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Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1994 Nov. 3 p. (Update No. 18)If diarrhoea in children is to be managed correctly, there is need to look beyond public sector health facilities. Good management has to be promoted in the home, and there is also a need to improve the practices of all providers of care, particularly in the private sector. Retail drug businesses are particularly important providers of care because: in most countries, pharmacies and over-the-counter drug stores are widely distributed geographically; they are the most frequently visited of all health-related facilities; for purposes of training, drug retail outlets are relatively easy to reach; products sold and advice given to customers for treating diarrhoea are generally inappropriate and, in some cases, dangerous. (excerpt)
Oxford, United Kingdom, OXFAM, 1982. 277 p.Third World countries face foreign domination of their drug markets, a glut of overpriced and unnecessary medicines, a short supply of essential drugs, technical obstacles to local production, unethical promotion techniques, and inadequate warnings about the side effects of certain drugs that may be banned in the developed world. However, a number of small-scale grass roots projects are attempting to redress this situation. For example, Gonoshasthaya Kendra (People's Health Center) in rural Bangladesh operates a pharmaceutical factory which manufactures inexpensive, essential generic drugs. Profit margins are set lowest on drugs considered most useful, and research and development are tailored to local needs. In addition, countries such as Sri Lanka and Mozambique have adopted comprehensive national drug policies that give priority to essential drugs for primary health care. To make the benefits of modern medicine more available to the poor, Third World governments must prioritize preventive and primary health care services and reallocate resources to the poor majority. National drug policies should include identification of essential drugs, compulsory use of generic names, balanced drug information sheets for prescribers and patients, establishment of an efficient public sector drug distribution system, controls on private distribution, and strict curbs on promotion. Medical training should be rooted in social and economic realities so health workers become oriented toward prevention. Also, the schools, mass media, and community organizations should be used to challenge people's dependence on drugs. The success of new drug policies requires the support of the major drug producing nations. These nations should increase their financial support to UN programs aimed at the needs of developing countries and should not obstruct the World Health Organization in its work on an international code of drug marketing practices. Nongovernmental agencies should publicize examples of constructive policy initiatives and continue to fund community health projects that avoid high technology options. The major transnational drug companies should be consistent in the standards they apply, regardless of loose controls in developing countries, and should demonstrate social responsibility by not creating a demand for nonessential preparations.
Bulletin of the Pan American Health Organization. 1983; 17(2):201-3.A field study to ascertain the status of drug delivery systems for primary health care centers in Latin America was conducted by the Pan American Health Organization (PAHO) in 1980-81. Countries studied included Bolivia, Ecuador, Peru, Honduras, Panama, and the Dominican Republic. The planning and purchasing functions of the drug distribution systems were found to be highly centralized, failing to take local morbidity patterns or drug demand levels into account. Storage areas lacked adequate equipment and were poorly designed. Personnel were insufficiently trained and were found to ignore procedures regarding the handling of damaged or expired drugs. Also noted was a lack of adequate equipment for transporting medicines to rural clinics. A widespread characteristic was the lack of formal supervision and control (excluding fiscal) at national, regional, and local levels. Many essential drugs were unavailable at the local level, and formulations with unjustified associations and products for which there are more advantagous substitutes were found. These results were presented at the PAHO-sponsored Regional Workshop on Administration and Supply of Essential Drugs held in 1981. The workshop made 5 recommendations to governments: 1) every national health plan should include a national drug policy; 2) the drug policy should encompass a registry of all drugs sold, a list of essential drugs by level of care, quality control measures, educational activities for personnel, proper financing, and an evaluation methodology; 3) an integrated system for managing drug distribution should be designed; 4) information on essential drugs, legislation, pricing, and quality control should be exchanged among regions; and 5) centers should participate in the WHO-developed quality certification system. In addition, it was recommended that PAHO should: 1) participate in developing a system of regional cooperation, 2) identify regional centers for training personnel in the management of drug distribution systems, 3) stimulate development of training programs, and 4) support operational research on drug distribution systems.