E-DRUG: International Society for Improving the use of medicines (3)
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Dear E-Druggers
I would encourage all people interested to promote rational (quality,
correct) use of medicines to join ISIUM in order to stimulate funding and
change.
We have recently discussed the need for an authoritative open access
database on medicines information and medicines policies to promote
rational use of medicines. We have noted that a major barrier to promoting
rational use of medicines has been lack of funds and lack of interest by
many governments and the international community to provide the funding.
How can we stimulate interest by governments and the international
community to fund initiatives to promote rational use? I think it is by
undertaking much more advocacy based on good evidence. ISIUM can play a
role in this on the international stage, but we need people in countries to
collect local evidence of what is happening and what works to promote
better use, undertake advocacy and lobby their own governments.
At the recent ISIUM meeting and at the Prince Mahidol Award Conference,
both of which took place in Bangkok in Jan 2020, there was discussion about
the need for a new WHO Assembly Resolution to follow up the last one (WHA
60.16) of 2007. The idea was mooted of countries working towards being
classified as a "Rational Drug Use Country" based on whether they were
implementing policies as advocated by WHO in its 2002 Policy Perspectives
on Medicines No.5 - Promoting Rational Use of Medicines: Core Components
URL: http://archives.who.int/tbs/rational/h3011e.pdf
This old, but still relevant document, lists 12 core policies to promote
rational use of medicines, as follows:
1. A mandated multi-disciplinary national body to coordinate medicine use
policies
2. Clinical guidelines
3. Essential medicines list based on treatments of choice
4. Drugs and therapeutics committees in districts and hospitals
5. Problem-based pharmacotherapy training in undergraduate curricula
6. Continuing in-service medical education as a licensure requirement
7. Supervision, audit and feedback
8. Independent information on medicines
9. Public education about medicines
10. Avoidance of perverse financial incentives
11. Appropriate and enforced regulation
12. Sufficient government expenditure to ensure availability of medicines
and staff
These policies were all mentioned in the WHA 60.16 resolution on "Progress
in the rational use of medicines" in 2007:
https://apps.who.int/gb/ebwha/pdf_files/WHASSA_WHA60-Rec1/E/reso-60-en.pdf#page=27
and again in a 2013 WHO publication entitled "The pursuit of responsible
use of medicines: sharing and learning from country experiences".
https://www.who.int/medicines/publications/responsible_use/en/
There is now mounting evidence for the association of these policies with
better use - see the links to articles to already mentioned in previous
E-drug communications. Also, all these articles and other resources are
listed on the ISIUM website:
https://www.isium.org/resources/medicines-policies-interventions/
Out of the 12 policies listed above, current evidence from
low/middle-income countries suggests consistent association with better
quality use of medicines with the following caveats:
(1) continuing medical education is effective if directly provided by
government, but is often not effective (when provided by others e.g.
pharmaceutical industry).
(2) essential medicines lists and clinical guidelines are effective if they
are implemented through provider education, distribution to providers and
use in drug supply, but not if they just exist without other implementation
measures.
There are many limitations to the evidence that we so far have, but it is
sufficient to be able to start asking governments why they are not
implementing these policies. If there is no information on policy
implementation and use in a country, then a summary of how to collect this
information rapidly can be found in the below article. "Promoting quality
use of medicines in SE Asia: reports from country situational analyses"
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3333-1
I can also share the tools used to collect such information.
By conducting in-country advocacy based on local evidence, sharing
information through the international platform provided by ISIUM, using the
concept of "Rational Drug Use Countries", and working towards a new WHA
Resolution, perhaps we can stimulate countries and the international
community to invest in promoting rational use of medicines.
Best wishes
Kathleen Holloway
Institute of Development Studies, University of Sussex, UK
Email: kaholloway54@gmail.com