E-DRUG: Drug donations (cont)
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Dear e-drug subscribers,
Zimbabwe is to be congratulated on its national guidelines for recipients
of drug donations. Charon Lessing makes an important suggestion (for a
regional study), which I hope will stimulate action.
We should remember that it has been 20 years since the WCC NGO Guidelines
were first drafted, and it has taken 4 years to develop the WHO Interagency
Guidelines which were finally produced in March of this year.
However, as recently as May the WHO audit of drug donations in Albania and
Macedonia confirmed that an unacceptable proportion of donated medicines
actually added to the workload of professionals who should have been better
occupied than sorting unusable drugs. Presumably these drugs will now have
to be disposed of safely - at considerable cost. Is the pattern being
repeated in Turkey at this very moment?
Michael Reich's recent study contributed usefully to what we know about the
'natural history' of donations, but it was limited to American donors, and
concentrated on 2 distributors and 3 countries. Recently the World Council
of Churches/Community Initiative Support Services' Pharmaceutical Programme
did research on the NGO sector in Africa.
These studies have contributed to our understanding, but there are still
fundamental questions awaiting answers. To what extent do donated drugs
have a beneficial role in the survival of health services in countries
unable to pay for all their supplies? What part can they/should they play
in countries suffering disasters, post-emergency transition and long-term
dependency on external support? Are they in fact undermining local
agencies such as MEDS in Kenya, and LOCOST in India - or national drugs
programmes and local industry for that matter?
And then there are further challenges in the supply of medical equipment,
lab and other supplies. My own experience 2 years' ago of seeing
quantities of decomposing dressings from a Nato hospital dated 1982 in one
national children's hospital will always stay with me. I realised that one
reason that such material accumulates is that staff who dispose of 'gifted'
equipment could be accused of diverting it to the black market.
Improving the quality of drug donations raises many key questions, and
should challenge all of us, donors and recipients, governments and NGOs, to
integrate the principles outlined in the WHO Guidelines in our own
practice. Donated drugs should be regarded conceptually in the same way as
all drugs: they should be necessary, safe, of good quality and not
undermine systems which seek to mediate their beneficial use. Therefore
all concerned should get to work on drafting and implementing policies and
organisational guidelines.
Finally, there are many complex issues concerning donated drugs for public
health (disease control and disease eradication) which have still to be
worked through. It will be extremely difficult to do this if the necessary
groundwork has not been done by organisations with responsibilities for drugs.
best wishes,
Philippa Saunders.
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Philippa Saunders & Gill Stoker
Essential Drugs Project
77 Lee Road
Blackheath
London SE3 9EN
UK
tel/fax 44 (0)20 8318 1419
email edp@gn.apc.org
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