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Geneva, Switzerland, WHO, Action Programme on Essential Drugs, 1993. ii, 87 p. (WHO/DAP/93.1; DAP Research Series No. 7)The WHO Action Program on Essential Drugs has developed and field tested a core set of drug use indicators capable of describing drug use patterns and prescribing behaviors in a country, region, or individual health facility. These indicators can be used to measure the impact of interventions designed to change prescribing practices, detect performance problems, and compare the performance of providers and institutions. Three categories have been developed: 1) prescribing indicators--average number of drugs per encounter, percentage of drugs prescribed by generic name, percentage of encounters with antibiotic prescribed, percentage of encounters with injection prescribed, and percentage of drugs prescribed from essential drugs list or formulary; 2) patient care indicators--average consultation time, average dispensing time, percentage of drugs actually dispensed, percentage of drugs adequately labelled, and patients' knowledge of correct dosage; and 3) facility indicators--availability of copy of essential drugs list or formulary and availability of key drugs. All data required to measure the core indicators can be derived from medical records or direct observation. Field testing in developing countries such as Nigeria and Tanzania found these measures both feasible to obtain and informative as first-level indicators. Also presented are descriptions of key issues related to study design and sampling, field methods, analysis, and follow up.
DEVELOPMENT DIALOGUE. 1985; (2):15-37.This paper discusses the principles involved in formulating international standards to regulate the appropriate use of drugs. It focuses particular attention on the role of the World Health Organization (WHO) in organizing this. The following questions are addressed: What is meant by the appropriate use of drugs? What are the main determinants of appropriate drug use that all the main actors agree on? How appropriately are drugs used today? To what extent are the standards agreed on in principle actually observed in practice? Is regulation called for? What kind of regulation is appropriate? What standards would meet the needs of all countries? Appropriate drug use is the provision of drugs to people who really need them and restiction of the supply of drugs to those who don't need them. Primary health care requires a continuous supply of essential drugs. As many as 70% of the pharmaceuticals on the market today are inessential and/or undesirable products, and many pharmaceutical products are marketed today with little concern for the differing health needs and priorities of individual countries. Few countries systematically monitor drug prescribing standards and consumption patterns. There is chronic and serious under-reporting of adverse reactions to drugs. Regulation implies control over the activities of the main drug producers. This requires international initiatives, since an essentially transnational industry is involved. Transnational corporations dominate the world market for drugs. All pharmaceutical products must be approved and registered for use by the competent government authority. All pharmaceutical products shall have full regard to the needs of public health.
DEVELOPMENT DIALOGUE. 1985; (2):1-4.On November 25-29, 1985, the World Health Organization held a Conference in Nairobi of Experts on the Rational Use of Drugs. In the early 1980s, both the International Federation of Pharmaceutical Manufacturers Association (IFPMA) and Health Action International (HAI) had developed codes of pharmaceutical marketing practices in order to come to terms with the malpractices in this field. A more comprehensive approach was needed, however. Prime responsibility for rational drug use must rest with the member governments, operating through national regulatory authorities and assisted in their work by guidelines on minimum requirements for national drug regulation prepared by WHO. The Dag Hammarskjold Foundation organized a seminar on Another Development in Pharmaceuticals as an independent contribution to the international debate on this global issue. The seminar emphasized that development should be need-oriented, self-reliant, and based on structural transformations. Governments view the pharmaceutical crisis as 1 facet of the more general problem of spiralling health costs which put an intolerable burden on already overstretched welfare services. The pharmaceutical industry sees the crisis largely in terms of excessively restrictive regulations which stifle innovation of products. Some doctors and pharmacists feel that increased regulatory measures will erode their rights to prescribe and to control the supply and information to patients. On the other hand, some clinical pharmacologists and administrators express concern about excessive, irrational and uneconomic prescribing and its effects on public health. Consumer groups define the problem in terms of an overbearing and greedy business community. The general public fail to understand the effects of pharmaceuticals.
Tropical Doctor. 1984 Jan; 14(1):8.Enormous problems in developing countries concerning drug supply, such as inadequate control of money spent on drugs, insufficient government supervision of the importation and distribution of drugs, dumping, and so on, prompted the World Health Organization to set up an expert committee to compile a list of drugs which would provide adequate health care. This Essential Drug list is intended to extend the accessibility of the most necessary drugs to those populations whose basic health needs could not be met by the existing supply system. In cooperation with Medicus Mundi Nederland the use of this basic list is investigated in a population of medical doctors in Africa, sent out by Medicus Mundi. Investigated were: actual use of the essential drug; use of other drugs in the same pharmacotherapeutical group; priority; availability; and suppliers. In addition, insight into a number of other factors, such as the number of patients, beds, stocklists, local production, and supply of information, was obtained. The total number of patients in the combined areas was about 3,500,000. It was found that 3% of WHO's suggested drugs were not used at all, 22 essential drugs were used by only 5% of the doctors, and 41 essential drugs were used by more than 95% of the doctors. In the 1979 Revised List 25 drugs had been added and 10 deleted, compared with the 1st list, although it should be remembered that the differences were not always great. Several essential drugs mentioned for the 1st time in the Revised List are little used. Some complementary drugs scored better than the essential drugs from the same group. A number of drugs not mentioned in the List of Essential Drugs have a high priority. The results of the inquiry will be useful to evaluate the list further.
Tropical Doctor. 1984 Jan; 14(1):3-7.On April 27, 1982 the Ministry of Health of the government of Bangladesh, set up an 8-man expert committee to evaluate all the registered pharmaceutical products presently available, and to formulate a draft National Drug Policy. Objectives are: 1) to provide support for ensuring quality and availability of drugs; 2) to reduce drug prices; 3) to eliminate useless, nonessential, and harmful drugs from the market; 4) to promote local production of finished drugs; 5) to ensure coordination among government branches; 6) to develop a drug monitoring and information system; 7) to promote the scientific development and application of unani, ayurvedic, and homeopathic medicines; 8) to improve the standard of hospital and retail pharmacies; and 9) to insure good manufacturing practices. 16 criteria were agreed on as guidelines for evaluating the drugs on the country's market. Drugs in Bangladesh have been classified into 3 categories. The 1st is drugs that are positively harmful. They should be banned immediately and withdrawn from the market. There are 265 locally manufactured drugs and 40 imported drugs in this category. The 2nd, drugs to be slightly reformulated by eliminating some of their requirements. There are 134 drugs in this category. The 3rd is drugs that do not conform to 1 or more of the 16 criteria/guidelines. There are over 500 drugs in this category. The new drug policy will produce a saving of 800 million taka (US $32.4 million). Drug supply in Bangladesh is a problem. The public sector distributes 20% of the total. In the private sector, drugs are supplied through import and local production. Investment for research by the pharmaceutical companies is essential. The principles laid down by the International Federation of Pharmaceutical Manufacturers Associations for the supply of good medicine needs to be put into practice.