When the pharmaceutical system creates persistent attachments or new appropriations of drug molecules : divergent ACT distribution and use in Benin and Ghana

In this chapter, the authors examine artemisinin-based combination therapy (ACT) use in Benin and Ghana. Although these two neighboring countries have similar epidemiological profiles and perceptions of malaria, ACTs are used in very different ways: much more appropriately in Ghana than in Benin. In this latter country, there is a surprising simultaneous presence of different antimalarial treatments (quinine, ACTs, sulfadoxine-pyrimethamine [SP], and even chloroquine). The compounds were integrated into the countries' existing pharmaceutical systems, which have a considerable impact on how the medications are used. This chapter highlights how the ties that bind individuals to pharmaceutical compounds - through attachment, rejection, or appropriation - are constructed through existing legislation and pharmaceutical distribution methods. The different situations in the two countries raise questions for public health regarding both issues of parasite resistance and of inappropriate medication for malaria. Understanding the availability of inexpensive molecules (whether subsidized or reimbursed through various insurance mechanisms), the distribution channels used (formal or informal) and how they are present in the country, is essential to build policies to combat diseases and assess their consequences on individual and public health as well as on the economy and society.