Paul Kutyabami
MPHP439
“Rational Drug Use” as a Public Health Concept
(In developing
world)
Table of Contents
1)
Overview
2)
Poverty as a Factor in Disease Prevalence
3)
Drugs Use in Public Health
·
Access to Drugs in Developing Countries
·
Reasons for Concern about Drug Use and
Consequences of Inappropriate Use
4) Defining
appropriate or Rational Use of Drugs
·
Examples of irrational Use of Drugs
·
Causes of Irrational Drug Use
o
International Level
o
National Level
o
Health Systems Level
o
Prescribers Level
o
Dispensers Level
o
Patients and Community Level
·
Strategies for Improving and Promoting
Rational Use of Drugs
·
Challenges to Rational Drug Use in Developing
countries
5) Suggested
Further
6) Reference
Overview
The World Health Organization (WHO) indicates
that most leading causes of death and disability particularly in developing
countries can be prevented, treated or alleviated with appropriate use of drugs
and vaccines (Essential Drug Monitor, No. 23 1997). However, a third of the
world’s population living mostly in developing countries lacks access to drugs
resulting in preventable serious disability, morbidity and mortality. It is
estimated that two out of every three deaths in developing countries is caused
by infections that could be prevented with the use of drugs (WHO, 1999). Table:
1 and 2 below show the 7 major causes of death and their impact on the
population expressed in Disability Adjusted Life Years (DALYs) respectively, for
both African and American region. Disability Adjusted Life Years (DALYs) is a
measure of disability and death caused by a disease. It is obtained by assessing
the burden caused by disease and death on the population through measuring the
gap between current and ideal health condition (Quality of life and Mortality).
Higher percentages indicate greater deleterious effect on the population.
Table: 1 leading causes of deaths in WHO regions
|
Rank |
African Region |
% total deaths |
Rank |
American Region |
% total deaths |
|
1 |
HIV/AIDS |
22.6% |
1 |
Ischemic heart
disease |
15.6% |
|
2 |
Lower respiratory
infections |
10.1% |
2 |
Cerebrovascular
disease |
7.7% |
|
3 |
Malaria |
9.1% |
3 |
Lower respiratory
infections |
4.4% |
|
4 |
Diarrhoeal
diseases |
6.7% |
4 |
Trachea, bronchus,
lung cancers |
3.9% |
|
5 |
Perinatal
conditions |
5.5% |
5 |
Diabetes mellitus |
3.7% |
|
6 |
Measles |
4.3% |
6 |
COPD |
3.5% |
|
7 |
Tuberculosis |
3.6% |
7 |
Violence |
2.7% |
COPD in full is Chronic Obstruction Lung
Disease
Table: 2 leading causes of Disability Measured in DALYs
|
Rank |
African
Region |
%
total DALYs |
Rank |
American
Region |
%
total DALYs |
|
1 |
HIV/AIDS |
20.6 |
1 |
Unipolar Disorders depressive |
8.1% |
|
2 |
Malaria |
10.1 |
2 |
Alcohol use
disorders |
4.4% |
|
3 |
Lower respiratory
infections |
8.6% |
3 |
Ischemic heart
disease |
4.4% |
|
4 |
Perinatal
conditions |
6.3% |
4 |
Perinatal
conditions |
3.9% |
|
5 |
Diarrhoeal
diseases |
6.1% |
5 |
Violence |
3.8% |
|
6 |
Measles |
4.5% |
6 |
Cerebrovascular
disease |
3.3% |
|
7 |
Tuberculosis |
2.8% |
7 |
Road traffic
accidents |
3.2% |
This data was
adopted from the Global Burden of Disease:
Comparing the ranking between Mortality and
DALYs in the African and the American regions, the major causes of deaths, are also
the major causes of disability in the African region whereas in the American
region there is a greater proportional burden of less fetal conditions.
Table 3 below shows how the seven leading
causes of disease in the African region can be prevented, treated or
alleviated.
