[e-drug] Inappropriate donations to South East Asia

e-drug
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E_DRUG: Inappropriate donations to South East Asia

So it happened again.....

http://www.pharmj.com/Editorial/20050205/news/p139asia.html
Tonnes of inappropriate medicines arrive in SE Asia

Appropriate shipments should be put together in collaboration with the
WHO

WHO/Dermot Tatlow

Tonnes of inappropriate medicines have arrived in South-East Asia
following the tsunami disaster, according to a report by Pharmaciens
Sans Frontihres (PSF).

Medicines with leaflets in languages unknown to local health workers and
too short shelf lives are stockpiled in warehouses across the region.
The first and most urgent challenge faced by PSF teams working in the
affected countries is to act as garbage collectors, says Ghislaine
Soulier, a PSF spokeswoman.

In the Indonesian city of Banda Aceh alone, a warehouse the size of a
football pitch would not be sufficient to house all the unusable
donations sent by different individuals and organisations. In the rush
to provide relief, the need to help comes before the real needs of
the recipient countries, she added. Weve seen this time and time again
in all recent disasters.

The biggest question asked in the PSF report is why tonnes of branded
medicines were shipped to South-East Asia when that part of the world
produces a large percentage of the generic medicines used in
humanitarian operations. The pharmaceutical companies in the region have
the capacity to supply the required medicine. Niyada Kiatying-Angsulee,
of the faculty of pharmaceutical sciences at Chulalongkorn University,
Bangkok, said: There is no serious drug shortage in Thailand because we
have a competent local pharmaceutical industry and a good infrastructure
developed by the ministry of health.

British pharmaceutical companies have donated both medicines and cash,
but according to the Association of the British Pharmaceutical Industry,
these shipments have been put together in collaboration with the
recipient countries ministries of health and the World Health
Organization.

PSF has now submitted a proposal for its first project in the region. In
partnership with local health agents and the WHO this project focuses on
the organisation of unusable donations and the distribution of quality
medicines in the province of Aceh.

Ms Kirsten Myhr, MScPharm, MPH
Head
RELIS Oest Regional Drug Info and ADR Monitoring Centre
Ulleval University Hospital
0407 OSLO, Norway
Tel: +47 23 01 64 11
Fax: +47 23 01 64 10
myhr@online.no

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E-DRUG: Re: Inappropriate donations to South East Asia (1)

Dear e-druggers,

During the recent tsunami disaster, UNICEF was contacted by numerous
donors of various supplies, including pharmaceuticals. Apart from a few
"Trojan Horse" incidents, which we quickly opened up, I must say that the
majority of donors were well-meaning and expressed, up-front, their
concern about not violating the International Guidelines on Drug donations,
which WHO very promptly re-emphasized at their website. As I was very
closely involved, I would like to share my experience with you.

I came to the conclusion that many cases which result in inappropriate
donations, in my assessment, seem to lie with the judgement and actions of
"intermediaries" at both ends of the give-and-take divide. On the give
side, such intermediaries assure the primary donor that special clearances
would be obtained from the local authorities in the name of emergency. This
could probably have been based on similar assurances at the receiver end.

In some cases, I found that such assurances were actually based on
"promises" claimed to have been made by local authorities. However, the
necessary administrative and logistics actions were then not followed up
to prepare for this. In one case, the assurance was given that as long as
medicines were used in a clinic-setting, for example Intravenous infusions
labelled in a foreign language, health staff would know what to do. If
staff then moved on to other places or countries, in the rapidly evolving
situation, by the time goods actually arrived the question would be "who
sent these and for who?". When local and International NGOs raised concern
about the lack of coordination, this was one example.

I am not sure what we can do about the legitimacy of intermediaries, but
they too should consider themselves part of the donor responsibility and
not as mere conduits. I can, however, add that as part of the concern of the
majority of donors to conform to regulations, as well as UNICEF's support
of the international guidelines, tons of supplies were turned down which
could have definitely made the situation worse.

On the matter of capacity, I think we should not equate capacity with
availability. But even where supplies are available, the question is
getting them quickly to where they are required. Local industry, from a
commercial point of view, may understandably not be positioned to respond
to the immense logistical issues, especially in the early days.

It seems to me, all in all, that our problem largely lies with Emergency
Response planning. If we start working on this when the disaster strikes,
it is already too late, and inappropriate actions become a dangerous
reality. This is an area which PSF may wish to look at.

Murtada M. Sesay
Technical Officer (Pharmaceuticals)
UNICEF Supply Division

Tel: +45 3527 3098
Mobile: +45 28 23 28 07
E-mail: msesay@unicef.org
Web: www.unicef.org/supply

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E-DRUG: Inappropriate donations to South East Asia (3)
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Has there been any tally taken of what was wastage?

Stevan Gressitt, M.D.
www.mainesenate.org/expiredmeds
gressitt@uninets.net

[If yes, PSF (Pharmaciens Sans Frontieres) would probably know. KM]