I repeat again and again my mantra: a huge amount of drugs is wasted. At least 50% of drugs (antibiotics in premature babies, for instance) are prescribed unnecessarily worldwide, i.e., are literally wasted. Rich countries can afford this wastage....poor countries NOT.
Poor people are neglected: they are forced to pay for drugs that they do not need... money that should be allocated to buy food. Poor countries are forced to pay a huge amount of money to import drugs manufactured by western pharmaceutical companies: a loss of money, paid to who are already rich, by poor countries that should spend their little money for other sectors, like agriculture or education. Medicine is being vilified more and more. Resistance to antibiotics is a worldwide super serious worry.
All the above are facts:
The culprits? prescribers/doctors, all those that accept market instead of medicine...and these are the majority.
My opinion on this is that; some prescribers do over-prescribe out of ignorance. I therefore advice that, some investment should be made in capacity building to medical personnel on rational use of medicines. Refresher courses to staff who completed medical school's some years back should be planned, as much as we can afford.
Frank Komakoma
Pharmacist
P.O Box 12896
Dar-es-Salaam
Tanzania
+255 754 378887 mailto:fkoma@yahoo.com
You have raised a vital issue that seriously demands urgent attention. Wastage of drugs, over prescription also trend in Nigeria. People that are completely outside the medical field and even illiterate open pharmaceutical stores across streets and the ignorant rely on their prescriptions! Petty traders not in drug business must at least sell paracetamol in her shop. Something needs to be done.
Capacity building on rational use of medicines is certainly a good thing.
But I am not sure, if ignorance is the only or even the main cause for
over-prescription. I have the feeling that a broader approach would be
necessary to make any significant improvements in this regard.
Reinhard
--
Reinhard Koppenleitner, MD MPH AGEG Health Department Advisor
Winsstr. 32 10405 Berlin (Germany)
Tel +49 (0) 30 4737 7560 Mob +49 (0) 173 940 2610
Headoffice: AGEG Consultants eG - Jesinger Str. 52 - 73230 Kirchheim unter
Teck (Germany)
Tel: +49 (0) 7021-9708718 - Fax: +49 (0) 7021-970879 mailto:RKoppenleitner@t-online.de
When anyone can go to a pharmacy and ask for medicine, there is no control on who takes what medicine or why. People throughout the world think antibiotics will cure most things so they take them indiscriminately. The capacity building needs to be done by educating the people. Pharmacies will continue to sell antibiotics to whoever asks for them as they are more concerned with the money that the problems such indiscriminate use of antibiotics causes.
Best Regards,
Sandra
--
Sandra Basgall
Chief of Party
Social Impact, Inc.
Democracy and Governance Program Evaluations in Bangladesh
House No. 42A, Road 42
Flat No. B-1, Gulshan-2
Dhaka, Bangladesh 1212
+880.177.580.0390
SKYPE: sbasgall
www.socialimpact.com mailto:sandra.basgall@gmail.com mailto:sbasgall@socialimpact.com
I agree with you, that something has to be done! Unfortunately, behind all these malpractices, politics has a big role to play. Laws and regulations are very clear on who should possess poisons, who should open a pharmacy, etc... However, regulatory bodies are powerless at this point! Even when they close the unregistered pharmaceutical outlets and take these guys to the court, there are no heavy punishments for them and therefore no one is afraid to open the same outlet the next day. When the regulatory bodies fight these malpractices, politicians back them!
I think that when politicians will stop interfering with professionalism, then we will move forward.
Pharm. Frank Komakoma
P.O Box 12896
Dar-es-Salaam
Tanzania
+255 754 378887 mailto:fkoma@yahoo.com
Perhaps part of the solution lies in your first sentence, ‘there is no control on who takes what medicine or why’. From this statement, it is clear that more stringent regulation should be part of the solution. Here is the reality: When I have a nibble in my stomach, whether I am in Washington DC, Dhaka, Monrovia, or Kampala, I would like to take metronidazole, for example, to take care of the ‘bug’. The difference between these places is that in Washington I would need a prescription to get the medicine. The mere effort of visiting a physician to get the prescription would make me think twice about taking an antibiotic for a mere nibble. In the other places I cited as examples above, I would simply walk into a nearby pharmacy/medicine store and buy the medicine. Regulation is thus a critical component of addressing the issue in question.
