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