E-drug: Bamako article from Nigeria
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There is a fascinating article in the latest Health Policy and Planning. The
reference is Benjamin SC Uzochukwu, Obinna E Onwujekwe, and Cyril O Akpala
Effect of the Bamako-Initiative drug revolving fund on availability and
rational use of essential drugs in primary health care facilities in
south-east Nigeria
Health Policy Plan. 2002 17: 378-383. [Abstract]
<http://heapol.oupjournals.org/cgi/content/abstract/17/4/378> [PDF]
<http://heapol.oupjournals.org/cgi/reprint/17/4/378>
The URL to download the article is at
<http://heapol.oupjournals.org/cgi/reprint/17/4/378.pdf>
The abstract reads
Objectives: To compare the level of availability and rational use of drugs
in primary health care (PHC) facilities where the Bamako Initiative (BI)
drug revolving fund programme has been operational, with PHC centres where
the BI-type of drug revolving fund programme is not yet operational.
Methods: The study was undertaken in 21 PHC centres with BI drug revolving
funds and 12 PHC centres without BI drug revolving funds, all in Enugu State
of Nigeria. Data were collected on the essential and non-essential drugs
stocked by the facilities. Drug use was determined through analyses of
prescriptions in each health centre. Finally, the proportion of consumers
that were able to remember their dosing schedules was determined.
Findings: An average of 35.4 essential drugs was available in the BI health
centres compared with 15.3 in the non-BI health centres (p < 0.05). The
average drug-stock was adequate for 6.3 weeks in the BI health centres, but
for 1.1 weeks in non-BI health centres (p < 0.05). More injections (64.7 vs.
25.6%) and more antibiotics (72.8 vs. 38%) were prescribed in BI health
centres than in the non-BI health centres (p < 0.05). The BI health centres
had an average of 5.3 drugs per prescription against 2.1 in the non-BI
health centres. However, the drugs prescribed by generic name and from the
essential drug list were higher in the BI health centres (80 and 93%) than
the non-BI health centres (15.5 and 21%, respectively) (p < 0.05).
Conclusion: It was observed that the BI facilities had a better availability
of essential drugs both in number and in average stock. However, the BI has
given rise to more drug prescribing, which could be irrational. The findings
call for strategies to ensure more availability of essential drugs
especially in the non-BI PHC centres as a strategy to decrease medical costs
and improve the quality of PHC services, while promoting rational drug use
in all PHC centres. More detailed studies (for example, by focus group
discussion or structured interviews) should be undertaken to find out
reasons for the over-prescription and to develop future interventions to
correct this.
What is fascinating about this article is that it documents what was
predicted in the original 1989 Lancet editorial on the Bamako Initiative
that while availability might improve there was a real danger that rational
drug use would deteriorate. The differences are quite dramatic!
I wish that this study had been done 12 years ago!
Richard Laing
Associate Professor
Tel 617 414-1444
Fax 617 638-4476
Department of International Health
Boston University School of Public Health
http://dcc2.bumc.bu.edu/richardl/
715 Albany St Boston MA 02118-2526
richardl@bu.edu <mailto:richardl@bu.edu>
[If you cannot access the website to get the full article, contact
e-drug. The pdf document can be sent to you directly. BS]
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