The Senegalese Pharmacie Nationale d’Approvisionnement (PNA), a state-owned enterprise, is responsible for importing, storing, and distributing the drugs on the national essential drug list. The drugs flow from the PNA downward through several levels of the public sector and are accessible to consumers in a variety of places, but always involve interactions with health care providers (physicians, midwives, nurses, or health workers.

The PNA supplies five regional stores (Pharmacie Regionale d’Approvisionnement [PRA]), which in turn supply the district depots, which then provide drugs to the health facilities. Similarly, health centers and health posts are supplied by the district depot. Health huts obtain their supplies from the posts. Overall, the public sector accounts for about 35 percent of the sales value of antimalarials.

Most pharmaceuticals are imported from India (some also come from Zimbabwe, Tanzania, Kenya, and South Africa) and most come in as finished products, which are exempt from import duties and taxes. Six local companies manufacture generic essential drugs in Zambia (one meets international Good Manufacturing Practice standards). No multinational pharmaceutical companies produce drugs in Zambia.

All drugs on the national essential drug list, including antimalarials, are procured by the Central Board of Health, either by international competitive bidding or by selective tender. Preference (including a 15 percent price advantage) is given to locally manufactured or procured drugs. Local companies are rarely awarded large tenders, however, because they cannot meet some of the conditions.

All drugs procured by, or on behalf of, the government are delivered to Medical Stores Ltd. (the country’s Central Medical Stores). Public sector drugs and medical supplies are delivered to all districts, nine general hospitals, and four specialized hospitals. When Medical Stores Ltd. cannot supply all the needs of districts, they purchase their own drugs to fill gaps.

The public sector is more important in Zambia than in many other countries. Up to 70 percent of people seeking treatment for malaria go first to the public sector. However, private sector use is increasing and use of public health facilities is decreasing, in part due to only partially effective exemption mechanisms for the poor and frequent drug shortages in the public sector.

Front Matter (R1-R20)

Executive Summary (1-16)

Part 1: A Response to the Current Crisis1 Malaria Today (17-60)

2 The Cost and Cost-Effectiveness of Antimalarial Drugs (61-78)

3 The Case for a Global Subsidy of Antimalarial Drugs (79-111)

4 An International System for Procuring Anitmalarial Drugs (112-122)

Part 2: Malaria Basics5 A Brief History of Malaria (123-135)

6 The Parasite, the Mosquito, and the Disease (136-167)

7 The Human and Economic Burden of Malaria (168-196)

8 Malaria Control (197-251)

9 Antimalarial Drugs and Drug Resistance (252-298)

Part 3: Advancing Toward Better Malaria Control10 Research and Development for New Antimalarial Drugs (299-311)

11 Maximizing the Effective Use of Antimalarial Drugs (312-328)

Acronyms and Abbreviations (329-333)

Glossary (334-346)

Index (347-364)