Table: 3 Gives
various ways available to ameliorate the seven leading causes of death in
African region.
|
Rank |
Disease |
Treatment |
Prevention |
Alleviation |
|
1 |
HIV/ AIDS |
No Cure Yet but Treatment for opportunistic
infections is available |
Behavioral Change |
Anti Retro Viral Drugs & various Drugs for
opportunistic infections |
|
2 |
Lower Respiratory Infections |
Antibiotics |
|
Proper diagnosis & adherence to treatment |
|
3 |
Malaria |
Antimalarial
drugs e.g. Chloroquine, Quinine |
Mosquito nets & eradication of mosquito
breeding grounds |
Proper diagnosis, early treatment & adherence
to treatment |
|
4 |
Diarrhoeal Diseases |
Oral Rehydartion Salts |
Good hygiene |
Oral Rehydartion Salts |
|
5 |
Perinatal Conditions |
Vitamins |
Vaccination & antenatal care |
Regular antenatal check ups |
|
6 |
Measles |
No cure but treatment for opportunistic infection
is available |
Vaccination |
Treatment of opportunistic infections |
|
7 |
Tuberculosis (TB) |
Various drugs are available that can cure TB |
Vaccination |
Early Diagnosis treatment and adherence to treatment |
Poverty as a Factor in Disease Prevalence
Underlying virtually all major causes of
death in developing countries is the significant role played by poverty and its
associated problems (Merson et al, 2001). Poverty has three main effects: it is
a cause of disease; it is a reason for inappropriate drug use and access to
drugs; and it is an impediment to successful implementation of interventions in
rational drug use. The last two issues are discussed in detail later in the
chapter. The effects of disease will lead to further
promotion of poverty among the population. Prevention of morbidity and
mortality from specific infections in developing countries has been the focus
of many governments and organizations. Access to drugs and ensuring their
appropriate use has been key in these efforts.
Drug Use in Public Health
Drugs
are among the most salient and cost-effective elements of health care and often
a key factor for the success of health sector reforms (Falkenberg et al, 2000).
Because drugs make health care delivery credible by relieving symptoms and
curing diseases, there are compelling arguments in favour of ensuring their
steady supply.
Table 4 below gives the summary of issues
that surround drug use in developing countries.
Table: 4 Drug
Use in Developing Countries
|
|
Effects of
IDU |
Examples of
IDU |
Causes of
IDU |
Strategies
for Improvement |
Challenges |
|
International
Level |
Lack of Access |
Substandard drugs, unreliable Med-info. High
prices |
Drug marketing & profiteering, Patents and
Trade agreements |
Provide Tec-Assis.
& funding |
|
|
National
Level |
Poor health indices |
Substandard drugs |
Budgetary constraints, weak laws &
regulations, poor infrastructure |
NDP & A |
Budgetary constraints,
poor infrastructure |
|
Health
System Level |
Loss of confidence & wastage of resources |
Drug shortages, expired drugs Lack of MIS |
Unreliable supplies, bad procurement practices,
poor infrastructure |
Drug Committees Essential Drugs list |
Lack of trained manpower, Budgetary constraints |
|
Prescriber
Level |
Drug wastage, drug resistance |
Poly pharmacy, wrong drugs, over prescribing |
Lack of knowledge, patient over load |
Training, S.T.G |
Lack of training |
|
Dispenser
Level |
Drug wastage, drug resistance |
Inadequate patient counseling |
Lack of Knowledge, Patient overload |
Training |
Lack of training |
|
Patient
& Community Level |
Drug resistance, drug dependence Increased costs of treatment, Death |
High cost of drugs, sharing of drugs, self medication, |
Poverty, illiteracy, culture, self medication |
Community outreach, Advertising, posters, Leaflets |
Illiteracy, traditional medicines, Poverty |
IDU. refers to irrational drug use
Med-info. Refers to medical information
Tec-Assis. Refers to technical assistance
NDP & A refers to National Drug Authority and Policy
S.T.G refers to Standard Treatment Guidelines
MIS refers to Management Information Systems
Access to Drugs in Developing Countries
It is estimated that one-third of the world’s population lacks regular access to
essential drugs, with this figure rising to over 50% in the poorest parts of
Africa and
Although there has been an improvement in
access to drugs world wide from one third in 1975 to two thirds presently (W.H.O.
