On the background of increasing resistance of malaria parasites, WHO recommends that falciparum malaria cases should be treated with combination chemotherapy to delay resistance. One challenge is ensuring the availability of combination products at a cost so low that patients will not, for economic reasons, opt for monotherapy. This could be addressed by a global high-level subsidy for artemisinin-based combination therapies (ACTs). Such a mechanism, as well as other related ones, received much attention during a supply shortage of ACTs in 2004-5, which was related to the difficulties of rapidly scaling up the production of artemisinin, from plants. Attention is now reverting to the generic requirements for rational use of medicines in developing countries, but the implementation of ACT policies may fail, unless the international community decides resolutely to ensure that ACTs are available at low cost to the patients through all service delivery channels
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