E-drug: Essential drugs in Tokyo University (cont)
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Dear Dr. Sesay:
I was also under the same impression when I provided my own response to
Francisca Flores. However, according to my understanding, she
(He?) was more interested in learning about the factors associated
with ACCESS to the LIST of essential drugs.
Under this perspective, my contribution was provided to indicate the
magnitude of the variable of interest (ACCESS) and how this access was
associated with the setting of practice (Rural versus Urban) and the
country of employment. As such, it (my contribution) was deemed useful
because so far there has not been any way of saying how much access to the
WHO List or to a national list there is. Knowing the magnitude and
variability of ACCESS to the WHO list or to the national list is important
before one can move to the next step of assessing what
factors make this magnitude to vary either as a qualitative variable
(with two modalities of Poor Access and Rich Access) or as a
quantitiative variable along any scale that could be conceived.
The setting of practice has been shown to be one such factor
affecting ACCESS to the list of essential drugs.
I must admit that when you refer to access to essential drugs, you
are talking about a different variable. In my view, this is not what
Francisca Flores was alluding to, at least so far as we can strictly
consider her (his) terminology. This is not to say that access to
essential drugs per se is not important. I tend to think that this
type of access is a process outcome of a higher level than access to
the list of essential drugs (another process outcome). As such, it is
a very important consideration and it is logical to assume that it is
linked to a certain extent to the availability of and to access to the
LIST of Essential Drugs. There is a need, I think, to first confirm
which variable is being considered as the dependent variable so that
we can all focus on the same target. This seems more important before
we can embark in the examination of the validity of the comprehensive
model you are alluding to.
Let me say that I feel confident to talk about this topic since
according to my own study, I have empirical data and results to
discuss access to essential drugs at least so far as we focus on those
professionals called to prescribe, dispense and administer them. Again
from this other side, I can say what the magnitude is and which
variables are associated with its variability. However, I prefer NOT
to engage very much on this other path until we have a common
understanding about what is our dependent variable.
It will suffice to say that health care professionals report knowing
more about essential drugs that about non-essential drugs. However,
the extent of their knowelegde is not something to be overly proud of
if one is concerned about achieving TOTAL QUALITY in the provision of
pharmaceutical care.
In a future message, I would be glad to provide some information on
the average number of essential drugs known and the lag time before a
health care profesional becomes aware of its availability. As patients
cannot usually have access to drugs without going through their health
care providers, it is safe to think that their access to essential
drugs will also depend to a certain degree on how much and how fast
their health care providers know and use these essential drugs. When
looking at the situation in the two countries that I have surveyed, I
do not feel that I can share your enthusiasm on this matter.
It is very encouraging that we alll strive to ensure adequate access
to essential drugs. However, I must confess that, I tend to think that
such an ideal state is still far away. It calls for strategies and
efforts beyond what we have seen so far.
I would be glad to learn about your comprehensive model and to see
how empirical data have been able to validate it.
Sincerely,
Ngoyi. K. Zacharie Bukonda, M.P.H., Ph.D.,
Assistant Professor,
Public and Community Health Programs
College of Health and Human Sciences
School of Allied Health Professions
Northern Illinois University, DeKalb, IL 60115, USA
Telephone: 815-753-4801
Fax: 815-753-0720
E-mail: nbukonda@niu.edu
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