Report on the Progress in Essential Drugs and Medicine policy 1998-1999), this has
not been reflected significantly in developing countries. The international
community through international agencies such as W.H.O. and World Bank has
instituted a variety of approaches to mitigate this problem. W.H.O for example introduced
the Essential Management Program in 1975 to increase access to drugs that treat
the most prevalent diseases. This program had an objective of making available essential
drugs that satisfy the
health care needs of the majority of the population at all times, in adequate
amounts and in the appropriate dosage forms (W.H.O, 1987). This has been done
through helping countries set priorities in drug procurements following a model
list of essential drugs established by experts at W.H.O. On the other hand, the
World Bank committed more funding to developing countries towards the procurement
of the seriously needed drugs and medical equipment (Falkenberg et al, 2000).
To a great extent, these interventions have resulted into improvement in
accessibility to drugs in developing countries. However, such improvement
should be evaluated along side with the appropriate or rational use of the drugs.
The rest of the chapter is focused on appropriate or rational use of drugs as a
measure for improving public health in developing countries
Reasons for the Concern about Drug Use and Consequences
of Inappropriate Drug Use
Governments in developing
countries spend 20-50% of their national budgets on drugs and medical sundries,
making the economic impact of pharmaceuticals on these economies
substantial (World Bank, 1994). In most developing countries pharmaceuticals
are the largest public expenditure on health after personnel costs and the
largest household health expenditure (World Bank, 1994). The substantial
expense put on drugs provides reason for countries all over the world to be
concerned about them.
Studies
done in
Many societies consider drugs as key health
technologies involving both public health and safety and when they run out of stock;
the credibility of the health system is lost leading to escalation of
irrational use of drugs and its related effects. As result governments are
concerned about the availability, handling and the effective and safe use of
drugs (Ratanawijitrasin et al, 2001). However, the W.H.O. Policy Perspective on
Medicine (2002) indicates that even when drugs are made available, more than
50% are prescribed, dispensed or sold inappropriately while 50% of the patients
fail to take the medicines correctly leading to harmful consequences.
According to figures gathered by
surveys presented to the World Health Organization, in 2000, about 60% of
antibiotics in
Inappropriate
use of drugs may lead to drug resistance and tolerance particularly if it
involves anti infective agents on top of wasting of resources. For example; misuse
of antibiotics is contributing to the worldwide increase in antimicrobial
resistance that is now being observed for most common pathogens. Chloroquine
resistance has been reported from 81 countries, and up to 98% of Neisseria
gonorrhoea is resistant to penicillin (W.H.O. Reports). The costs associated with
antimicrobial resistance are very high. For example second-line treatment for
resistant meningitis or malaria may be 50-90 times as expensive as the original
drugs, while one year’s treatment of multi-drug resistant tuberculosis costs
US$ 8,000-12,000, compared with about US$ 40 for first-line treatment
(W.H.O Reports). Drug resistance and tolerance may also lead to mortality as
patients fail to respond to available treatment.
Because of these
and other reasons that we shall see later, there is great concern about how
drugs are handled and finally used by the patients.
