In the countries sharing the Amazon basin, the various Ministries of Health (MoHs), through their respective National Malaria Control Programs (NMCPs), guarantee the availability of antimalarial medicines, free of charge, for all patients diagnosed with malaria at public institutions. Although the sale of antimalarials in private pharmacies is not explicitly prohibited by regulations currently in force in these countries, the free availability of such medicines in the public sector is expected to act as a disincentive to their sale in the private sector.
Nevertheless, scattered information provides evidence of the availability and unrestricted sale of antimalarial medicines to the general public in countries sharing the Amazon basin. One study conducted in Bolivia in 2005 revealed the unrestricted sale of antimalarial medicines in 61 percent of all pharmacies visited. 1 A second study carried out in Colombia in the same year provided evidence of the unrestricted prescription of antimalarial medicines by private pharmacies in Córdoba and Nariño. 2 A recent study conducted by the Management Sciences for Health Strengthening Pharmaceutical Systems (MSH/SPS) Program in Colombia3 also suggests that the private market for antimalarials may be significant, despite the presence of almost universal free medicine coverage for the entire population. The importance of this private sector market in the region, in terms of patients treated and pharmaceuticals sold, is unknown.
The private sale of antimalarial medicines creates a risk of treatment without appropriate diagnosis, a risk of incomplete or inadequate treatment, and the risk of the use of monotherapies (particularly artemisinin derivatives) that may generate resistance. Accordingly, the Amazon Malaria Initiative (AMI), with funding provided by the U.S. Agency for International Development (USAID), is seeking to determine the magnitude of this market in countries of the Amazon basin.