Over prescription of drugs in our sub-saharan setting are seemingly propped on the following pillars - in no order of priorities:
- inadequate geographical access to proper prescribers leading to medicine supply points outnumbering prescribers leading to opportunities to interface with client needs directly without adequate diagnosis,
- geographical and resource challenges of regulatory structures and mechanisms,
- non-robust regulations with weak sanctions,
- poor peer and ethical constraints to promote adherance to best practises,
- profit considerations from medicine provider and prescribers ( who double as sole meds providers too in many situations).
These and more in addition to factors provided earlier by colleagues need consideration for remedial strategies to promote appropriate prescribing.
Thank you.
Egbert K. Bruce
JSI/ USAID |DELIVER PROJECT
GHANA office
00233 244233931 mailto:ekbruce@gmail.com
I agree with you that education is the key. I will certainly differ on the target or recipients of the education.
The health professional are those to whom the awareness should be raised. From our experience in Cameroon, many prescribers just do it ignoring the driving force behind. In the second stage, corporations should endeavour to discipline defaulters. Many prescribers ignore, I mean refuse to comply with national guidelines and by doing so impoverish their patients by over-prescription.
It is clear that the issue is serious and should be tackled as such.
I agree with you, but in countries in which corruption and graft are the norm, regulation will not happen. I can walk into a pharmacy in most of the world and get what I ask for over the counter without a prescription. We regulate and educate in the US and Europe, but when the majority of the world does not or chooses not to regulate, we will continue to have germs resistant to most drugs. Frankly, it is quite scary to me and I have seen exactly what I have described throughout Africa and Asia. I bet it is in Latin America also.
If you can figure out how to regulate, and this is not passing laws, but also enforcing them in the places where I work, you can bring about world peace also!
Best Regards,
Sandra
--
Sandra Basgall
Chief of Party
Social Impact, Inc.
I have worked in Cameroon and as long as there is profit, the pharmacies will sell whatever the customer wants! I have also work in Cameroon on TB and because the medicine makes the patient feel sicker than the TB, as soon as the worst symptoms are gone, they stop taking the drugs making them carriers and further assisting the TB germs to become resistant. It is a much bigger issue than this discussion and if we do not work on all fronts, we will fail. How soon will our super drugs be as worthless as placebos!
Best Regards,
Sandra
--
Sandra Basgall
Chief of Party
Social Impact, Inc.
I entirely agree with Bruce for the essentials pillars raised as factors of over-prescription of drugs in our settings.
I am pleased he mentioned that he was enumerating not in order of priority.
I would like to point out the fact that the geographical access to proper prescriber may be of little importance if a robust tool is used for analysis. From our experience, even learned or highly educated persons in our towns go for street drugs or once in a hospital setting abide more to counsel from a junior staff than the right prescriber.
I am aware , many factors come into play but the end result is that auto medication has a very favourable and fertile land in our countries.
To my opinion, only by raising the issue , we have started to get a solution.
Best.
--
Dr. Armand S. NKWESCHEUMD, MPH
Epidemiologist/ Research Officer - Division of Health Operations Research.
Ministry of Public Health of Cameroon.
Office Tel: (237) 22 23 45 18 / Fax: +22 23 45 79
Location: Rue Roudolf Douala Manga Bell- Messa ( "Hygiene Mobile")
Private:
Home Tel: (237) 22 20 96 98
P.O.Box 6266 - Yaoundé
Mobile phone (237) 99 95 84 49/Fax(Home): (237) 22 20 77 45
"If you don't learn to share when you don't have, you will not share even if you have" (Wilfred MBACHAM-2004)