Defining Appropriate or Rational Use of Drugs
According to the World Health Organization
conference that took place in
·
Correct
drug
·
Appropriate
indication (the reason for prescribing is based on sound medical consideration)
·
Appropriate
drug (the drug should be of the required quality, efficacy at the time the
patient uses it and at the right cost)
·
Appropriate
dosage (administration of right quantities and duration of treatment)
·
Appropriate
patient (no contra indications exist and the likelihood of adverse drug
reactions is minimal)
·
Correct
dispensing (including appropriate information to the patient about the drugs)
·
Patient
adherence to the treatment
(This
criteria has been adopted from Managing Drug supply, 2nd edition,
Authored by WHO/ Management Science for Health)
Examples
of Irrational Drug Use
The
availability of substandard or counterfeit drugs in a country is an example of
irrational drug use that affects the entire country. Many developing countries
do not manufacture drugs locally, so they rely on importation and drug
donations from the developed countries. Health workers and the community rely
on government to ensure quality of drugs. Substandard or counterfeit drugs are a growing problem. W.H.O data base of
counterfeit drugs for example reported 771 cases in 1999, 77% of which were
from developing. Counterfeit drugs are a waste of money because they are
illegal copies of particular brands of drugs and patients are lured to by them
expensively as though they were buying the brand and if substandard, they
prolong treatment periods, exacerbate the conditions being treated and help
create drug resistance with its associated problems. Counterfeit and substandard
drugs are mainly the result of failure to comply with good manufacturing
practices (GMP) (W.H.O. Report on the Progress in Essential Drugs and
Medicine policy 1998-1999).
Drug
shortages, presence of large quantities of expired drugs and presence of drugs
that are not required by a setting are manifestations of inappropriate use of
drugs at the health systems level.
Examples
of inappropriate use of drugs at the Prescribers level are usually noted by how
prescriptions are written. Use of drugs when no drug is needed, use of wrong
drug and poor prescribing habit are some of the examples noted. Poor
prescribing habits may include prescribing too many drugs for a patient
referred to as Polypharmacy or over prescribing at particular drug or dosage
form. Prescribers tend to embark on poly
pharmacy in their attempt to treat a number of possible diseases simultaneously
(Uzochukwu et al, 2002).
At
the dispenser level, drug shortages, poor drug records, poor storage facilities
and lack of appropriate dispensing equipment and materials are common examples.
All
the examples noted above will have manifestations at the consumer or community
level either through unavailability, wrong use or over use of drugs. Drugs commonly
used incorrectly include; antibiotics, anti-diarrhoeals, pain killers, Cough
and cold preparations, vitamins, injections and anti malarial drugs is seen in
many communities (Le Grand et al, 1999). However at the consumer level, the
following are significant examples of inappropriate use of drugs: Sharing of
drugs and self medication.
Sharing
of drugs occur when patients stop taking drugs as
soon as symptoms recede and keeping whatever remains for others with similar
symptoms or for future episodes of the disease. For example, in cases of
epidemics such as malaria one member of the family would seek treatment and
will share out the drugs with other sick family members or friends. Either way the
patients will not have received the correct amount of treatment for the
recommended period of time.
Self medication will involve
patients, recommending to himself or by a peer with no medical knowledge
without visiting a health setting. Self-medication
occurs in both industrialized and developing countries, as the most common
reaction to perceived symptoms (Fresle, 1997). During a disease episode, the
patient has the option of going to a prescriber or to buy the drugs from a drug
store normally located with in the community. Choice depends on a number of factors
but most importantly the perceived severity of the disease. In the Loa study,
84% of all drugs bought from private pharmacies were self medication. The study
also indicated that 40% of drugs bought from private were decided by the
patients themselves and 19% by friends and the drugs were being brought for
themselves, family members and friends. Household survey and other community
based studies in
Causes of Irrational Drug Use
A multitude of factors have been found to
lead to irrational use of drugs and these affect at various levels at which
drugs are handled. Research studies conducted by international Health
organizations such as W.H.O, reveal that factors such as knowledge, attitudes
and practices within the community, economic incentives and promotional
practices contribute towards irrational drug use (The essential Drug Monitor,
No. 23, 1997).
International
Level
At the international level, drug promotion
and marketing by the multinational pharmaceutical companies plays a big role in
providing information to both health workers and patients through direct
advertising. Such information is often misleading, biased, scientifically
inaccurate and always persuasive to encourage over use of particular drugs or
brands. Studies indicate that in the French speaking countries, over half of
the information provided by Drug companies did not match the official drug
monographs (Lexchin, 1992).
