E-DRUG: rational drug use training in rural India
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[A field experience from India. Next week will be the ICIUM conference in
Thailand (see www.icium.org). E-drug welcomes more stories from the
grassroots! WB]
dear E-druggers
Community Development Medicinal Unit [CDMU] West Bengal, is a not-for-profit
voluntary organisation, established with the objective of improving access
to essential medicines in the non-governmental organisation (NGO) sector in
India. It is located in the state of West Bengal, with drug distribution
outlets at Kolkata and Siliguri. For the past two decades CDMU has been
successfully running a project for procurement and supply of essential drugs
of good quality at affordable price, thereby allowing disadvantaged sections
of different communities access to essential medicines. A central selection
team of experts updates CDMU�s list of essential drugs and list of suppliers
every year after reviewing tender quotations submitted by various drug
manufacturers. There are no unproven, hazardous, or irrational drugs in the
CDMU list. Suppliers are selected only if they meet certain
pre-qualification norms. A section of the procured drugs are tested for
quality in approved laboratories. Drugs are purchased in bulk directly from
the manufacturers and can therefore be supplied to member organisations or
MOs (organisations to which CDMU supplies drugs on a regular or periodic
basis), even in remote areas, at prices substantially lower (up to 250%
lower) than open market prices. CDMU membership has grown from 15 in 1985 to
over 400 currently. Majority of the MOs are voluntary organisations in and
around West Bengal, providing healthcare on a charitable basis.
It was a matter of grave concern to note that MOs, who procure drugs and
medical supplies from CDMU, faced problems in using such items rationally.
Many of them were not even equipped with trained doctors to run their
clinics, and depended on nurses, pharmacists or paramedical staff, in their
healthcare delivery programs. However, irrespective of whether the health
facilities were manned by doctors or non-doctor healthcare providers, they
often lacked an optimum idea of rational prescribing and dispensing. There
was a tendency to use popular branded drugs without considering adequately
their prices and justification. There was a serious lack of unbiased
information on available drugs. Therapeutic guidelines either did not exist
at all or, if they did, were often impractical. Thus access to essential
drugs in the most appropriate manner with emphasis on their rational use was
not being ensured.
It was thus realised that unless the procurement-distribution of essential
drugs could be supplemented with appropriate educational activities
upholding the cause of rational use of drugs, the very philosophy behind
CDMU�s mission would be defeated. This led to the establishment of the CDMU
Documentation Centre in the early 1990s, dedicated to campaigning on
rational therapeutics. The Documentation Centre through its diverse
activities like preparing information-education-communication (IEC)
materials, publishing drug bulletins and organising meetings / workshops /
seminars with rational drug use as the focus, aims at influencing doctors
and paramedics towards adopting a rational prescription habit and a rational
attitude towards drug use, appropriate to the needs of the community they
serve. This effort has now been systematised by a new project for promoting
the idea of rational use of drugs professionally.
Objectives of the project
Through this project conscious attempts would be made and would help the
member organisation in following manner:
Promoting the concept of rational drug use
Providing unbiased and updated information on essential medicines at the
grassroots level
Raising the awareness of the concerned population in matters of drug use
Developing a closer liaison between CDMU drug distribution units and MOs
Helping to re-orient and upgrade the existing stores management systems of
MOs
Increasing supply of essential medicines by CDMU
Methodology
CDMU has appointed a team, trained in marketing principles, to visit the
NGOs working in the field of healthcare delivery in the state of West
Bengal. They are meeting the administrators, medics and paramedics to
discuss with them the need for rational use of medicines and the benefits
which the organisation, in its own sphere of activity, may derived from
implementing such a policy. The team utilises various IEC materials prepared
by CDMU, such as flash cards, posters, drug information sheets, in English
and in vernacular. Meetings / workshops are arranged for the medics and
paramedics in small groups, where resource persons and specialist speak
about rational use of drugs (RUD), optimum management of diseases found in
their localities, organisation of medical stores, etc. Where feasible,
meetings are also be organised with common people of the locality, exposing
them to the various pros and cons of medicine use through posters and group
discussions. This in turn will help the MO in implementing RUD in the
locality.
CDMU expects to increase the circulation of its existing quarterly bulletin
Rational Drug Bulletin published in English. Another bulletin in local
vernacular is also published. Handouts on standard treatment of diseases
found in the community will also be occasionally published.
The project also entails various surveys. From the inputs available from
MOs, local patterns of disease and therapeutic practices will be analysed. A
manual of standard treatment guideline is hoped to be eventually developed.
Surveys will also be conducted to find out the access to essential drugs in
different localities and the constraints towards implementation of a RUD
policy.
Project evaluation
The project is sought to be evaluated after every six months for which
indicators have been prepared. New indicators may also be developed based on
field work. An internal system monitoring team has been set up with CDMU
resource persons and administrative staff, to evaluate progress every month.
Two external evaluators and an external auditor have been selected who will
meet in six months to evaluate the project impartially.
The project has been initially designed for three years. Successful
implementation will give CDMU the impetus to continue beyond the initial 3
years to further its social commitment in a systematic manner. Further
details are available at www.cdmubengal.org
Dr. Amitava Sen
Project Coordinator
CDMU Documentation Centre
cdmudocu@vsnl.com
www.cdmubengal.org
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