Procurement of Antimalarial Medicines in Africa and the Role of UNDP

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The progress of health problems is closely related to such factors as an environment, education, quality assurance, procurement services, and the structure of pharmaceutical systems. In Africa, many hospitals undergo significant medicine shortages in the public sector, leaving some tropical diseases untreated (Modisakeng et al., 2020). The threat of communicable diseases cannot be ignored because they have a number of negative outcomes on human lives, including the challenge of intellectual abilities, poor educational performance, low productivity, and increased poverty (Kirigia & Mburugu, 2017). According to the World Health Organization (2019), malaria, neglected tropic diseases (NTDs), HIV/AIDS, and tuberculosis are the important causes of death in Africa. Many countries are interested in controlling the spread of these diseases by improving procurement services and the quality of medications that may be available to the African population. The United Nations Development Programme (UNDP) is a global network that enhances technical and humanitarian support to developing countries, including the procurement of health products to challenging environments. The UNDP’s impact on tropical malaria management in Africa will be offered as a central theme of this thesis project regarding the current situation in local hospitals.

Background

At this moment, Africa is the second largest continent in the world. There are 54 countries that are located in five main sub-regions, namely Northern, Eastern, Central (Middle), Western, and Southern (Worldometer, n.d.). According to Modisakeng et al. (2020), medicine shortages are observed in many African countries, and South Africa is one of the regions that strive for universal access to health care and medication supply. During the last several years, malaria is defined as a dangerous mosquito-borne disease that was diagnosed in more than 228 million people globally and caused about 405,000 deaths in 2018 (Centers for Disease Control and Prevention, 2020a). Specifically, in Africa, approximately $12 billion are spent to manage economic problems related to this disease (Centers for Disease Control and Prevention, 2020a). Despite the access to appropriate medications and diagnostic tools in developed countries, travelers are still exposed to the threat of tropical diseases brought from African countries.

Problem Statement

Millions of people are aware of malaria and NTDs’ risks in Africa, but they cannot stop traveling to different regions due to their work-related or personal purposes. For example, in the United States, about 2,000 cases of malaria are discovered in returned travelers (Centers for Disease Control and Prevention, 2020b). These patients get special treatment, including drugs, appropriate regimens, and lifestyle recommendations. However, those who stay in Africa, cannot receive the same quality of services. Many African hospitals lack medications and professional care providers who could help patients and protect the population. Not many organizations are ready to contribute to the development of pharmaceutical and healthcare services in all African countries. Therefore, the attention of global organizations and the impact of such programs as UNDP cannot be ignored. Even if additional sources to deliver antimalarial medicines under the UNDP are discovered, the problem of quality assurance and rational use of medications stays unsolved. Communication with local care providers for informative and educational purposes is required.

Purpose of the Study

In this thesis project, it is expected to investigate the current malaria situation in several African regions and gather information from local care providers about available medications and preventive strategies. The main purpose of the study is to identify if the UNDP global fund system is beneficial for a pharmaceutical system’s ability to provide quality assurance and rational use of medications for malaria in Africa. Additional objectives in this work are to reveal the current strengths and weaknesses of the health information system, learn available supply resources, and examine the level of the staff’s knowledge in African hospitals. The procurement of antimalarial medicines in Africa is not stable. Considering the UNDP’s goals to reduce inequalities and promote structural transformations in developing countries, it is important to clarify if this network could bring effective results in stabilizing malaria treatment for the population.

Significance of the Study

This study creates several opportunities for the researchers to analyze the current pharmaceutical procurement system in African hospitals, identifying the gaps in the system and the role of global organizations. Its focus is on the demand and supply of antimalarial medications among African citizens and the readiness of hospitals to provide patients with the necessary help in treating the chosen tropical disease. According to the World Health Organization (2020), African regions demonstrates disproportionally high rates of the malaria burden, with about 94% of global cases and death being registered there. Children turn out to be one of the most vulnerable groups affected by the disease (World Health Organization, 2020). Therefore, it is believed that an improved procurement system under the guidance of the UNDP could promote the quality and safety of the African population.

