health resources and, thus, resources available for malaria management are effectively shrinking.5 This is occurring at a time when …