E-drug: Essential Drug Successes (cont)
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I put out a request on E-Drug for suggestions and was pleased to
receive a number of useful suggestions. There may be too many but I
would like to list them as some may have implications for other
chapters. These are my suggestions broken out by area of Access.
Disease Control Priorities Project (DCPP: Implementation Success Stories
Selection
The WHO Expert Committee on the Selection of Essential Medicines
The committee has been in existence for 25 years and has met
regularly. Over 150 countries now have essential drug or Medicines
Lists. The committee has managed the change from experience based to
evidence based approaches well.
This must be one of the few WHO publications that people are waiting
for and complain if there is a delay in the release of the document.
An article is
coming out in the next month or two in Lancet that could be used as the
basis for a description.
A country that has done well with drug selection is South Africa which has
combined development of treatment guidelines with the production of the
list. Andy Gray has written about this.
Procurement
Delhi State drug procurement
I quote from the following nomination by Hilbrand Haak a Dutch Essential
Medicines consultant - I think any publication on essential drugs success
stories should list the experiences from Delhi State in India. In the
early 1990's the Minister of Health felt that the public sector
budget for
pharmaceuticals was largely squandered for drugs that were far too
expensive and of poor quality. The approach that was used was
basically applying the lessons from 10-15 years of essential drugs
programmes in the world (evidence based selection, generics policies,
pooling of drug needs, good procurement practices, pre-qualification of
suppliers, quality assurance, efficient distribution, together with active
efforts to improve drug prescribing and use, etc). In short, all the
things we know, but which are not always applied for a variety of
reasons.
What impresses me most on this story was that the programme was
not led or imposed by donors, but inspired by common sense of a
State Minister of Health, who decided that he was not prepared any
longer to waste his drug budget, and that he was going to stop it. As
far as I know, no donor is funding this programme. The programme is
largely funded by the tremendous savings that it has generated! To
bypass government bureaucracy, an independent NGO (the Delhi
Society for Rational Use of Drugs - DSPRUD) was established to
implement all selected strategies. And with success (see publications
below).
For more information, see (please repair url):
-
http://www.who.int/medicines/organization/par/briefing/17pooled-procurement.ppt
- Chaudhurry, RR. (1999) Rational use of drugs: Delhi's change in
policy saves lives. Essential Drugs Monitor, 27: 2-4.
Eastern Caribbean Pooled Procurement Scheme
This is an amazing story. Initially funded by USAID, after 5 years was self
supporting and for the last 10 years have procured essential medicines of
good quality and low prices for a number of small Caribbean Islands. I have
an article by Francis Burnett the director of the program that will be
coming out in the Essential Drugs Monitor soon.
Global Drug Facility for the Stop TB Initiative
This success may be better placed in the TB Chapter but it should be
covered somewhere. Ian Smith at WHO is writing a short article about
the scheme for the Essential Drugs Monitor.
Distribution
Here the major successes has been by the non profit supply agencies. The
best examples of these are UNICEF, IDA in Amsterdam, MEDS in Kenya
and JMS in Uganda. For more information on MEDS and JMS see report at
http://dcc2.bumc.bu.edu/richardl/IH820/Resource_materials/MEDS_JMS/Default.h
tm
Rational Use
Changing Injection Use in Yogyakarta Indonesia
This is the best documented success in a wide range of work that has been
done at Gadjah Mada university. The rate has changed from about 65%
to less than 13%. The work has been reported in Social Science and
Medicine and the Essential Drugs Monitor.
Drug Information Center Penang Malaysia
By combining Drug Information with a poision center this organization has
been extremely successful in sharing information through many different
communication media. The web site at http://prn.usm.my/ is I think a good
example of how information can be shared.
Monitoring of Pharmaceutical Access
Namibia Serial Surveys.
Based on work previously undertaken in Zimbabwe the government in
Namibia have undertaken serial surveys of drug access and use. Such
surveys replace routine reporting and provide quality data for
decision making. This was reported in the essential drugs Monitor and
I have a copy of the latest report.
Quality Assurance
The WHO Pilot Procurement Quality and Sourcing Project: Access to
Antimalarial, Anti-tuberculosis and HIV/AIDS Drugs and HIV/AIDS
Diagnostics of Acceptable Quality. This scheme although still
relatively new can be labelled a success. By doing rigorous
prequalification reviews of producers and products and publishing
these results regularly countries can be confident of the quality of
the products they are purchasing. See
http://www.who.int/medicines/organization/qsm/activities/pilotproc/pilotprocmain.shtml
Financing
Management Sciences for Health Drug Price Indicator Guide
This publication that has been in existence since 1988 has been an
invaluable source of market intelligence for people to know what the true
international price for essential generic drugs are. The Guide is now
available on the web at
http://erc.msh.org/mainpage.cfm?file=1.0.htm&id=1&temptitle=Introduction&module=DMP&language=English
National program
Bhutan
Here I think the Bhutan program is a good example as to how a small
country can achieve a high level of access using essential drugs
concepts.
As you will see from this list there have been many successes. But access
still remains a problem in many places. The answer to this problem
seems to me to be a combination of improved funding mechanisms and
the use of proven management techniques.
One person suggested that the use of ORS could be labelled as a success but
I thought that should be put in the Diarrhea chapter.
Please get back to me if you need any further information on these
successes.
Richard
Richard Laing
Associate Professor
Department of International Health
Boston University School of Public Health
http://dcc2.bumc.bu.edu/richardl/
715 Albany St Boston MA 02118-2526
Tel 617 414-1444
Fax 617 638-4476
richardl@bu.edu
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