The huge investment in Research and
Development by pharmaceutical companies, the role of patent laws and other
international trade agreements under The World Trade Organization together with
costs of promotion and marketing lead to drug prices to be out of reach by the
majority of people in developing countries. At the same time, many
pharmaceutical companies are not willing to invest in developing countries
because these provide a low market potential due to the poor economy and low
purchasing power hence limiting accessibility and affordability of drugs to the
people who need them.
The National Level
Weak
laws and regulations in a country encourage dubious individuals with selfish
interest to get involved in drug handling and supplies. Examples such as
counterfeit or substandard drugs highlighted earlier on are effects of such. Good
laws and regulations provide a frame work under which issues concerning drug
use are to be handled and monitored and when these are missing result are
always chaotic. At the same time such
laws and regulations require personnel and equipment to enforce them both of
which are significantly lacking in developing countries.
The
weak economic conditions in developing countries that has resulted in general
poor infrastructure and other economic indices are a cause of the lack of
access to drugs by many in these countries.
Health
Systems Level
The Health System inefficiencies disable
health workers from performing efficiently to ensure rational use of drugs. Causes
of irrational drug use at the Health system level include the following;
·
Unreliable
suppliers of drugs; whose quality and cost of supplies may be questionable
·
Poor
planning of the drug needs of the unit
·
Poor infrastructure
for storage
·
Poor
information management systems
·
Lack of
monitoring and supervision
Prescribers
Level
Irrational drug use has often
been thought to be entirely due to health workers lacking information and
training; thereby it could be solved by providing such information and
training. Although lack of information and training are indeed major factors, out dated prescribing practices, heavy
patient load, pressure from peers and patients together with those factors at
international such as drug promotion, National such as economic factors and
health system level such as lack of diagnostic equipment too affect the
effectiveness of Prescribers in ensuring the rational use of drugs.
Sometimes, there is a conflict of interest
particularly with Prescribers practicing privately that motivate them to make
choices of drugs that will maximize profit.
Dispenser
Level
Dispensers
are usually the last health professionals in the drug use process to interact
with the patient. This gives them a crucial role in the therapeutic process and
in ensuring adherence to the standards of rational drug use. Just as under Prescriber
level, lack of information and training, patient overload and the factors at
the other levels including Prescribers affect the quality of services among
dispensers. Studies done in Loa People’s Democratic Republic to look at
practice in both public and private pharmacies indicate that 54% of the staff
in public pharmacies where medical assistant or nurses and more than 60% low
level nurses in the private pharmacies. Although almost all the staff in
private pharmacies where knowledgeable about regulations none was in the public
pharmacies. These can not provide credible information the patients ensure
rational drug use (Syhakhang et al, 2001). They are very few pharmacists and
qualified dispensers to fill the job market and as such many setting particularly
in the private sector a filled by non trained staffs.
At
the same time, the perception of patients that dispensers as mere keepers of
drug with no significant value to add to the quality of health, makes patients
not take the information provided by dispensers seriously.
Patients
and Community Level
Patients are the ultimate users of drugs.
They make the final decision about whether or not to seek health care, where to
seek it, and what medicines to actually take and at what intervals or duration.
Correct prescribing does not guarantee that drugs will be properly used. Non
adherence to prescription is very common (Le Grand et al 1999). Decisions by
the patient are influenced by many factors, including cultural beliefs, the
communication skills and attitudes of health workers, accessibility to and
nature health service delivery point, community belief about the efficacy of
certain drugs, routes of administration and the patient’s assessment of a
particular disease. For example some diseases are regarded as simple and may
not necessitate visiting a physician so a patient may decide to medicate him or
herself.
Patients’ perception of disease symptoms as
minor or their thinking that they are sufficiently familiar with the disease
and how to treatment it makes them believe they do not need to visit a health
facility and therefore able to avoid the inconvenience and cost of doing that.
