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PubMed1996

Essential drugs supply and usage as a reflection of outpatient morbidity in Kirinyaga District, Kenya.

This study was carried out in all the twenty eight Government rural health facilities (RHF's) in Kirinyaga District of Kenya. It aimed at determining whether the quantities and types of drugs supplied to the RHF's matched the morbidity patterns, and also whether the disease patterns continued to be used as a basis for requesting stocks of essential drugs. It also investigated the constraints associated with the programme with an ultimate aim of improving service delivery. The information was obtained through records review of the Bin card books, Out-patients Department (OPD) register, morbidity monthly returns, staff and patient interviews. A highly significant (p < 0.01) variation in morbidity (workload) by season of the year and between the ecological divisions of the district was observed. Significant differences were also observed between the quantities of drugs supplied and the actual monthly requirements in all the RHF's, implying that the disease patterns were not necessarily being used for requesting stocks of essential drugs. A distribution of essential drugs based on two broad ecological divisions of the district was recommended. One of the major constraints found to be associated with the Essential Drugs Programme was the delay in procurement/distribution of essential drugs to the RHF's. This was mainly due to the tendering procedures of Kit 2 by the Ministry of Health (MOH) and also occasional lack of transport at the district level.

Drug Utilization Review↗
PubMed2006

Rare essentials: drugs for rare diseases as essential medicines.

Since 1977, the WHO Model List of Essential Medicines (EML), published by WHO, has provided advice for Member States that struggle to decide which pharmaceutical technologies should be provided to patients within their public health systems. Originating from outside WHO, an incentive system has been put in place by various governments for the development of medicines for rare diseases ("orphan drugs"). With progress in pharmaceutical research (e.g. drugs targeted for narrower indications), these medicines will feature more often on future public health agendas. However, when current definitions for selecting essential medicines are applied strictly, orphan drugs cannot be part of the WHO Essential Medicines Programme, creating the risk that WHO may lose touch with this field. In our opinion WHO should explicitly include orphan drugs in its policy sphere by composing a complementary Orphan Medicines Model List as an addition to the EML. This complementary list of "rare essentials" could aid policy-makers and patients in, for example, emerging countries to improve access to these drugs and stimulate relevant policies. Furthermore, inconsistencies in the current EML with regard to medicines for rare diseases can be resolved. In this paper we propose selection criteria for an Orphan Medicines Model List that could form a departure point for future work towards an extensive WHO Orphan Medicines Programme.

Cost-Benefit Analysis↗
PubMed1988

Computerized calculation of essential drug requirements.

The implementation of an effective essential drug programme, although accepted by most WHO member states is still meeting serious problems. Apart from politics the reasons for this slow implementation should be sought in organizational difficulties. A methodology for the calculation of national drug requirements has been developed for Gabon based on standard treatments and estimated number of cases per disease (also known as the demand-morbidity method). Allocation of these drugs to the Gabonese health institutions is calculated based on data from the existing health information system such as days of hospitalization and number of patient visits. A rudimentary form of the demand-morbidity method has been used manually in the past but was extremely cumbersome. Modern microcomputers and standard software have now improved speed and flexibility of the method and have therefore made its implementation feasible even in developing countries. The advantages of the method are the improved availability of essential drugs at all levels of the health system and a decrease of the required drug budget (for Gabon it was calculated that a saving of 45% could be obtained). The method makes possible interaction between health planners and peripheral staff unimaginable a few years ago.

Developing Countries↗
PubMedDate not supplied

Translating the essential drugs concept into the context of the year 2000.

The WHO Essential Drugs List (EDL) was first published in 1977. It must continue to be adapted to a changing world with new drugs, new indications and new diseases. Médecins sans Frontières is concerned that the eleventh list is outdated. The EDL should be stricter about its inclusion of first-line drugs and price should not be a criterion for excluding drugs from the list. Second-line drugs are complementary and their inclusion would in no way undermine the essential drugs concept. The EDL should be updated regularly and in a transparent manner, by an independent panel of experts chosen for their competence. Decisions regarding the inclusion of drugs in the list should be evidence-based, and the evidence should be available to the panel of experts long before their final sessions on updates to the EDL. The WHO not only has the challenge of defining a EDL that addresses today's epidemiological reality, but also a responsibility to assist countries in gaining access to these treatments.

Developing Countries↗
PubMed1991

Changes in the World Health Organisation essential drug list.

The World Health Organisation Model List of Essential Drugs is an attempt to provide guidelines for selection of essential pharmaceuticals. Analysis of the six lists produced between 1977 and 1990 shows an increase in the number of items from 205 to 268. 120 drugs have been added and 57 deleted; however, only 16 of the additional drugs can be considered new clinical entities or to have new indications. The original purpose of the essential drug list was to itemise the minimum number of essential drugs. Many additions were due to a change in perception about the usefulness of a particular drug, not scientific advances. Nevertheless, the list remains a useful guide for countries selecting their own national lists.

Pharmaceutical Preparations↗
PubMed1995

Does health information alone help in equitable distribution of essential drug kits between health units at district level?

In Tanzania, the essential drugs programme (EDP) faces acute shortage of drugs brought about by a deteriorating economy and an expanding primary health care system. Many health units complain of shortages of drugs but no increase in the district allocation of EDP kits is foreseen. In the light of the aforementioned problem, a study was carried out in the Kisarawe district of Tanzania to discover, on behalf of the District Health Management Team (DHMT), the extent of the maldistribution with a view to reallocate the EDP kits among the health units on the basis of workload and catchment population. The relative workload of each health unit was estimated from the number of outpatient attendants and the catchment population estimates are based on a 1988 national census. An equitable distribution of EDP kits for each indicator was then developed by ranking the health units in order of workload and catchment population and dividing up the available number of EDP kits proportionately. Health units were categorised as either 'over-allocated', 'appropriately-allocated' or 'under-allocated' with EDP kits by comparing their actual drug supply with the equitable supply. The findings were presented to a meeting of the DHMT attended by the Regional Medical Officer and Ministry of Health officials. Despite being presented evidence of astounding inequity in drug distribution, there was a marked reluctance on the part of the DHMT to decide upon actions to redress some of the imbalance. In this study, we demonstrated that although data from the routine information system on essential drugs at peripheral health units provided sufficient information for managerial purposes, decision-making was delayed and limited. Several possible reasons for this are discussed.

Administrative Personnel↗
PubMed1998

Performance of village pharmacies and patient compliance after implementation of essential drug programme in rural Burkina Faso.

After implementation of a nation-wide essential drug programme in Burkina Faso a prospective study was undertaken consisting of non-participant observation in the health centre and in the village pharmacy, and of household interviews with the patients. The study covered all general consultations in nine health centres in three districts over a two-week period as well as all client-vendor contacts in the corresponding village pharmacies; comprising 313 patients in consultations and 498 clients in eight village pharmacies with 12 vendors involved in dispensing 908 drugs. Additionally patients were interviewed in their households. Performance and utilization of the village pharmacy: 82.0% of the drugs prescribed in the health centres were actually dispensed at the village pharmacy, 5.9% of the drugs were not available at the village pharmacy. Wrong drugs were dispensed in 2.1% of cases. 41.3% of the drugs dispensed in the village pharmacy were bought without a prescription. Differences are seen between the district and are put in relation to different onset of the essential drug programme. Patient compliance: Patients could recall the correct dosage for 68.3% of the drugs. Drug taking compliance was 63.1%, derived from the pills remaining in the households. 11.5% of the drugs had obviously been taken incorrectly to such an extent that the occurrence of undesired drug effects was likely. The study demonstrates the success of the essential drug programme not only in performance but also in acceptability and utilization by the population.

Burkina Faso↗
PubMed2004

Molecular properties of WHO essential drugs and provisional biopharmaceutical classification.

The purpose of this study is to provisionally classify, based on the Biopharmaceutics Classification System (BCS), drugs in immediate-release dosage forms that appear on the World Health Organization (WHO) Essential Drug List. The classification in this report is based on the aqueous solubility of the drugs reported in commonly available reference literature and a correlation of human intestinal membrane permeability for a set of 29 reference drugs with their calculated partition coefficients. The WHO Essential Drug List consists of a total of 325 medicines and 260 drugs, of which 123 are oral drugs in immediate-release (IR) products. Drugs with dose numbers less than or equal to unity [Do = (maximum dose strength/250 mL)/solubility < or = 1] are defined as high-solubility drugs. Drug solubility for the uncharged, lowest-solubility form reported in the Merck Index or USP was used. Of the 123 WHO oral drugs in immediate-release dosage forms, 67% (82) were determined to be high-solubility drugs. The classification of permeability is based on correlations of human intestinal permeability of 29 reference drugs with the estimated log P or CLogP lipophilicity values. Metoprolol was chosen as the reference compound for permeability and log P or CLogP. Log P and CLogP were linearly correlated (r2 = 0.78) for 104 drugs. A total of 53 (43.1%) and 62 (50.4%) drugs on the WHO list exhibited log P and CLogP estimates, respectively, that were greater than or equal to the corresponding metoprolol value and are classified as high-permeability drugs. The percentages of the drugs in immediate-release dosage forms that were classified as BCS Class 1, Class 2, Class 3, and Class 4 drugs using dose number and log Pwere as follows: 23.6% in Class 1, 17.1% in Class 2, 31.7% in Class 3, and 10.6% in Class 4. The remaining 17.1% of the drugs could not be classified because of the inability to calculate log P values because of missing fragments. The corresponding percentages in the various BCS classes with dose number and CLogP criteria were similar: 28.5% in Class 1, 19.5% in Class 2, 35.0% in Class 3, and 9.8% in Class 4. The remaining 7.3% of the drugs could not be classified since CLogP could not be calculated. These results suggest that a satisfactory bioequivalence (BE) test for more than 55% of the high-solubility Class 1 and Class 3 drug products on the WHO Essential Drug List may be based on an in vitro dissolution test. The use of more easily implemented, routinely monitored, and reliable in vitro dissolution tests can ensure the clinical performance of drug products that appear on the WHO Essential Medicines List.

Administration, Oral↗
PubMed1998

[The essential drugs program in Haiti].

A survey was carried out by random sample among institutions that had benefited from the programme of humanitarian assistance during the period of economic embargo imposed in Haiti. The objective of this survey was to determine the effect that the distribution of medicines during this period had on the reactivation of the programme for essential drugs. Of the 51 health institutions selected, 45 provided satisfactory information. The results show that 42 institutions received medicines from the humanitarian aid programme. Six months after the end of the programme for humanitarian assistance, 39 of these institutions were using essential drugs in dispensaries and in health centres without beds. Essential drugs predominated over special medicines. These institutions continued to stock up at the PROMESS centre for essential drugs. This institution, initially created for the programme for humanitarian assistance, continued to function in October, 1994, a year after the end of the programme, and became the object of the adaptation of long-term support for programmes of the national health plan. The study also showed that the recovery of costs of medicines is a current practice within 44 of the 45 institutions surveyed, no matter whether their status is public, private, or mixed, thus emphasising the availability of the community for participating in financing health services. These results show that the humanitarian assistance programme, through the distribution of medicines and independently of its specific objectives, reinforced the programme for essential drugs. This is an indication that humanitarian assistance programmes may not only carry out their objectives, which are often limited and short-term, but may also produce lasting results that favour the reinforcement of development structures.

Altruism↗
PubMed1991

Four years of essential drugs' list in Nigeria.

A survey using questionnaires was carried out to determine the extent of awareness and acceptability of the Nigerian Essential Drugs' List and its effect on drug procurement and prescription pattern in some health institutions. Analysis of the responses showed that there was a 100% awareness on the part of the health professionals involved in the survey. Acceptability of the list was low: 96% of the sample group were of the opinion that the essential drugs' list should be abrogated. Medical doctors prescribe drugs without due consideration for the list while pharmacists stock and dispense drugs on a similar basis. The concept of the essential drugs' list has not been included in the curricula of the universities and other teaching institutions studied. It was also found that essential drug supply by manufacturers in Nigeria is inadequate.

Drug Prescriptions↗
PubMed2001

From policy to action: access to essential drugs for the treatment of hypertension in the Small Island States (SIS) of the South Pacific.

The existing acquisition cost for essential drugs in the Cook Islands, Kiribati, Marshall Islands, Nauru, Niue, Tuvalu, is sufficiently high to compromise equitable access to quality drug therapy. The difficulty of access is further compounded by problems of distance from drug manufacturers and suppliers, associated with inadequate transport and communication links. In some of the Small Island States of the Pacific, internal distribution challenges further reduce access to drugs for those people who live on the outer islands. Two management processes to address these problems which have successfully been used in the past, are the establishment of an essential drug list to guarantee consistent appropriate treatment, and the introduction of pooled or bulk purchasing in order to achieve economies of scale. The major non-communicable diseases (NCDs) in the South Pacific include diabetes, hypertension and cardiovascular disease. These diseases, in association with life-style factors of obesity and smoking result in significant morbidity and mortality. This paper demonstrates that collaboration in drug purchasing of a defined list of essential drugs for hypertension would be beneficial in the South Pacific, and that the process is a model for achievement of rational drug treatment for NCDs in isolated small economies.

Antihypertensive Agents↗
PubMed1993

Essential drugs and registration of pharmaceuticals: the Sri Lankan experience.

Many factors influence the regulation of pharmaceuticals in a country. The essential drugs concept, formulated by the World Health Organization to assist developing countries in selecting appropriate drugs, also provides a basis for regulation. Sri Lanka has long regulated pharmaceuticals as part of its health policy. Over 70% of 3436 pharmaceutical product registrations were found to be drugs (or alternatives) named in the country's essential drugs list. This is despite the fact that product registrations are mainly for the private health care sector, and the list is for the state sector. The essential drugs concept therefore appears to have influenced the pharmaceuticals registered in Sri Lanka.

Drug Prescriptions↗
PubMed1997

Stability of essential drugs in the field: results of a study conducted over a two-year period in Burkina Faso.

To evaluate the stability of essential drugs stored in realistic tropical conditions, we have carried out a two-year prospective study in western Burkina Faso. Twenty-seven essential drugs were stored in a rural site and a urban one where temperature and hygrometry were recorded daily. Samples of each drug were taken for further analysis to the World Health Organization Collaborative Center for the Study of Stability of Drugs in Nantes, France every three months. Quantitative analysis showed that the majority of samples suffered no significant loss of their active ingredient. In contrast, ampicillin, erythromycin, sulfaguanidine, injectable furosemide, penicillin G, trimethoprim, and chloroquine showed more than a 10% quantitative loss of their active ingredient. Thus, it is not recommended that these essential drugs be stored for more than one year in a tropical climate.

Burkina Faso↗
PubMed1989

Impact of an essential drugs programme on availability and rational use of drugs.

Availability and rational use of drugs was assessed in a random sample of 19 peripheral health units in two governorates in Democratic Yemen in which an essential drugs programme has been operational for the past few years. Findings were compared with those from seven health units in one governorate in which no such programme had been started. On average, 27 essential drugs were available in the programme area, compared with 17 in the control area. Programme areas carried on average 1 non-essential drug, compared with 17 in control areas. Average stock was adequate for 4 weeks in programme areas and for 1 week in control areas. Health workers in the programme area scored slightly, but not significantly, better in a test on theoretical knowledge on rational drug use. However, programme areas differed considerably from control areas in patterns of drug use, with fewer injections (24.8% vs 57.8% of prescriptions) and fewer antibiotics (46.3% vs 66.8%) being prescribed in programme areas, which also had fewer drugs per prescription (1.5 vs 2.4). The programme has significantly improved the availability and rational use of essential drugs in peripheral health units.

Community Health Centers↗
PubMed2006

Improving access to essential drugs for rural communities in Nigeria: the Bamako initiative re-visited.

One of the major indices of the performance of the primary healthcare delivery remains improved access to essential drugs. The Bamako Initiative (BI) was introduced by WHO/UNICEF in the late 1980's to improve access to essential drugs for the most vulnerable in the society and thus improve the health outcomes. However, almost 20 years post-inception, the outcomes and/or impact of the BI on the health indices of many implementing African countries remains varied, with not so significant improvement in health status being registered in a majority of countries. A review of literature suggests that the poor outcomes may be attributable to issues more fundamental than just the absence of adequate funding. Although the current Nigeria Drug Policy (NDP) clearly enunciates and provides policy direction for the core objective of the Bamako Initiative (BI), which is "EQUITABLE ACCESS TO ESSENTIAL DRUGS at the community level", it appears the implementation guidelines may not have drawn on the NDP policy guidelines to provide an adequate framework/tools to ensure efficient realization of the core objectives of the BI. This paper appraises the implementation of the BI in Nigeria within the context of the NDP. It reviews the current status of the BI in the country and attempts to proffer solutions for improvement and/or functionality. The paper seeks:1. To provoke thoughts and direct attention to an aspect of Public Health Pharmacy, which had been hitherto neglected by Pharmacists and Programme Planners.2. To get pharmacists more involved in ensuring the efficiency and safety of drug supply at the community level.3. To engender more research by pharmacists and stakeholders for improved outcomes in this service area.

Community Pharmacy Services↗
PubMedDate not supplied

[Hospital staff use of generic essential drugs: the case of Yalgado Ouedraogo University Hospital Centre (Burkina Faso)].

With the institution of the primary health care strategy in 1978 and the devaluation of the CFA franc in 1994 the French-speaking countries of Africa are striving to encourage the prescription of generic essential drugs. However, their prescription rates continue to remain low in these countries, especially in the major hospitals. The aim of this study was thus to determine how prescribers at the national hospital in Ouagadougou were informed about genetric drugs and to analyse their attitudes and practices with a view to elucidating the barriers to a more widespread use of generic essential drugs in hospital practice. The study consisted of a survey of all of the qualified prescribers (n=194) at Yalgado Ouedraogo University Hospital Centre in 1998. Thirty refused to participate and 35 questionnaires were discarded because they were poorly filled out. So, the responses of 129 (66.5%) prescribers in all were analysed. More than 80% (106/129) of the prescribers were aware of the existence of generic drugs in the hospital, but only 24.8% of them considered generics to have the same efficacy as their corresponding proprietary drugs. However, 64.3% of the prescribers felt that there was a place for generic drugs in a last-resort echelon of medical care, such as the national hospital in Ouagadougou, and 85.3 % were willing to prescribe them for their patients because of their low cost. The analysis of the data and the responses to the open questions show that the main conditions that would boost the prescription of generic essential drugs by hospital staff are as follows: generic essential drugs available in appropriate dosage forms and of guaranteed quality; appropriate basic training starting in medical and nursing schools; providing the prescribers with information and further education about generic drugs; and better dispensing of these drugs by the hospital's central pharmacy.

Adult↗
PubMedDate not supplied

Contribution to the issue of essential drugs in Czechoslovakia.

OBJECTIVE: To determine the ratio represented by essential drugs (EDs) in the total consumption of drugs in Czechoslovakia in 1989. DESIGN: Retrospective analysis of the assortment and consumption of EDs in 1989. SETTING: Department of the Organization and Management of Pharmacy, Faculty of Pharmacy, Bratislava. MAIN OUTCOME MEASURES: Consumption of drugs and/or pharmacotherapeutic groups, expressed by the number of formulations, number of units, and in financial terms. RESULTS: EDs constitute approximately one-third of the total consumption of drugs in Czechoslovakia (both in terms of volume and finances); almost 60 percent of EDs have dosage forms and concentrations identical to those shown in the World Health Organization Model List of Essential Drugs (Sixth List). CONCLUSIONS: The results obtained indicate that there is need for a regular updating of the drug policy within the public health branch of the government to more effectively regulate the production and import of drugs.

Chemistry, Pharmaceutical↗