Saving Lives from Malaria

Expanding Access to Medicines in Cambodia
Each year, thousands of children die from treatable illnesses in areas with few resources and little medical knowledge. To address this situation, Management Sciences for Health works through the USAID-funded Rational Pharmaceutical Management Plus (RPM Plus) Program to expand access to essential medicines and increase awareness about effective treatments.

One Cambodian mother's story is a tragic example of why expanding access to medicines is critical to decrease child mortality. The woman brought her son, ill with malaria, to a village nurse for treatment. The infant was given Paracetamol and Quinine, pills which his mother broke into small pieces for him to swallow. The young boy took the Quinine pills everyday for almost 15 days, but became more ill over the course of treatment. Though the provider insisted the child be given Quinine like an adult, the small boy's body was not equipped to deal with the pills; after many days of the strong medication and no clinical supervision, the child was critically ill.

The mother explained that she was already short on food, and could not afford to bring her son to a private clinic. When she finally brought him to the referral hospital, it was too late; the little boy died in the evening. The woman still owes the hospital money for her son's care.

Despite seeking advice from a clinic, this mother was not informed about treatment options or alternative medicines: she had never heard of the artesunate and mefloquin combination treatment, which is the first-line treatment for malaria in Cambodia's Battambang province. In Cambodia, many patients do not use appropriate diagnostic and treatment services for various reasons, including high costs of medicines and services and lack of knowledge. Recent RPM Plus surveys have also indicated inappropriate malaria prescribing practices. Malaria treatment and diagnosis have improved over the past several years, but practices in rural remote regions still lag behind. Caregivers may receive inappropriate, substandard or counterfeit medicines, a particular concern in the entire Mekong Region. Such practices further weaken sick children and contribute to the spread of multidrug-resistant malaria.

MSH is working in Cambodia to strengthen the management of childhood illnesses and promote appropriate and timely treatment of curable diseases like malaria. MSH/RPM Plus collaborates with the Cambodian Ministry of Health, the Global Child Survival Partnership, WHO and other key stakeholders to identify pharmaceutical management issues that may affect access to essential medicines. MSH is working to incorporate drug management into a national child survival strategy, and to design and implement clinical and policy interventions.

No child should die of a treatable illness. This mother's story is a reminder that equitable access to quality health care and medicines is crucially important to reduce infant and child mortality.