E-DRUG: Definition of "waste" in drug supply
----------------------------------------
[Discussion about an 'appropriate' level of 'waste' arose from a colleague working in procurement asking me for a reference for the 5% level that he had heard of. A very interesting and helpful discussion was generated and revealed that there is no % for an appropriate level. My conclusion is that 'waste' should be minimised by good management - efficient procurement operations from reliable sources accompanied by use of medicines strictly in accordance with treatment guidelines, accurate record keeping, and accurate and timely ordering from all services to the central store. These practices should lead to better forecasting and appropriate procurement - and less 'waste'. I think Susan's very useful document support's this approach. Beverley Snell - moderator]
Dear colleagues
This interesting discussion has raised the issue of what is the scope of
"waste". I would like to argue for a broader definition encompassing
many types of suboptimal management which results in losses of various
kinds. A long time ago (1990) I wrote a paper for the World Bank (still
available at
http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/1990/06/01/000009265_3960930001126/Rendered/PDF/multi0page.pdf
(It was also published in Social Science and Medicine: SD Foster, Supply
and use of essential drugs in sub-Saharan Africa:
some issues and possible solutions, Soc. Sci. Med. 32 (1991), pp.
1201–1218 -- but this is hard to get electronically).
In this paper I collected and reviewed evidence of suboptimal practice
(leading to "waste" in many cases) at various levels of the drug supply
chain from the literature. This (below) is the table which resulted.
(The information in this table was taken up by the authors of Better
Health in Africa where it was transformed into a somewhat misleading
graphic, which unfortunately lives on today, and is the source of the
often quoted statement that as much as 80-90% of drugs are "wasted"...).
Even though the data are old, I believe that many of these problems
exist today. The data suggest that the definition of "waste" could
encompass for example, bad procurement decisions such as the use of
brand names when good generic equivalents are available.
For example, in one Sahelian country, when I was part of a WHO mission, we used ABC
analysis and identified one drug, injectible ampicillin, which was used
very widely, and which if procured in generic form rather than as a
French brand name, would yield savings on the order of 15% of the total
drugs budget for the country! Switching to oral ampicillin in most cases
would have yielded another large savings.
Another Sahelian country had expired drugs on its shelves, accumulated over the years, which were worth almost the entire annual drugs budget. Assuming these drugs had accumulated over say 4 years, the "waste" they represented was on the
order of 25%. Polypharmacy continues to be a problem, and a 3- or 4-drug
prescription in many cases includes at least 1 if not 2 drugs which are
not truly needed, and therefore "wasted".
from S.D. Foster (1990) Improving the Supply and Use of Essential Drugs
in Sub-Saharan Africa
<http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/1990/06/01/000009265_3960930001126/Rendered/PDF/multi0page.pdf>,
www.worldbank.org accessed December 6, 2007.
Needless to say, reining in all these sources of "waste" would exceed
the 5% threshold quite quickly. But this way of approaching the problem
also points to several areas where suboptimal management could be
improved and which would lead to significant savings and reduction of
"waste".
best wishes,
Susie Foster
--
Susan Foster, PhD
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street, 2nd Floor
Boston, MA 02111
617 636 3961 (phone)
617 636 3999 (fax)
www.apua.org
susan.foster@tufts.edu