BENIN: ACT DRUGS ON PARALLEL MARKET

UNCLAS COTONOU 000067 DEPT FOR AF/W; AID/W PMI; GH/AA:REAR ADMIRAL TIMOTHY ZIEMER; PMI: RICHARD GREENE; AFR/W: HOPE SUKIN E.O. 12958: N/A TAGS: SOCI PGOV EAID ETRD BN SUBJECT: BENIN: ACT DRUGS ON PARALLEL MARKET ¶1. Summary: The Artemisinin-based combination therapy drug Coartem, for the treatment of uncomplicated malaria, supplied to the public health sector in Benin by the USG through the President's Malaria Initiative (PMI),the World Bank Booster Program and the Global Fund, have been found on sale in the country's informal markets since late 2008. Post is working with the Ministry of Health to stop the theft and put in place measures to better manage donated drugs at the Ministry of Health. During a Mission-requested tour d'horizon on February 2, 2009, the Health Minister and staff briefed health donors on the extent of the problem and proposed next steps. End Summary. ¶2. Under the PMI, the USG is working closely with the Government of Benin within the existing national malaria control strategy and plans. Other national and international partners are coordinating efforts to ensure that investment objectives are achieved. Key partners include the World Health Organization, the United Nations Children's Fund, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, Roll Back Malaria, the World Bank Booster Program, and non-governmental and private sector donors seek to ensure that investments are complementary and that PMI, Roll Back Malaria and Millennium Development Goals are achieved. ¶3. Benin adopted Artemether-Lumefantrine (AL, or Coartem) as the first-line treatment for uncomplicated malaria in 2005. Major contributors of Coartem to the National Malaria Control Program (NMCP) include World Bank, PMI and Global Fund resources. In 2008, PMI procured 1,073,000 Coartem treatments. This procurement complemented those of the World Bank Booster Program and contributed to covering Benin's needs for Coartem throughout the year 2009. In accordance with the Ministry of Health distribution policy, the ACT stocks provided by PMI and the Booster Program were delivered to the Central drug warehouse (CAME) for distribution to health zones and health facilities. ¶4. On November 7, 2008, the local news paper "L'Autre Quotidien" reported the sale of ACT drugs, including Coartem, in popular local markets in capital Cotonou and other major cities in Benin, namely: Adjegounle, Azove, Parakou and Kandi. Purchase of Coartem from the Dantopka Market in Cotonou has also been reported by several people. Immediate public statements from the NMCP Pharmacist asserted that the drugs were not from the lots supplied to the programs in Benin. ¶5. Despite these assurances by the NMCP Pharmacist, USAID sent a letter to the Minister of Health on November 21, 2008 requesting that (1) an investigation be carried out to clarify the situation and (2) appropriate measures be taken to avoid leakage of public goods into the black market. In December 2008, USAID determined that some of the drugs had the same batch number as those recorded at CAME and briefed the Ambassador on the problem. During a meeting with Ambassador Brown on January 2, 2009, the new Minister of Health affirmed that he had requested an investigation into the leakage of the donated malaria drugs onto the informal markets which are for sale at higher prices than in GOB facilities. Acting USAID Director Janet Schulman also raised the issue during a courtesy call on MFA Acting Director for the Americas Eusebe Agbangla. ¶6. Health donors and the Minister of Health participated in a policy dialogue meeting on February 2, 2009. During this meeting, Ambassador Brown inquired about the status of the investigation. The Minister's Technical Advisor for Pharmacy confirmed that the investigation had been conducted and the report is expected soon. She reported that not only has Coartem been found in informal markets across the country, but that some health workers have been found guilty of stealing Artemisinin-based Combination Therapy (ACT) drugs from the public health facilities for re-sale in public markets at higher prices. She added that the health workers identified were asked to refund the cost of the stolen drugs. ¶7. The PMI program in Benin includes a component to strengthen logistics management for anti-malarial medicines and other prevention commodities. After an initial assessment of the system in March 2008 by Management Sciences for Health (MSH),PMI financed an in-depth evaluation of the transparency and governance of CAME to better define the support it needs to improve drug management in Benin. ¶8. Based on the recommendations of this assessment and evaluation, Post is working very closely with the Ministry of Health to develop ways to stem future thefts and sale of donated drugs on the black market. USAID is collaborating with the Ministry of Health to strengthen existing drug distribution policies and manage donated drugs through stricter monitoring and accounting for stocks and ensure better forecasting and quantification by appointing a pharmacist in each of the six regional health offices to oversee the supply chain management. The Ministry of Health will reinforce the warehousing capacity of CAME and support the creation of zonal pharmaceutical depots to improve stock management and quantification of essential medicines. BROWN