Speech By

H.E Yoweri Kaguta Museveni President of the Republic of Uganda

At the Launch of the

Ministry of Health and Medicines for Malaria Venture-led (MMV) Initiative

Kaliro, September 19, 2008 .

The Honourable Minister for Health, The Honourable Members of Parliament, The Chairperson MMV Board of Directors, The Country Representative, WHO,

1 The President and Chief Executive Officer MMV, Development partners, The WHO/Roll back malaria (RBM) representatives, National Malaria Control Programme Managers from Malaria- Endemic Countries, Experts in malaria prevention and control, Distinguished ladies and gentlemen.

I am delighted to welcome you all to the launch of this important initiative to deliver effective and highly subsidized antimalarial medicines in the private sector in Uganda.

As you may recall, in May last year at the 7th Medicines for Malaria Venture (MMV) stakeholders meeting held at the SPEKE Resort, Munyonyo, I announced a collaboration between my Government’s Ministry of Health and the Medicines for Malaria Venture (MMV). This collaboration was to design an initiative to study the impact of responsibly providing highly subsidized effective treatment for malaria through the private sector to complement our health facility based distribution.

2 Today we are gathered here to celebrate the launch of this very initiative. The development of this programme has involved a deeper understanding of the issues on the ground and the designing of interventions to address these issues. Most importantly the programme will also assess the health impact of this initiative with a view to possible national scale- up.

We are all very aware that malaria is among the leading, most widespread and serious communicable diseases in the world. In Uganda we are particularly hard hit – all levels of malaria transmission exist, with high transmission in approximately 90-95 % of the country. Epidemic prone areas cover about 5- 10 % of the country, mostly in highlands of south western Uganda.

We measure the intensity of malaria transmission by the average number of infective mosquito bites per person per year in a given area. In Uganda, this number varies from about 3 infective bites per person per year in Mubende in central Uganda; to over 1,500 infective bites per person per year in Apac, in Northern Uganda. Over 1,500 bites is the highest ever reported in the world! My government is addressing the challenge of this heavy malaria burden through well-planned interventions that are in

3 line with international and national policies. The international response to malaria has gathered momentum in the past decade. In 2000, the African Summit to Roll Back Malaria (RBM) was held in Abuja, Nigeria. This summit reflected a real convergence of political momentum, institutional synergy and technical consensus on malaria. African leaders re- dedicated themselves to the principles and targets of the Harare Declaration of 1997 and committed themselves to an intensive effort to reduce the malaria mortality by a half for the people in Africa by 2010. The Leaders also resolved to initiate appropriate and sustainable actions to strengthen health systems to ensure that by the year 2005: • At least 60% of those suffering from malaria have prompt access to, and are able to correctly use, affordable and appropriate treatment within 24 hours of the onset of symptoms;

• At least 60% of those at risk of malaria, particularly children under five years and pregnant women, benefit from the most suitable combination of personal and communal protective measures such as insecticide-treated mosquito

4 nets and other accessible and affordable interventions to prevent infection and suffering; and • At least 60% of all pregnant women who are at risk of malaria, especially those in their first pregnancies, have access to preventive intermittent treatment. In addition, international development partners were called upon to cancel in full the debt of heavily indebted poor countries within Africa to release resources for poverty alleviation programmes, and to allocate substantial new resources of at least US$1 billion per year to roll back malaria. On the research front, during the last decade, new medicines and preventive approaches have been developed for malaria case management and for selective vector control, as well as epidemic prevention and control. Malaria has also become integrated into national health systems of most countries and partnerships have increased and strengthened both locally and internationally to fight the disease.

However, we still have a long march ahead. We only have two years left to meet the Abuja targets. This is too little time, but we cannot give up hope and must maintain and renew

5 our efforts to achieve success. I am proud to state that Uganda continues to prioritize malaria prevention and treatment at national level. The Uganda National Health Policy (NHP) and Health Sector Strategic Plan I (HSSP I) were launched in 2000, while HSSP II was launched in 2006. Both the policy and plan identify malaria as one of the country’s priority health problems in the minimum healthcare package. In addition, in 2005, Uganda developed her third malaria strategic plan whose goal is to prevent and control ill health and deaths due to malaria, and to minimize the consequent social effects and economic losses. The over-arching objective of malaria control in Uganda for the period 2005/06 – 2009/10 is: to rapidly achieve and sustain national coverage with a package of effective and appropriate interventions to promote positive behaviour change and to prevent and control malaria.

