PQM in Africa: Activities by Country
Benin
Benin has a low life expectancy of only 53 years and high rates of maternal and child mortality, both of which are caused primarily by lack of access to quality healthcare. Over the past few years, USAID has focused health intervention efforts on the disadvantaged areas in central and northern Benin. This has improved access to health services and increased use of family health services.
PQM is helping USAID implement the President's Malaria Initiative, which aims to reduce by half the number of deaths caused by malaria in children and pregnant women.
Ethiopia
Although it is the ninth largest country in Africa by size and the second largest by population, Ethiopia remains one of the poorest and least developed countries on the continent. According to the World Health Organization, Ethiopia ranks seventh among the world's 22 countries with a high rate of tuberculosis (TB). The TB burden is exacerbated by the country's HIV/AIDS epidemic—nearly one-third of adult TB cases are HIV-positive, and strains are increasingly growing resistant to anti-TB medicines.
Diseases such as malaria, TB, and HIV/AIDS account for 60–80% of the health problems in the country. In 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) began providing support to Ethiopia to put into place HIV/AIDS prevention, treatment, and care programs. The HIV transmission rate ranges from 0.9% in the rural areas to 7.7% in more populous urban settings. In 2009, PEPFAR began working to strengthen services for mothers and children to improve nutrition and expand delivery of antiretroviral medicines.
Malaria is a primary challenge to healthcare in Ethiopia; approximately 67% of the population lives in malaria-endemic areas. The President's Malaria Initiative (PMI), which has provided support to Ethiopia since the program began in 2005, focuses many of its activities in the Oromia region, the largest area and the most malarious. Malaria contributes to up to 20% of deaths in children under the age of five; in epidemic years—every 5-8 years-malaria may claim up to 100,000 children. PMI programs aim to lower the malaria incidence and reduce the frequency of malaria epidemics.
PQM is working with PMI, PEPFAR, and the Ethiopia Ministry of Health to ensure the quality of the medicines available in the marketplace and to advance the capacity of Ethiopia's national laboratory to monitor medicine quality.
Ghana
In the 1980s, Ghana began to experience a period of substantial economic growth that it still enjoys today. Despite the economic success, however, Ghana suffers from significant health problems related to malaria. Malaria continues to be endemic in all areas of Ghana, accounting for more than 44% of all outpatient visits and 25% of mortality in children under five years of age. Malaria is so widespread in Ghana it is considered one of the major causes of poverty and low productivity. In 2007, the total reported malaria cases numbered 3,123,147–more than one million of which were children under five years of age.
In 2005, the President's Malaria Initiative (PMI) began funding efforts to help control malaria in the 15 hardest-hit countries; in 2008, that funding was extended for another six years with the goal of cutting in half the mortality rate in 70% of Sub-Saharan African countries. PMI has supported PQM activities to determine the prevalence of substandard and counterfeit medicines and expand Ghana's ability to monitor and control antimalarial medicine quality.
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Kenya
Kenya faces significant health threats due, in part, to tuberculosis (TB) and malaria, compounded by an increase in HIV/AIDS-related illness. Malaria is the leading cause of illness and death in the country, particularly among children under the age of five—more than 34,000 die each year. Almost 70% of the population is exposed to malaria-endemic areas, which vary across the country along geographic lines.
One of the 15 original countries to receive funding from the President's Malaria Initiative, Kenya has been a focus country for malaria control interventions. The disease has been in decline recently thanks to efforts to involve communities in adopting prevention methods.
Yet Kenya still faces threats from TB and HIV infection. The World Health Organization ranks Kenya tenth among the world's top 22 countries suffering from a high TB burden. Efforts to control TB are hampered by the spread of HIV infection, further straining the country's health systems. Further complicating the problem is an increase in drug-resistant strains of TB, making the disease more difficult and more costly to treat.
Liberia
Liberia suffers from a diminished healthcare workforce, posing a challenge to the government's ability to provide basic health services. The strain is most apparent in women and newborns, due largely to a lack of safe birthing services. Other health challenges include malaria and HIV/AIDS.
Malaria is one of the major health burdens hindering Liberia's development. It is endemic and is the leading cause of outpatient attendance (38%) and inpatient deaths (42.3%). Essentially, the entire population is at risk year-round. The high incidence of malaria in Liberia has made it a focus country for the President's Malaria Initiative (PMI).
PMI supports efforts by the Ministry of Health and National Malaria Control Program to meet Roll Back Malaria targets for reducing malaria morbidity and mortality in Liberia. Given that the country only recently emerged from years of civil war, a major challenge was to first build the systems needed to deliver basic and essential health services to its citizens—an agency and regulations to ensure quality control for medicines. PQM is assisting the USAID and PMI with their efforts to control malaria.
