E-DRUG: Essential drugs in Tokyo University (cont)

E-drug: Essential drugs in Tokyo University (cont)
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Hi, Dr. Takeo!

Thanks for sharing some information about the situation of essential
drugs in Japan. I am glad to learn that Japan is now engaged in
printing the latest version of the WHO's model list of essential
drugs. Assuming that nobody will confiscate and burn these printed
materials to perpetuate the status quo, I can say that the initiative
hopefully will help to expand the magnitude of awareness and adoption
of the concept of essential drugs in your beautiful country (I have
never been there).

So far as finding which health authorities, individuals, or agencies
to blame about the mediocre situation, let me say that this is a quite
sensitive issue. I tend to think that the WHO has done a very good job
of endorsing and promoting this concept. However, given the reality on
the field in many parts of the world (based on what you say about
Japan, what Osundu et al. say about Nigeria, what has just been said
for the situation in Malasia, and what my own study shows) we must
have the courage to recognize that a lot remains to be done and that
the WHO might need to revise its strategy for expanding this concept.

Because, we have spent some time thinking through this issue, we have
to say that the first place to start should be to clearly define the
problem without engaging in fingerpointing or in prejudging any body.
I am saying this since it is possible to envision a situation where
health professionals in a hypothetical country could be using
essential drugs in a more extensive and rational way without even
knowing that they are using essential drugs. I use to assimilate this
group with people who have been using PROSE all their life without
knowing that they are doing it as a way of life and without even
knowing what is the definition of that term (Prose).

Armed with real data, we can then know where the problem lies and
what is the extent of its severity in the various parts of the world.
Using this information, we all can then play a role to change the
situation. This is not meant to say that some agencies and individuals
do not have any special responsibility in this regard. I feel and I
know that many would agree with me when I say that WHO and the various
ministries of health do have the moral responsibility not only to
preach the evangile of essential drugs, but also to make it a reality
for millions of our fellow human beings who so far have been deprived
of access to the necessary medicines they so badly need.

WHO as well as each ministry of health in each country of the world
has the fundamental responsibility to be really converted to the new
evangile of essential drugs and to embrace an approach that will
maximize the benefits of this concept. Sometimes, I wonder if part of
the resources invested in revising the list of ED could not be used to
accelerate the process of diffusion of this concept. Indeed, what is
the point in having the 11th revised edition of the WHO's list of EDs
when in some countries such as Japan reports indicate that nobody
knows about or implements this concept. Given this situation, a
balance needs to be found between the speed of revision and efforts
aimed at expanding the adoption of the basic concept of essential
drugs. A marginal analysis could be done to show how much health
benefit results from each additional revision of the WHO model list of
EDs versus each dollar amount spent in expanding the list as it is
known now.

Without having any data to back my thinking, I am of the opinion
that, instead of focusing in the revision of the list, WHO could more
advantageously devote a gretaer share of its budget to the
distribution of appropriate materials on this concept. WHO can also
more advantageously expand its influence in training programs to
ensure that every medical doctor, pharmacist, and nurse who graduates
from a formal training program is already equipped with the necessary
knowledge and positive attitude regarding essential drugs. This is a
real challenge!

In line with this thinking, in the Democratic Republic of Congo, we
had organized in 1985/1986 a national workshop with funding from
WHO-Afro to integrate the components of primary health care into
training programs. This effort was conceived as a strategy to
accelerate the speed of adoption of the PHC strategy (which also
includes the concept of essential drugs).

Unfortunately, for this country, under Mobutu's dictatorship, the
minister of health managed to divert money that was budgeted for the
printing and distribution of the report of this national workshop.
Furthermore, despite the invitation that was sent to them, the deans
for the main medical school and the main school of pharmacy in
Kinshasa did not participate in this workshop and did not even send
any representatives.

From this example one can tell that blame can easily be expanded also

to other categories of people and institutions because of their
failure to play a positive role in regard to their main
responsibilities.

I would like to conclude by saying that, instead of wasting our time
fingerpointing, we need to move into working diligently to expand our
knowledge about the diffusion of the concept of essential drugs. We
have the responsibility to expand this concept beyond the limited area
where nowadays it remains unfortunately confined.

One major challenge is to use this knowledge to set achievable
objectives to expand the adoption of this wonderful concept. This is
an area where those without a medical, pharmacy or nursing degree can
also play a great role provided they are given the chance to join the
battlefield. Another question seems to be "Are we willing to let them
join the battlefield?"

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

[Thankyou to Takeo Saio and Dr Bukonda for leading the debate around this
very difficult issue. I think we can close the current discussion now and
look forward to hearing about future developments. BS Co-moderator]

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