In the last decade Uganda’s malaria treatment policy has been complicated by the emergence and spread of drug resistance to widely used antimalarial medicines. We successfully

6 changed the first-line antimalarial treatment policy twice in just five years: The problem of chloroquine resistance became so significant that the country was compelled, in 2000, to change the first line option from chloroquine alone to a combination of Fansidar and chloroquine. However, the lifespan of the new policy was short-lived, again due to resistance. Consequently, in 2004, Uganda once more changed the treatment policy to the WHO recommended artemisinin combination therapy (ACT).

We adopted the ACT, Artemether Lumefantrine, and deployed it in 2006, making it available free of charge through the extensive network of public and not-for-profit health facilities.

Despite these clear national strategies and initiatives, malaria remains a leading cause of disability and death in Uganda, especially among the vulnerable - pregnant women and children under 5.

One of the reasons for this is that effective ACTs are as yet not easily available in the private sector, which is the first

7 port of call for over 60 % of Ugandans across all socio- economic groups seeking treatment in the event of fever. So our people continue to die of malaria because they cannot afford or access treatments that work, through the channels that they commonly frequent.

In 2006 we heard of the Affordable Medicines Facility malaria (AMFm), presently under discussion, which will provide a framework to close this critical private sector distribution gap. The AMFm aims to provide a high level subsidy which will radically reduce the price of ACTs to the level of chloroquine, thus making them more affordable. It will also support a core set of supportive interventions designed to ensure the uptake and correct use of the subsidized medicines.

The urgent need to find a sustainable means to making effective antimalarials available through the private sector compelled the Ministry of Health to collaborate with MMV in a two-year programme, starting today, to responsibly provide a highly subsidized ACT through the private sector. A number of essential activities have been carried out in the past year to bring us to this critical point of launch today. Baseline surveys were carried out in 2007 to better

8 understand the antimalarial market from both a supply and demand perspective. It was these surveys that revealed that the private sector, in spite of being a source of antimalarials to about 60% of Ugandans, was not dispensing affordable and effective ACTs. The strategy for the intervention was thus informed by the results of surveys and developed in a consultative process involving national and international stakeholders. The objectives of this initiative are to assess if the distribution of a subsidized ACT will contribute to the reduction of malaria morbidity and mortality; and if successful, will lead to a sustainable model for national scale-up.

The first phase of the initiative will be carried out in 4 districts in the East, where malaria transmission is high – Kamuli, Kaliro, Pallisa, Budaka, with Soroti as the control district. The next phase will cover 2 districts in the West which has medium malaria transmission – Kabarole and Kamwenge, with Mubende as the control district. It is now over seven years since the Abuja declaration and we are half way through the allotted span to achieve the Millennium Development Goals (MDGs). Time is running

9 out and malaria continues to hold back the social transformation of Africa. Countless mothers and caregivers still give their sick children medicines that no longer work, because too often, ineffective options are the only ones they can afford. They need effective ACTs and these ACTs must also be affordable. The initiative I am launching today aims to pave the way for the provision of affordable ACTs through the private sector and thus save the precious lives of our children. What could be more important than securing our country’s future through securing the lives of our children? Finally, I would like to thank all those that have been involved in the design of this important initiative; and those who will be involved in its implementation. Specifically, the Ministry of Health and the Medicines for Malaria Venture for their leadership, as well as other stakeholders who will be directly involved including Surgipharm and IDA solutions, the National Drug Authority, PSI Uganda, the Malaria Consortium and many more that will join this initiative. I give my full support and wish this initiative all the success. I hope it will ultimately lead to a reduction of our heavy

10 burden of malaria.

I thank you.

Kaliro,

September 19, 2008

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