E-DRUG: Essential medicine policies to promote rational/quality use of medicines
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Dear E-Druggers
The current Corona virus pandemic is highlighting for all of us the
importance of comprehensive health system approaches, inclusive of a strong
public sector, for the provision of adequate quality care. In this regard I
would like to draw to your attention to a recently published article
clearly showing that implementation of essential medicines policies are
associated with better quality use of medicines.
Holloway KA, Ivanovska V, Manikandan S, Jayanthi M, Mohan A, Forte G, Henry
D. (2020). 'Identifying the most effective essential medicines policies for
quality use of medicines: a replicability study using three World Health
Organisation data-sets' PLoS ONE 15(2): e0228201,
https://doi.org/10.1371/journal.pone.0228201
This article describes an analysis of WHO global data on medicines use and
medicines policy (2007-11) and compares the findings with those found in
previous studies which examined global data (2003-7) and SE Asia data
(2010-2015). These studies show that ten medicines policies are
consistently associated with better quality use of medicines:
1. medicines free at the point of care in the public sector.
2. implementation of standard treatment guidelines (updated guidelines
together with undergraduate education and distribution of booklets to
health facilities).
3. a national body to promote quality/rational use of medicines.
4. a national strategy to contain antimicrobial resistance.
5. disallowing over-the-counter availability of systemic antibiotics.
6. generic substitution in the public sector.
7. hospital drug and therapeutic committees.
8. public education on medicines use.
9. an updated national formulary.
10. disallowing prescriber revenue from the sale of medicines.
National policies are more likely to have a sustained impact on quality use
of medicines than interventions which are limited in time and scope.
Yet, many countries are not implementing the above policies and data on
medicines use and policy implementation remain scarce. WHO global has many
limitations since the policy data relies on what governments stated in WHO
questionnaires (and some answers may have been inaccurate) and the
medicines use data relies on published surveys (which were often small and
not generalisable).
One attempt to overcome these limitations occurred in SE Asia where data on policy implementation and medicines use were collect
from the same sites by record review, observation and interview. Results
from this study showed similar results to global data and a summary of the
approach can be found in below article.
Holloway KA, Kotwani A, Batmanabane G, Santoso B, Ratanawijitrasin S, Henry
D. (2018). 'Promoting quality use of medicines in South-East Asia: reports
from country situational analyses' BMC Health Services Research; 18:526.
https://doi.org/10.1186/s12913-018-3333-1
Irrational inappropriate use of medicines still remains a global problem
that wastes resources and results in many negative effects including poor
patient outcome, unnecessary adverse events, and increasing antimicrobial
resistance. With this new evidence, governments and the international
community should now focus on holistic health system approaches to
promoting quality use of medicines, implementing and monitoring the
implementation of medicines policies, and monitoring medicines use.
Best wishes and keep well
Kathleen Holloway
Institute of Development Studies
Sussex University, Brighton, UK.
kaholloway54@gmail.com