Malaria

Many lower and middle-income countries are challenged by tropical vector-borne diseases, and malaria is one of them. Cohee and Laufer (2018) admit malaria eradication as a global priority because this disease puts children and pregnant women at high risk of living with disabilities or even death. Mosquitoes transmit malaria parasites to humans through their bites. Because of high mortality ratings and its worldwide morbidity, the World Health Organization and other governmental and non-governmental companies support antimalarial campaigns to control the situation. In a short period, a bitten person has the signs of malaria, including fever, chills, nausea, vomiting, and headache (Tizifa et al., 2018). Staying untreated, this disease could provoke acute kidney injury, liver damage, hypoglycemia, and pulmonary edema (Tizifa et al., 2018). Although malaria remains a burden in African countries, many researchers admit that it is preventable and curable (Cohee & Laufer, 2018; Kakmeni et al., 2018). American patients diagnosed with malaria at its early stage can be treated with artemether-lumefantrine, mefloquine, hydroxychloroquine, or tafenoquine (Centers for Disease Control and Prevention, n.d.). African patients do not have access to these drugs, but they can follow vector control interventions.

Healthcare System in African Countries

African hospitals experience severe challenges in the healthcare system due to the existing financial, human resource, technical, and political factors. Oleribe et al. (2019) recommend developing public-private initiatives to solve the problems of inadequate human resources, poor leadership, and unprofessional budgetary allocations. At the same time, it is wrong to believe that all African hospitals do not have high-quality health care. There are many regions where private hospitals meet the standards of global care. Still, not all citizens are able to address such facilities and continue living with serious diseases, being poorly diagnosed and untreated. As a result, medicine quality creates a threat to malaria management due to poor diagnostics procedures, lack of effective therapies, and insufficient access to medications (Newton et al., 2017). Many NTDs are considered as not major causes of death, and the related value of human life loss is about 0.1% (Kirigia & Mburugu, 2017). People find it normal to continue working and completing their routine tasks if no evident health problems are revealed. African citizens do not know a lot about preventive strategies, regular hospital check-ups, and cooperation with local doctors to maintain a healthy lifestyle.

Procurement System Peculiarities

Pharmaceutical processes become a crucial part of healthcare services and the improvement of life quality among Africans. According to Modisakeng et al. (2020), a continuous supply of medications is required to manage tropical diseases like malaria. A good procurement system includes the choice of reliable people (partnerships), high-quality technologies, and well-directed activities that ensure delivery (Modisakeng et al., 2020). In Africa, people suffer from production delays and shortages in equipment and material. People do not have the necessary experience in establishing contacts at regional, national, and international levels. Some organizations reject cooperation because of African pharmaceutical companies’ failures to pay and work with digitalized code lists (Modisakeng et al., 2020). If there is a trade agreement with another country or a global organization, procurement is challenged by storage shortages and lack of knowledge. The quality of products is not always high, and patients do not receive medical help. Walker et al. (2018) admit the challenge of poor-quality medicines (PQMs), namely, falsified (mislabeled), substandard (not compliant with standards), and degraded (passed expiry date or exposed to harmful environments). Medicine procurement services should be systematized, and the personnel must be acknowledged.

UNDP Contributions to Public Health

There are many ways to control and improve the work of pharmaceutical systems and provide quality assurance, rational use, and tropical disease prevention. In Africa’s case, many hospitals continue cooperating with their international partners like the Provincial Department of Health in South Africa (Modisakeng et al., 2020). The United Nations Development Programme (UNDP, n.d.) has several regional service centers in several African countries, including Ethiopia, Kenya, and some sub-Saharan regions. Its goals are to deliver desired services and promote state-society dialogue about tropical disease prevention as one of the crucial topics (UNDP, n.d.). In 2003, UNDP offered the Global Fund to fight AID, tuberculosis, and other tropical diseases like malaria in more than 50 countries around the globe (UNDP, 2018). In addition to education and social cooperation, UNDP provides implementation support like medicines’ procurement and capacity-building efforts. Africa needs international assistance in strengthening its healthcare system and logistic services. Medications are necessary to stabilize human health and reduce the progress of malaria-related complications and deaths.

Methodology

In proposing a new research project, it is important to identify and prove the appropriateness of the chosen methods. A descriptive, cross-sectional study will be conducted, covering the characteristics of medicine procurement systems in African hospitals and awareness of the staff about malaria prevention and the role of global organizations. There will be two phases in this research: a literature review to identify recent studies and statistics about the topic and an empirical investigation to gather current information from participants. It is impossible to promote an intervention directly to several African countries, so, the decision to develop an observational study. Due to the lack of a comparison group, a descriptive study is promoted to provide valid information on the topic and explore available resources and the already taken steps in the field (Barría, 2018). Longitudinal observational studies have to be made over a certain period of time. As the decision to work with several countries distantly is made, a cross-sectional design type is preferred to focus on a single occasion (problematic procurement systems).

