Sipilanyambe Naawa, Simon Jonathon L, Chanda Pascalina, Olumese Peter, Snow Robert W, Hamer Davidson H
Department of Community Medicine, University of Zambia, RW 0001, Lusaka, Zambia.
Malar J. 2008 Jan 29;7:25. doi: 10.1186/1475-2875-7-25.
Following the recognition that morbidity and mortality due to malaria had dramatically increased in the last three decades, in 2002 the government of Zambia reviewed its efforts to prevent and treat malaria. Convincing evidence of the failing efficacy of chloroquine resulted in the initiation of a process that eventually led to the development and implementation of a new national drug policy based on artemisinin-based combination therapy (ACT).
All published and unpublished documented evidence dealing with the antimalarial drug policy change was reviewed. These data were supplemented by the authors' observations of the policy change process. The information has been structured to capture the timing of events, the challenges encountered, and the resolutions reached in order to achieve implementation of the new treatment policy.
A decision was made to change national drug policy to artemether-lumefantrine (AL) in the first quarter of 2002, with a formal announcement made in October 2002. During this period, efforts were undertaken to identify funding for the procurement of AL and to develop new malaria treatment guidelines, training materials, and plans for implementation of the policy. In order to avoid a delay in implementation, the policy change decision required a formal adoption within existing legislation. Starting with donated drug, a phased deployment of AL began in January 2003 with initial use in seven districts followed by scaling up to 28 districts in the second half of 2003 and then to all 72 districts countrywide in early 2004.
Drug policy changes are not without difficulties and demand a sustained international financing strategy for them to succeed. The Zambian experience demonstrates the need for a harmonized national consensus among many stakeholders and a political commitment to ensure that new policies are translated into practice quickly. To guarantee effective policies requires more effort and recognition that this becomes a health system and not a drug issue. This case study attempts to document the successful experience of change to ACT in Zambia and provides a realistic overview of some of the painful experiences and important lessons learnt.
在认识到过去三十年中疟疾导致的发病率和死亡率急剧上升后，2002年赞比亚政府重新审视了其预防和治疗疟疾的工作。氯喹疗效不佳的确凿证据促使启动了一个进程，最终导致制定并实施了一项基于青蒿素联合疗法（ACT）的新国家药物政策。
对所有已发表和未发表的有关抗疟药物政策变化的文献证据进行了审查。作者对政策变化过程的观察补充了这些数据。这些信息经过整理，以记录事件发生的时间、遇到的挑战以及为实现新治疗政策的实施所达成的解决方案。
2002年第一季度决定将国家药物政策改为蒿甲醚 - 本芴醇（AL），并于2002年10月正式宣布。在此期间，努力确定采购AL的资金，并制定新的疟疾治疗指南、培训材料和政策实施计划。为避免实施延迟，政策变更决定需要在现行立法内正式通过。从捐赠药物开始，2003年1月开始分阶段部署AL，最初在7个地区使用，随后在2003年下半年扩大到28个地区，然后在2004年初推广到全国所有72个地区。
药物政策变化并非没有困难，需要持续的国际融资战略才能取得成功。赞比亚的经验表明，许多利益攸关方需要达成统一的全国共识，并且需要政治承诺以确保新政策迅速转化为实践。要保证政策有效需要付出更多努力，并认识到这成为一个卫生系统问题而非药物问题。本案例研究试图记录赞比亚向ACT转变的成功经验，并对一些痛苦经历和重要教训进行实际概述。
