Malaria treatment and test must become free

Making tests and treatment for malaria free dramatically increases the number of people who seek treatment for the disease that kills 1 million people a year, an international medical aid group said Tuesday.

Medecins Sans Frontieres, or Doctors Without Borders, acknowledged that that has sobering implications for the cost of wiping out malaria, but insisted it is necessary.

The group released a report with recommendations for combatting malaria based on its experience with hundreds of thousands of patients in Chad, Sierra Leone and Mali. It said free treatment, expanding the use of a quick test and training villagers to identify and treat simple cases themselves are key.

Christine Jamet, head of MSF's operations in Chad, told reporters at a news conference in Johannesburg that the number of patients treated in one region of that central African country after free tests and drugs were introduced increased in one year from 10,000 to 100,000.

Some 90 percent of the villagers in the region subsisted on less than a dollar a day, she said. If people living in those circumstances are asked to pay for treatment, Jamet said, "they will have to decide: `Do I choose to pay, or do I choose to buy food? It's as basic as that."

Seco P. Gerard, a Belgian-based MSF policy adviser, said existing clinics and medical staff could absorb some of the increase, but not all.

"Health has a cost, that's for sure," Gerard said. "It costs what it costs. It needs to be done."

The U.N. has launched an initiative to dramatically step up the fight against malaria with the ultimate aim of eliminating the disease, which is spread by mosquitoes and can be easily prevented or treated when resources are available. The head of the U.N. project said MSF's recommendations made sense.

Expanding testing will "ensure that we are treating malaria and not other diseases," said Awa Marie Coll-Seck, executive director of the Roll Back Malaria Partnership, a joint project of the World Bank and the U.N. health, children's and development agencies. That would safe lives now lost because of improper treatment, as well as help experts refine their estimates of the toll malaria is taking.

In launching its malaria campaign on the sidelines of the U.N. General Assembly last month, Roll Back Malaria estimated it would cost US$5.3 billion in 2009, US6.2 billion in 2010 and US$5.1 billion annually from 2011 to 2020. Coll-Seck in an interview with The Associated Press said some of that spending would be for providing free tests and treatment.

Roll Back Malaria was not involved in compiling the report MSF released Tuesday, but works with MSF on malaria projects. The U.N. group estimates 3.3 billion people - more than half the world's population - live in areas where they risk contracting malaria, and the disease kills nearly 1 million people every year, most of them children in Africa. Survivors may suffer brain damage.

"Those figures are even more revolting when you know we have the medical tools ... to diagnose the disease and treat it," Gerard said. "But the fact is that very few patients have access."

MSF treated 1.3 million malaria patients around the world last year. Pilot MSF projects in Chad, Sierre Leone and Mali focused on what the group saw as the two main barriers for many poor people: the costs of tests and of treatment with the state-of-the-art cocktail of drugs known as ACT, and the difficulties of reaching health centers.

"I fully agree with the strategy of using village health workers to provide health care for malaria," said Helen Counihan, an expert with the London-based Malaria Consortium. But she said more research was needed on village health workers' use of the rapid diagnostic tests MSF is recommending be more widely used.

The consortium, which is not connected to MSF or Tuesday's report, hoped to have results next year from a study it is conducting in Zambia evaluating whether community health workers continue to use the tests accurately over time with just routine supervision after initial training.

Sunil Mehra, executive director of the Malaria Consortium, applauded MSF's recommendations, but said the next steps would be finding funding, and political support at country level for change.

"We need to have some consistency amongst the donors," Mehra added.