E-DRUG: Drug donations - will we ever learn?: Actions? (6)
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Geoffery Crumplin has identified some key issues regarding the use of the WHO Guidelines in justifying donations practices, many of which are not in compliance (w/ the Guidelines) despite representations of various role players otherwise.
That said, the donations community comprised of the pharma industry, NGOs involved in collecting and delivering (and in some cases administering donations), and beneficiaries have significantly improved donations practices over the last ten years. This is in large part due to increased dialogue and collaboration among the key players - donors, consolidators, implementing organizations and recipients, Jim Russo and the PQMD group foremost among them in the United States.
It may benefit this discussion and help to further understanding of the complex issues at play in the donations equation to examine the objectives of the WHO Guidelines along with the realities faced by the participants mentioned above (even though it may be stating the obvious to many). Some definitions: donor - the pharma company donating the drug; consolidator - the organization that appeals for and collects the donation (typically with limited presence in the recipient country); implementing organization - an organization that delivers and oversees the donation in-country (in limited cases they are the actual recipient/healthcare provider as well); recipient - the actual provider of healthcare services, the hospital, clinic, or healthcare professional administering the drug to the patient (the recipient is typically an indigenous organization with limited resources). To further confuse the matter, with the exception of the pharma donors, there are often overlapping roles played by the participants, and these roles may vary greatly from country to country.
I would offer that no major pharma company would consciously make a donation that was not in compliance with the WHO Guidelines. In a typical US-originated donations scheme, the pharma donors respond to appeals made by these other participants. For the most part, they are reliant upon these organizations' representations. Consolidators and implementing organizations in a rush to attract and utilize monetary donations following an emergency are compelled to respond. The WHO Guidelines can play a significant role in this response.
Many NGOs use the Guidelines as a credential (my organization included, even though our donations are purchased based upon the recipient's specific request) citing adherence to, compliance with, signatory of, etc. in their promotional materials. Frequently, organizations use such representations in their appeals for donations to pharmaceutical companies, in essence, as part of their sales pitch.
The intent of the Guidelines is to ensure that donations are made based upon the specific needs of the recipient healthcare organization, the entity actually administering the donated medicines. In the ideal, donations are "pulled" from the donations system - the good will of the pharma industry, consolidators, and implementing organizations - based upon specific needs and expressed (and documented) requests from recipients. All in all, this system is effective in supplying needed drugs to healthcare providers that otherwise would have fewer resources.
Complex humanitarian emergencies and large scale natural disasters greatly exacerbate the entirety of issues surrounding drug donations. The resulting outpouring of support, a significant portion of which comes from organizations inexperienced or with no experience in the responsible use of donations, inevitably overwhelms the WHO donations model. More importantly, the abilities of receiving countries to monitor and utilize donations (of all kinds) is quickly outstripped by the scale of the response. The vast quantities of unneeded donations following December's tsunami are only the latest example wherein donors, consolidators, and implementing organizations "pushed" donations into the system with little if any input from the actual recipients. Strained or nonexistent communications, damaged infrastructure, overtaxed transportation systems and personnel resources in the affected countries virtually assure inflow of unneeded donations, including drugs and medical supplies.
In such situations, I am not convinced that any measures can be implemented that would significantly reduce unneeded donations. Of course, the donations community can continue its efforts to educate donors, recipients and other role players. Such efforts could reduce to a limited extent bad donations that result from the rush to respond. The pharma industry can be encouraged to donate only to those organizations that have demonstrated capability in utilizing donations in compliance with the Guidelines. Ideally, donations would be made to those organizations that have full-time personnel in country working with the recipient healthcare providers (unfortunately there are too few organizations that provide such a comprehensive approach to utilization) and excluding organizations that only provide delivery or facilitation.
Allow me to suggest, however, that the donations community should be compelled to contribute to post-disaster remediation efforts and that this discussion focus on ideas that would further such efforts. The inclusion of such post-donation criteria in the Guidelines would ultimately benefit all parties and with continued education and diligence potentially reduce the amount of unneeded donations in the future.
Andrew Hannah
Bridge Foundation
drewhannah@msn.com