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Misdiagnosing malaria: experiences of the AMFm scheme in Ghana

A few months ago Oxfam published a critical report on the Affordable medicines facility for malaria (AMFm), calling it a ‘dangerous distraction’ from more effective ways of providing treatment. Our problem with the scheme is that it relies on unqualified shopkeepers to diagnose and distribute drugs, rather than trained health workers. This means there’s a huge danger of people being misdiagnosed, given there are many other causes of fever, not just malaria.

Oxfam spoke to people in Ghana, to see what their experiences were. Christiana’s story highlights how harmful selling someone the wrong medicines can be. 

Christiana Donyinaa is 43 and makes a living selling cosmetics. A few months ago her youngest daughter, Gloria (age 12), became ill with a fever. Christiana went to a shopkeeper and described Gloria’s symptoms and was told her daughter had malaria. The shopkeeper sold her malaria drugs.  

“I gave Gloria the medicine and she felt better after a few days. The following week, schools were on vacation so she decided to visit her older sister, who lives in Accra. As soon as she got to Accra she felt sick again. Her sister took her to the hospital and she was diagnosed with typhoid fever.  She was admitted to hospital for several weeks.   

I got very worried because school had resumed and she was still in the hospital.  The doctor said Gloria had been suffering from typhoid for a very long time, but because we didn’t take her to the hospital, we didn’t realise it early enough.   
 
When I was told that she was sick, I was very concerned and quickly jumped on a bus to Accra.  When I got there her condition was serious and I stayed with her in the hospital for more than two weeks.”   

Gloria’s condition became quite serious, she found it difficult to breathe and couldn’t eat anything without being sick. Because Christiana was at her daughter’s bedside, she was unable to earn any money over those few weeks. She also spent all the money she needed to run her business on medical expenses. In the end Gloria spent several months off school recovering and has now fallen behind with her studies.

“Gloria’s sickness has affected her a lot. She wants to be a Nurse in future but her illness has set her back a bit.”
  
Christiana believes that malaria medication should only be prescribed and distributed by trained health workers and not through shopkeepers.

“The advice I have for the government and NGOs is that the malaria drug is very good, if you have malaria.  But they should not give it to the drug peddlers; they should give it only to clinics. Some of the drug peddlers have these medicines in their pockets. They sell it to you when you tell them you have a headache, they will just give you the medicines without any diagnosis.  This is very dangerous the drug peddlers don’t know what illness people have.

I will advise every parent that when their child is sick they should take them to a doctor. Because if I had taken Gloria to the hospital from the onset when she was sick I don’t think both of us would have suffered as we have done.”

Oxfam is warning against any further funding for the AMFm scheme and for money to be used to invest in the training and salaries of community health workers instead, who are proven to save lives.

Sarah Dransfield is the Essential Services Press Officer at Oxfam GB

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni