E-DRUG: Unethical drug donations?
---------------------------------
According to today's issue of the New England Journal of
Medicine (Dec 18, 1997 Vol. 337, No 25. Berckmans P, Dawans V,
Schmets D, et al.Inappropriate Drug-Donation Practices in Bosnia
and Herzegovina, 1992 to 1996) at least half the drugs donated
during the war in Bosnia were unusable, and there is evidence the
relief effort may have been used to dump outdated supplies. For
details go to the journal's website
http://www.nejm.org. The introduction follows below.
Cheers!
Syed Rizwanuddin Ahmad
E-Drug moderator
Email: srahmad@essential.org
----------------------------
Humanitarian assistance to people suffering as a result of
catastrophes generally includes large charitable donations
of drugs from sources such as private individuals or
companies, nongovernmental organizations, United Nations
agencies, and foreign governments. Unfortunately, evaluations
have repeatedly shown that many of the medical supplies sent
are not the appropriate ones. (1,2)
During the war in Bosnia and Herzegovina, many areas became
totally dependent on foreign help for medicines and medical
supplies. Information circulated about massive quantities of
irrelevant drugs that arrived in Mostar, Tuzla, Gorazde,
Sarajevo, and Bihac, cities that were key targets for
humanitarian assistance. These rumors prompted us to evaluate
the donation of medical supplies in terms of quantity, quality,
and appropriateness.
During August 1996, we met in central Bosnia with representatives
of national and local health authorities; international agencies,
including the World Health Organization (WHO), the United Nations
High Commissioner for Refugees, and the European Commission
Humanitarian Office; and nongovernmental organizations that
implemented drug-supply and drug-distribution programs in Bosnia
and Herzegovina. (3) Whenever permitted, we collected activity
reports, stock records, and accounting documents. Detailed data
were provided by 12 multilateral and nongovernmental organizations
that were reported to have provided at least 40 percent of all the
donated medical supplies. Additional data were obtained from local
administrative or health authorities, warehouse keepers, and
health workers. With these data, we compiled estimates of the
quantities of medical supplies that entered Bosnia and Herzegovina
between 1992 and mid-1996. To allow for the variation in accuracy
of the data from sources other than the 12 multilateral and
nongovernmental organizations, we present the results as minimal
and maximal estimates derived from our calculations.
The quality of the drugs was assessed according to their
appropriateness or inappropriateness. Inappropriate drugs were
defined as useless and unusable medicines. Useless drugs included
medicines irrelevant to the epidemiologic and clinical context or
those not on WHO's list of essential drugs. (4) Unusable drugs
were medicines that had already expired at the time of their
arrival or soon afterward, unidentifiable drugs (e.g., those
delivered unsorted or labeled in unknown foreign languages),
drugs damaged during the shelling of warehouses, and drugs spoiled
during transportation and storage.
To support our quantitative and qualitative appraisal of the
medical supplies donated during the war, we made every reasonable
effort to visit facilities where drugs and medical materials were
stored. At the time of our survey, a large part of the unused
medical supplies was stored in warehouses. However, not all the
storage places were known, and access to some warehouses was
restricted (e.g., because of a lack of cooperation from local
authorities). Nevertheless, we visited several important storage
places, including the four main drug warehouses in Mostar and
Tuzla. We were told that most of the storage places we did not
visit were similar to those that we did visit. These visits
permitted us to collect additional data on supplies sent by
various groups and to identify the various sources of
inappropriate drug donations. We also took pictures and
collected samples.
Finally, after the field survey, we cross-checked our estimates
with data on Bosnia and Herzegovina gathered by organizations in
Europe and North America that are active in research, policy, and
advocacy with respect to pharmaceutical issues, as well as by
pharmaceutical and waste-management companies.
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.