Health Infrastructure The organization of health services in a malarious area must be known in order to determine the feasibility of potential anti-malarial measures. The national health budget—both the amount available for malaria control and the relative importance assigned to health—must be known for appropriate planning to proceed and for affordable interventions to be selected. The status of health services must be critically evaluated in terms of distribution, efficiency, and effectiveness. The characteristics and orientation, whether vertical or horizontal, of the national malaria control program, as well as its strengths and weaknesses, must be understood. The effects of malaria control measures already undertaken should be known, and the adequacy of funding, availability of drugs and insecticides, level of competence among program planners, and quality of the field staff must be assessed.

In many areas, nongovernmental services can be more important than those provided by government facilities. Hospitals and district health clinics, organized and supported by religious missions, may have a greater impact on the health of the local populations than do programs administered by impoverished governments. In certain societies, traditional healers may play a major role in treating malaria patients and referring them to organized medical facilities.

Private health care, whether provided by clinics and hospitals, moon-lighting governmental health staff, traditional healers, private pharmacists, medical “quacks,” or drug sections of markets, are often more important for the delivery of health care at the local level than are organized governmental services. The impact of these alternatives must be understood and exploited during the planning and implementation of malaria control activities.

Availability and Effectiveness of Antimalarial Drugs The efficacy of anti-malarial drugs depends in part on cost, availability, acceptability to the local population, and patterns of parasite resistance. Highly effective drugs may be so expensive that neither patients nor control programs can afford them. A course of mefloquine, for example, may cost 25 times as much as a course of chloroquine. Programs that have been designed to use chloroquine may not be able to adapt to the use of a new, more expensive drug. Patients unable to buy a full course of medication may purchase only one or two tablets, making the treatment ineffective. If the practice is widespread enough, it may contribute to the selection of parasite populations resistant to the drug. If, because of cost, corruption, or disorganization, a program is unable to make effective drugs available to the population it serves, mortality, particularly among children in Africa, is bound to be high.



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