Working closely with the World Health Organization (WHO), USAID, and several Liberian government authorities and stakeholders, PQM was instrumental in helping Liberian officials draft the Liberia Medicines and Health Products Regulatory Authority Act.
Mali
Ranked as one of the world's poorest countries, Mali's healthcare system suffers from challenges related to poverty, malnutrition, and a lack of hygiene and sanitation. The country is dependent on international development organizations and foreign missionary groups for the majority of its healthcare.
Through the President's Malaria Initiative, USAID is working to slow the spread of malaria among children and pregnant mothers by using insecticide-treated bed nets, preventative treatments, and medicine for children displaying symptoms of the disease. PQM is working with Mali's medicine regulatory agency to strengthen the country's quality assurance systems.
Mozambique
The prevalence of HIV/AIDS, malaria, and other diseases, combined with a high infant mortality, limits the life expectancy of the average Mozambican to 42. Sixteen percent of the population—roughly 1.7 million people—are HIV-positive; more than half of those are women. Half a million children are orphaned because of the disease. The HIV epidemic is so pervasive that it has affected the country's development and seriously strained its healthcare system.
As part of a comprehensive plan between the governments of Mozambique and the United States, in 2004, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) began funding efforts to strengthen Mozambique's healthcare system and address the prevention, care and support, and treatment of HIV/AIDS. In 2009, PEPFAR reached more than 3 million Mozambicans and provided antiretroviral and other treatment to more than 116,000 citizens. In addition, USAID has provided technical assistance to improve the logistics and management for health, malaria, and HIV commodities as well as donating medicines and supplies. The PQM program will provide technical support to the Mozambique Ministry of Health to strengthen the country's medicine quality assurance and quality control systems, helping to develop the needed regulatory framework, infrastructure, equipment, and staff to provide full quality control services in the pharmaceutical sector.
Rwanda
In Rwanda, children frequently suffer from malnutrition and one in ten does not live beyond the age of five. A shortage of trained medical staff and facilities in Rwanda compounds the already significant health problems of HIV and AIDS, malnutrition, tuberculosis, and malaria. One of the most densely populated countries in Africa, Rwanda's entire population is at risk for malaria, which is endemic country.
Rwanda is one of the 15 original countries to receive funds from the U.S. President's Malaria Initiative, and the country has benefited. Since 2005 malaria transmission has decreased, as has the number of malaria cases reported to public health facilities. PQM is working with Rwanda's medicine regulatory authority to help the country build basic quality control capacity and build a sustainable medicine quality monitoring program.
Senegal
Like most Sub-Saharan countries in Africa, Senegal endures the numerous health problems typically associated with severe poverty—approximately 54% of all households in Senegal live below the poverty line. The country's most prevalent disease—malaria—is the leading cause of death in children under five years of age. The problem affects every region of the country and has shown limited evidence of decreasing in the past decade. It is exacerbated by the free flow of poor quality antimalarial medicines within the country and across its borders.
Results from the Quality of Antimalarial Medicines in Sub-Saharan Africa study conducted by PQM and WHO revealed that almost half of the medicines tested in Senegal failed quality testing. The main purpose of the study was to determine the prevalence of substandard antimalarial medicines in Sub-Saharan Africa, which are believed to contribute to increasing parasite resistance to traditional first-line treatments. The authorities face many challenges in regulating their markets, but officials have begun taking steps to target their efforts.
Due to the widespread prevalence of fake and substandard medicines in other regions of Senegal, the medicine quality monitoring program expects to expand, adding at least one sentinel site to those already established. Monitoring will continue to include, in addition to antimalarials, selected HIV/AIDS and tuberculosis medicines, and selected oral contraceptives. Samples of contraceptives will be collected during routine monitoring for the Minilab® program and submitted to the Official Medicine Control Laboratory to ensure quality control.
Tanzania
Tanzania's nearly 40 million people are at high risk for infectious diseases. HIV/AIDS has taken a heavy toll, putting the median age in Tanzania at less than 18 years, and malaria and bacterial diarrhea are common ailments. Acute diarrhea remains a leading cause of death among children in Tanzania.
In 2005, the World Health Organization (WHO) added zinc supplementation to the recommended treatment guidelines for acute diarrheal disease, but access to medicinal—quality zinc products—particularly those in acceptable forms for children—was almost nonexistent. PQM and USP developed pharmacopeial monographs for two oral forms of zinc supplements and guidelines for their quality-controlled manufacture. At the time, there were no zinc manufacturers prequalified by WHO, a requirement for UNICEF procurement. At the request of UNICEF and USAID, PQM began working with two manufacturers in Tanzania to help prepare them for WHO prequalification of zinc tablets and syrup.
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