New malaria drugs and expansion of ARV treatment push up government drugs bill

The Ghanaian government has issued tough new guidelines for medical practitioners as it prepares for a big hike in health spending. It has ordered a switch to more expensive, but more effective drugs for treating malaria and a big increase in antiretroviral (ARV) treatment for people living with AIDS. The 517-page guidelines, along with a new list of essential medicines, aim to deliver efficient treatment at least cost as the government prepares to boost its expenditure on drugs from the estimated 2004 level of US $6million. "I cannot give a specific figure on our drug procurement funds this year,” Sam Boateng, who heads the Health ministry’s drug procurements division, told IRIN. “But various interventions to tackle instances of resistance clearly show we will have an increased bill as compared to 2004." The ministry blames un-regulated medical prescriptions and the inappropriate use of certain drugs for a rise in cases of multi-drug resistant tuberculosis, penicillin-resistant pneumonia and chloroquine-resistant malaria. About three million of Ghana's 20 million population seek treatment for malaria each year, so officials have decided to tackle the mosquito-borne disease by switching from chloroquine to the more expensive artesunate-amodiaquine as the first line treatment, according to the Malaria Control Programme. "It will now cost US $1.30 from the previous 10 US cents to treat a single case of malaria,” Boateng said. “We hope there will be less malarial infections as we go along and this should reduce the cost of buying anti-malarial drugs." Government statistics show that malaria, a potentially lethal disease, accounts for 40 percent of all cases treated at outpatient departments around the country. It hits hardest at pegnant women and children under five. National Drug Programme Manager Martha Gyansa-Lutterodt, told IRIN that essential medicines prescribed by the new treatment guidelines would account for "a huge chunk" of the 2005 health budget. "We will ensure full compliance from medical practitioners to the documents to ensure healthcare quality is maintained," she added. A combination of antibiotics instead of penicillin alone will now be used for treating pneumonia, but drugs used for tuberculosis will remain unchanged while doctors monitor for resistant strains of the disease. "Unless there is a major resistant development, the current drug regime should do for the meantime. But we are monitoring the situation closely. As soon as we get signals to make a change, we will do so," Boateng said. The procurement of more ARV drugs for people living with HIV/AIDS will also send Ghana's drugs bill rocketing higher. In 2004, Ghana spent almost US $1.5 million to provide 2,100 people with these drugs that improve their wellbeing and prolong life. ARV treatment is heavily subsidised by government. It spends about US $600 a month for an individual treated with antiretroviral drugs, but the patient is charged only $5. The Health ministry says that ambitious plans to increase ARV treatment over the next two years will force its spending on the therapy to quadruple to $6 million in 2006. The release of the new medicines list and treatment recommendations foreshadows the launch of a new compulsory universal national insurance health scheme later this year. Until now patients have had to pay up-front for treatment at government hospitals. This has often pushed the cost of healthcare beyond the means of ordinary Ghanaians. Now, for an annual basic subscription that ranges from $8 for people on low incomes to $53 for high earners, members of the scheme will have access to benefits covering about 90 per cent of ailments treated in public hospitals. The scheme will not cover certain types of top-end health treatment such as heart surgery. All medical staff, hopsitals and clinics taking part in the scheme will be required to adhere to the government's new drug list and treatment guidelines. "Government will only reimburse institutions based on standardized treatments and prescriptions," Gyansa-Lutterodt said. Both will be reviewed in 2006.