Togo's health ministry is throwing its weight behind new combination drugs in the fight against malaria but their high price-tags put them beyond the reach of many people, who turn instead to traditional remedies and black market medicines.
Malaria kills an African child every 30 seconds, according to the World Health Organisation, which says one of the greatest challenges facing the continent is the parasite's increasing resistance to established treatments such as chloroquine, the cheapest and most widely-used antimalarial.
New Artemisinin-based combination therapy (ACT) drugs are more effective at fighting the mosquito-borne disease.
But these drugs retail in the Togolese capital Lome for between 3,000 and 8,500 CFA (US$6-16) per packet and that makes treating a malaria patient with ACT drugs more expensive than feeding a family of five for five days.
"The best medicines are expensive and beyond our grasp," student Jean-Paul Ezi told IRIN.
Togo, a narrow strip of territory sandwiched between Ghana and Benin, is one of the world’s poorest countries.
The European Union has witheld aid since 1993 in protest at what it calls poor governance by President Gnassingbe Eyadema, who has been in power for 37 years and is Africa's longest serving head of state.
Poverty and meagre inflows of international aid are hurting this small West African nation, which dedicates less than 10 percent of its small budget to the health sector. According to World Bank data, the Togolese government spends just $US9 per capita per year on healthcare. That compares to $19 in neighbouring Ghana and $12 in Benin.
Malaria cases accounted for 44 percent of hospitalisations in Togo in 2002, government statistics show. Among children, the rate is even higher. Six out of every ten children occupying hospital beds in Togo suffer from malaria.
According to Health Minister Suzanne Aho, "this is just the tip of the iceberg" because lots of Togolese fall outside the health system.
As part of the global Roll Back Malaria campaign, the government is aiming to halve the number of malaria cases and deaths by 2010. It aims to meet the first objective by increasing the use of impregnated mosquito nets and the second by improving treatment and promoting the use of newer, more effective drugs.
But the authorities may have a battle on their hands. Togo's Malaria National Programme To Fight Malaria estimates that just 30 percent of malaria patients turn to state or private health services for treatment, despite the fact that on average 60 percent of health costs are reimbursed.
Traditional medicine is often the first port of call, particularly in rural areas of a country where ancestral beliefs, sorcery and magic are woven into the fabric of everyday life,
Dried papaya leaves and the unripe fruits themselves form part of the malaria-fighting arsenal, as well as the bark from certain trees, which is put in water and cooked to extract the healing sap.
"When I feel ill, I'll take a remedy made with various plants. They are plants that our ancestors used and they often do you good," Navi, a street vendor in Lome told IRIN.
One Togolese journalist explained that traditional remedies were automatically his first choice.
"Since I was a child, I have used plants to cure malaria. My mother has a doctorate in traditional medicine," he quipped.
For those who cannot afford the new more powerful ACT drugs, but who still seek a remedy from modern medicine, the black market offers a cheaper option.
Instead of going to a clinic or pharmacy, they can buy drugs from street sellers who parade around, balancing baskets full of medicine packets on their heads. Some of these medicines have expired, some are placebos and some are officially banned by the authorities.
"I never have enough money to go to the hospital so I do my own diagnosis and prescription," explained Adjovi, a girl who works as a porter.
"Lome’s market is full of drugs that are not always safe and not always well-preserved, but poverty forces our hand. Many Togolese don’t have the choice," she added.
In another part of town, a high school student told IRIN how going to hospital for treatment was his last resort.
"If I think I have malaria, I'll go and buy medicine from the street vendors. If I don’t feel better I'll try traditional plant remedies. Only when it's really desperate do I go to the hospital," he said.
Togolese happy to use traditional medicine or buy anti-malaria drugs on the street pay no more than 500 CFA (less than 1US$) for a course of treatment -- six times less than the cheapest ACT drugs.
ACT drugs are derived in part from a Chinese herb. Because they combine two or more medicines which work in different ways, the WHO says it is unlikely that the malaria parasite -- which has rapidly developed resistance to other, single treatments -- will evolve to resist them.
Another organization that fully believes in ACT treatment is Medecins Sans Frontiers.
"The increase in cost will be repaid many times over in the years to come. Using effective treatment saves lives and reduces the enormous socio-economic burden of the disease," the Paris-based organisation says on its website.
Last May, Togo's health minister and the WHO organised a seminar for about 150 doctors, traditional medicine practitioners and pharmacists to promote the use of ACT malaria treatments.
But some health professionals say that unless drug manufacturers drop their prices or the government intervenes to make them cheaper, most Togolese will carry on buying the older cheaper drugs, even though they are less effective.
"When we write out prescriptions we have to take into account the financial situation of our patients. If we prescribe medicine that is too expensive, then they just won't buy it," Alphonsine, a nurse in one private clinic in Lome, told IRIN.
The counter at Lome's Liberation Pharmacy displays a vast array of treatment options available to Togo's malaria sufferers. It has everything from chloroquine-based drugs to ACTs such as Arinate, Cotexin and Coartem for those who have the cash to buy them.
"These are very effective medicines but people have trouble affording them," explained Ayi, the pharmacist. "Even if doctors prescribe these products, some people ask for less expensive treatments."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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