Patients may also avoid reporting some diseases because of the fear of being
stigmatized. Diseases such as sexually transmitted diseases are associated with
social stigma; patients would prefer to treatment themselves or at worst
consult with peers.
In some
instances, patients’ lack the knowledge to make appropriate judgement of their
drugs they require and the fear of the illness lead them to the demand for
inappropriate treatment. This
together with the concept that, there is a pill for every ill has resulted into
patients’ over reliance on drugs, becoming accustomed to using particular drugs
or dosage forms. For example, using injectables in conditions where oral dosage
forms would be more appropriate or using of antibiotics in the treatment of the
common cold.
The availability of drugs with in the
community has allowed unlimited access to patient of all classes of drugs. Reports
from WHO indicate that prescription drugs are widely available from a variety
of sources which include street peddlers, traditional healers and unlicensed
stores in most of the developing countries (WHO, 1997). Prescription-only drugs
are also routinely available direct to consumers even from licensed pharmacies
due to lack of state regulatory enforcement capacity. Drugs sellers and
consumers do not differentiate between the Over the counter (OTC) and the
prescription only medicines.
Lack of access to health facilities lead to
patients to resort to any form of health care available in the community,
including self medication as a result, irrational drug use is more prevalent in
areas that are less covered by public health unit than those that are covered.
Strategies for Improving and Promoting Rational
Use of Drugs
Effective treatment exists for most of the
leading causes of mortality and morbidity as has been noted earlier. The
challenge that remains is to ensure that people can access these drugs and be
able to translate the drugs into vital technologies to improve health. It is
through the appropriate use of drugs that health and quality of life can be
improved. Intervention in situations where inappropriate drug use is reported
is plausible and indeed many governments and organizations have undertaken
strategic steps to ameliorate problems related to drug use. Table 4 shows some
of the strategies and steps undertaken to improve Rational Drug Use.
Effectiveness of these interventions has been
noted in many of countries at various levels. Already W.H.O and World Bank
interventions in improving access to drugs have been discussed and these
organizations continue to provide technical assistance to countries involved in
rational drug use.
Through such technical assistance, many
developing countries have developed laws and regulations enshrined in their National
Drug Policies and established secretariats to monitor and evaluate drug use
problems in these respective countries.
There are various examples of successful
interventions at health systems level such as establishing drug committees,
setting up priority list for drug procurement and improving drug information
management systems.
At the same time health workers; Prescribers
nurses and dispensers have undergone various forms of training to improve their
knowledge in rational drug use.
Other interventions at both health workers’
and community levels have been undertaken in many counties.
Table
5, Educational, Managerial and regulatory Strategies for intervention in
Rational Drug Use
|
Strategies |
Interventions |
Targeted category of persons |
|
International
|
Technical
assistance Drug
Donations Funding |
W.H.O,
World Bank and Various international organizations |
|
Regulatory |
-Drug
registration -Essential
drug list -Laws
and regulations restricting dispensing, prescribing & the entire
pharmaceutical industry |
-Ministry
of Health -Ministry
of Health -Ministry
of Health & other relevant ministries and agencies. |
|
Managerial |
-Establishing
a priority list for drug procurement -Establishing
Drug committees -Establishing
price indicators -Establishing
a drug utilization information system for monitoring and evaluation -establishing
procedures for selection, procurement and distribution -Standard
operating procedures for dispensing and drug storage -Standard
diagnostic & treatment guidelines |
-Storekeepers,
Administrators, purchasers & Health workers -All
health Units -Accounts
& Purchasers -Drug
Use supervisors -Administrators,
purchaser & unit Heads -Store
keepers & Dispensers -Prescribers |
|
Educational |
-Formal
training(curriculum review) -Continued
Medical Education -Increased
supervision and support -Medical
Journals, Newsletter, Treatment Guidelines -Flyers,
Posters, Billboards & Radio spots -Community
outreaches and use of Folk media -Drug
Budgeting |
-Medical
& -In
service training for all Health workers -All
Health workers -All
health workers -Patients
and community -Patients
and community -Administrators,
Units Heads & Purchasers |
For example in Mexico after finding evidence
of overuse of drugs, a Non governmental organization embarked on a short but
intense educational campaign that involved development of posters, leaflets,
press articles, radio and television programs for health workers and the
community. Feed back from the campaign were positive (W.H.O, 1996).