Regarding the purpose of this study, the observation of the events in African hospitals and data collection will be developed at one point in time. It is planned to contact at least five hospitals per African region, meaning that 25 hospitals will be randomly chosen. Interviews with hospital representatives in the pharmaceutical department will be conducted, including ten open- and close-ended questions. The questions for participants to be answered will be divided into several sections as per the purposes of the study:

The description of the current situation in the regions

What is the current malaria situation in your region, including the statistical data of the disease and the demographics of patients?
How do you define the level of readiness of your hospital to help patients and provide them with the required care quality?
What medications are available to the population to be applied to a successful treatment plan at this moment?
What strategies does the hospital use to support the population, prevent the development of the disease, and educate local people about malaria’s threats and health consequences?

The work of pharmaceutical systems in the regions

5. Are you satisfied with the quality of work within your local pharmaceutical system, meaning the quality of delivery and supply resources?

6. How do you evaluate your awareness of malaria prevention and treatment strategies (from 0 to 10)? Explain your choice.

7. Are antimalarial medications rationally used in local hospitals? Explain your choice.

8. Do you have specialists who work in the medical quality assurance department?

The role of UNDP programs in the regions

9. Have you heard about UNDP programs that can be effectively used in African regions?

10. Do you believe that the use of UNDP medical resources could stabilize the malaria situation in your region? What areas in health care and pharmaceutics should be improved first?

There is a possibility of changing questions during the process of communication that will be organized online, via Skype. Invitation letters will be sent to participants after the hospital staff is researched online. Questions will be developed to gather information about current procurement opportunities and challenges, the participation of global organizations in medication delivery, and the awareness of the participants about the UNDP and similar initiatives.

Ethical Considerations

To meet all ethical standards of research procedures, it is necessary to obtain permission from the country’s ethics committee and the local academic facility. All information that will be collected from the participants will be treated confidentially, meaning that no names being mentioned in the study. The research team will have access to the details of interviews and follow the principles of respect, confidentiality, and anonymity. Informed consent will include information about the aims of the study, the identification of voluntary participation, and the deadlines. A covering letter will be sent to all participants for them to understand the importance of collecting information and its application in the study.

References

Barría, R. M. (2018). Introductory chapter: The contribution of cohort studies in health sciences. In R. M. Barría (Ed.), Cohort studies in health sciences (pp. 1-10). IntechOpen.

Centers for Disease Control and Prevention. (2020a). CDC’s malaria program. Web.

Centers for Disease Control and Prevention. (2020b). Malaria and travelers for U.S. residents. Web.

Centers for Disease Control and Prevention. (n.d.). Malaria in the United States: Treatement tables. Web.

Cohee, L., & Laufer, M. (2018). Tackling malaria transmission in sub-Saharan Africa. The Lancet Global Health, 6(6), 598-599. Web.

Kakmeni, F. M. M., Guimapi, R. Y., Ndjomatchoua, F. T., Pedro, S. A., Mutunga, J., & Tonnang, H. E. (2018). Spatial panorama of malaria prevalence in Africa under climate change and interventions scenarios. International journal of health geographics, 17(1). Web.

Kirigia, J. M., & Mburugu, G. N. (2017). The monetary value of human lives lost due to neglected tropical diseases in Africa. Infectious Diseases of Poverty, 6(1). Web.

Modisakeng, C., Matlala, M., Godman, B., & Meyer, J. C. (2020). Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications.BMC Health Services Research, 20. Web.

Newton, P. N., Hanson, K., & Goodman, C. (2017). Do anti-malarials in Africa meet quality standards? The market penetration of non quality-assured artemisinin combination therapy in eight African countries.Malaria Journal, 16(1). Web.

Oleribe, O. O., Momoh, J., Uzochukwu, B. S., Mbofana, F., Adebiyi, A., Barbera, T., Williams, R., & Taylor-Robinson, S. D. (2019). Identifying key challenges facing healthcare systems in Africa and potential solutions. International Journal of General Medicine, 12, 395-403. Web.

Tizifa, T. A., Kabaghe, A. N., McCann, R. S., van den Berg, H., Van Vugt, M., & Phiri, K. S. (2018). Prevention efforts for malaria.Current Tropical Medicine Reports, 5(1), 41-50. Web.

United Nations Development Programme. (2018). UNDP quality assurance policy for health products. Web.

United Nations Development Programme. (n.d.). About us: Regional service center. Web.

Walker, E. J., Peterson, G. M., Grech, J., Paragalli, E., & Thomas, J. (2018). Are we doing enough to prevent poor-quality antimalarial medicines in the developing world? BMC Public Health, 18(1). Web.

World Health Organization. (2019). Annual report 2017: Communicable diseases cluster. Web.

World Health Organization. (2020). Malaria. Web.

Worldometer. (n.d.). How many countries in Africa? Web.

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