Challenges to Rational Drug Use in
Developing Countries
The state of health and general
well being in developing countries is generally poor with a high disease burden
that encourages the use of drugs. The social and cultural perceptions of
disease and drugs that view these differently from the west make the task of
intervention enormous. Successful intervention requires the political goodwill
to be registered with subsequent enactment of laws and regulations that focus
on drug handling. In some states reports of political patronage have been
sighted as the reasons for the presence of counterfeit drugs on the market.
Rational drug use relies on the availability
of the necessary infrastructure for easy communication and transportation,
disease diagnosis, drug storage and a quick information processing mechanism.
The low technology exhibited and lack of infrastructure may make implementation
of some of the intervention strategies impossible. For example laboratory
testing is only possible with the necessary equipment, the lack volumes of
information relating to drug utilizations may be difficult to hand without computers
and the long distances patients have to walk to the nearest health units and
the lack of proper roads may prevent patients from seeking services from
trained health workers.
Success in implementing any
intervention requires human resources to perform the task. One of the problem
sighted as a cause for irrational drug use is lack of trained health worker. It
is apparent that interventions that will successfully address irrational drug
use need to focus at this as a long term strategy. However in the short term
lack of man power to perform the different tasks in many countries is the major
impeding factor in successful implementation.
Many of the interventions
employed to address the problem of irrational drug use in the community,
require one’s ability to read and understand the message. With the high rates
of illiteracy in developing countries, there is a need to design messages in
ways that can ensure comprehension of the community. This will mean that
messages are put in audio form in local languages which in the end may be
costly to disseminate. The high levels of poverty on top of being a cause of
irrational use of drugs may also impede strategy implementation. Patients even
after knowing the value of taking a complete dose of drugs may be unable to buy
it end up either not taking the drugs at all or taking a fraction of the dose.
Traditional
medicine includes diverse health practices, approaches, knowledge and beliefs
incorporating plant, animal and/or mineral based medicines, spiritual
therapies, manual techniques and exercises, applied singularly or in
combination to maintain well-being, as well as to treat, diagnose or prevent
illness (W.H.O. Policy Perspective on Medicine No.2 May 2002). There is a
growing population using traditional medicine world wide. Populations throughout the world including
Table 6, Percentage population of
Selected Countries Using Traditional medicine for Primary Health Care
|
Country |
|
|
|
|
|
|
|
% of the population |
90 |
70 |
70 |
70 |
60 |
60 |
Sources: (W.H.O. Policy
Perspective on Medicine No.2 May 2002)
The wide spread and growing use of
traditional medicine provides a challenge to public health in terms of safety,
quality, efficacy, access and rational use. Governments and organizations
dealing with rational drug use and access to medicine need to incorporate
traditional medicine in their strategic plan in order to ensure balanced
success.
Suggested Further
1.
Management
Science for Health/WHO/DAP. Managing drug
supply, 2nd edition.
2.
Essential
Drug s monitor produced and distributed by The W.H.O department of essential
Drugs and Medicines Policy (EDM)
Accessible at: http://www.who.int/medicines/default.shtml
Reference
1.
Le Grand
A. et al. Interventional Research in Rational Use of Drugs: A Review. Health
Policy and Planning, 1999 14 (2) pp 89-102
2.
Bennett S. et al, PUBLIC-PRIVATE ROLES IN THE
PHARMACEUTICAL SECTOR: Implications for equitable access and rational drug use,
(1997) WHO/DAP/97.12
3.
Bexel P.
et al. Improving Drug Use through Continuing Education, A Randomized Controlled
trial in
4.
Brudon P.
et al. Indicators for Monitoring National Drug Policies: A Practical Manual.
2nd edition, World Health Organization.
5.
Chukwuani
C. M. et al. Survey of drug use practices and antibiotic prescribing pattern at
a general hospital in
6.
Egger, G
(1980): Psycho-Social Aspects of Increasing Drug Abuse. A Postulated Economic Cause in Social Science and Medicine
7.
Essential
Drugs Monitor Number 23 (1997) WHO publication.
8.
Falkenberg
T. and Tomson G. The World Bank and Pharmaceuticals. Health Policy and
Planning, 2000 15(1) pp 52-58
9.
Fresle
DA, Wolfheim C. (1997) Public Education in Rational Drug Use: a Global
Survey W.H.O Geneva 1997
10.
Stimsom
G. V. Promoting Rational Drug Policy. International Journal of drug policy,
2001
11.
Gupta,
A.I (1997): Power, Patents and Piles: An Examination of GATT/WTO and Essential
Drugs Polices, Fragile Economics, Flooded Market; Networking For Ration
Drugs use in
12.
http://www.who.int/medicines/strategy/rational_use/strudmon.shtmlal
13.
vanHyfte
D. M.H. et al. Towards a Rational Use of Psychoactive Substances in Clinical
Practice. Pharmacopsychiatry, 2001 vol.34 pp 13-18
14.
Isah A.
O. et al. Drug Use Profile in a
15.
Kamya M. R. et al.
Increasing Antimalarial Drug Desistance in
16.
Kanji N.
Charging for Drugs in
17.
Lexchin
J. Pharmaceutical promotion in the third world. In: The Journal of Drug Issues. (1992). 22(2) pp 417-437
18.
Management
Science for Health/WHO/DAP. Managing drug supply, 2nd edition.
19.
Merson
MH, Black RE & Mills AJ eds International
Public Health: Diseases, Programs, Systems and Polices (2001) Aspen
Publishers Gaithersburg
20.
21.
Ratanawijitrasin
S. et al Do National Medicinal Drug policies and Essential Drug Program Improve
Drug Use: A Review of experiences in developing countries. Social Science
and Medicine, 2001 vol.53 pp 831-844
22.
Syhakhang
L. et al. The quality of Public and Private Pharmacy practices: A Cross
sectional study in the Savannakhet province, Loa PDR European Journal of
Clinical Pharmacology, 2001 vol.57 pp 221-227
23.
Uzochukwu
B. S. C. et al. effect of the Bamako Initiative Drug Revolving Fund on
Availability and Rational Use of Essential Drugs n Primary Health Care
Facilities in South East Nigeria. Health Policy and Planning, 2002.
17(4) pp 378-383
24.
Vázquez
E.C.S, Increasing Drug Access for the Poor Using Generic Drugs: Regulation and
Policy Alternatives, (2003)
http://www1.worldbank.org/hnp/hsd/documents/drugaccess.pdf
25. W.H.O
Conference of Experts on the Rational Use of Drugs,
26.W.H.O Traditional Medicine Growing Needs and Potential, W.H.O. Policy Perspective on
Medicine No.2 May 2002
27.W.H.O World Health Organization Report on Infectious Diseases:
Removing Obstacles to Health Development (1999)
28.W.H.O. Promoting Rational Use of Medicines: Core Components. W.H.O
Policy Perspectives on Medicines, 2002
29.W.H.O. Report on the Progress in Essential Drugs and Management
Policy 1998-1999
30.Warhurst D. C. and Duraisingh M. T. Rational use of Drugs
against Plasmodium Falciparum Transactions of the Royal Society of Tropical
Medicine and Hygiene, (2001) 95 pp345-346
31.World Bank. The Importance of Pharmaceutical and Essential Drug
Programs: Better Health in