PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Drugs, Essential”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed2001

Do national medicinal drug policies and essential drug programs improve drug use?: a review of experiences in developing countries.

Increasing concerns regarding access to and appropriateness of medicinal drug use have led many governments in developing countries to develop national policies and regulations intended to increase the affordability, supply, safety, and rational use of pharmaceuticals. However, little is known about the intended and unintended impacts of these social experiments on actual drug use. We conducted a critical review and synthesis of the international literature in an attempt to define the current state of knowledge regarding drug policy effects on drug use, and to extract from the evidence important lessons for future policy and research. Literature sources included the archives and computerized databases, articles published in medical and pharmacy journals, as well as published annotated bibliographies. The evaluated interventions included three broad categories: (1) multi-component national drug policies including essential drug programs; (2) drug supply and cost-sharing programs; and (3) regulatory measures. Most of these studies utilized weak research designs that evaluated programs solely on the basis of post-intervention measures. Only two studies measured pre-policy utilization, but did not include a control group. Thus, none of the results are conclusive, and the findings represent, at best, hypotheses for more rigorous studies of policy impacts. Some suggestive findings include an association between increases in the supply of essential drugs (combined with training) and more appropriate use of medications in primary care settings. In addition, preliminary data suggest some unintended effects of de-registration of drugs or upward reclassification of specific medicines. Similarly, loosening restrictions have sometimes been accompanied by increased dispensing of specific drugs by unqualified personnel. The available studies focused only on a few categories of national and regulatory policies. Because of poor study design, the results do not provide valid data to determine whether national drug policies improve drug use. Moreover, no studies have evaluated the effects of major and recent changes, such as increased use of product patents, national pharmaceutical insurance policies, and increased privatization of pharmaceutical products and services. Future studies need to explore the consequences of these emerging developments on drug access and use. Despite the difficulties inherent in evaluation of national policies, stronger research designs can and should be carried out. Interrupted time-series analysis and other more rigorous designs should become standard designs for policy evaluation in the same way that standard treatment guidelines are intended to guide medical practice.

Developing Countries↗
PubMedDate not supplied

[Overpricing and affordability of drugs: the case of essential drugs in Mexico].

Accessibility and availability of drugs has been a matter of great concern for health services all over the world, especially for less developed countries. The World Health Organization has devoted considerable time to this matter, as evidenced in several documents and policies, such as model lists of essential drugs and the strategy "Health for All by the Year 2000". The WHO policy for essential drugs has been widely accepted, and the WHO List of Essential Drugs is now in the ninth revised edition. Although the essential drug policy has been well-accepted by health agencies and NGOs, the pharmaceutical industry has not proven willing to produce essential drugs at affordable prices. The purpose of this study is to examine price levels of essential drugs in Mexico. The evaluation was performed through a comparison of international and national prices for leading drugs in the respective therapeutic categories and included in the WHO model list of essential drugs. The study shows clearly that prices of essential brand-name drugs in Mexico are very high. Per capita consumption has remained stable despite a sharp decrease in the Mexican GDP since 1995. The article discusses the reasons for this and proposes measures to deal with the problem.

Costs and Cost Analysis↗
PubMed1998

The use of essential drugs. Eighth report of the WHO Expert Committee (including the revised Model List of Essential Drugs).

This report presents the recommendations of a WHO Expert Committee responsible for updating and revising the Model List of Essential Drugs. The first part provides guidance for countries wishing to establish national programmes for essential drugs, and includes discussion of quality assurance, essential drugs for primary health care, post-registration drug studies, drug information and educational activities, and research and development. In the light of increasing resistance to antimicrobials, particular attention is drawn to the need for and use of reserve antimicrobials. The second part presents the tenth revised model list, together with details of changes that have been made, a glossary of terms and an alphabetical list of all the drugs included.

Drug Resistance↗
PubMed2002

Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria.

OBJECTIVES: To compare the level of availability and rational use of drugs in primary health care (PHC) facilities where the Bamako Initiative (BI) drug revolving fund programme has been operational, with PHC centres where the BI-type of drug revolving fund programme is not yet operational. METHODS: The study was undertaken in 21 PHC centres with BI drug revolving funds and 12 PHC centres without BI drug revolving funds, all in Enugu State of Nigeria. Data were collected on the essential and non-essential drugs stocked by the facilities. Drug use was determined through analyses of prescriptions in each health centre. Finally, the proportion of consumers that were able to remember their dosing schedules was determined. FINDINGS: An average of 35.4 essential drugs was available in the BI health centres compared with 15.3 in the non-BI health centres (p < 0.05). The average drug-stock was adequate for 6.3 weeks in the BI health centres, but for 1.1 weeks in non-BI health centres (p < 0.05). More injections (64.7 vs. 25.6%) and more antibiotics (72.8 vs. 38%) were prescribed in BI health centres than in the non-BI health centres (p < 0.05). The BI health centres had an average of 5.3 drugs per prescription against 2.1 in the non-BI health centres. However, the drugs prescribed by generic name and from the essential drug list were higher in the BI health centres (80 and 93%) than the non-BI health centres (15.5 and 21%, respectively) (p < 0.05). CONCLUSION: It was observed that the BI facilities had a better availability of essential drugs both in number and in average stock. However, the BI has given rise to more drug prescribing, which could be irrational. The findings call for strategies to ensure more availability of essential drugs especially in the non-BI PHC centres as a strategy to decrease medical costs and improve the quality of PHC services, while promoting rational drug use in all PHC centres. More detailed studies (for example, by focus group discussion or structured interviews) should be undertaken to find out reasons for the over-prescription and to develop future interventions to correct this.

Developing Countries↗
PubMed1993

Essential and non-essential drugs marketed by the 20 largest European pharmaceutical companies in developing countries.

This study estimates the proportion of essential drugs out of all drugs offered for sale in six regions of the developing world by the 20 largest European pharmaceutical companies. The total number of drugs offered for sale by the 20 companies is estimated from citations in the most important drug compendia in each region for 1988 and 1989. Essential drugs are defined as drugs listed on the 1988 version of the World Health Organization's (WHO) essential drugs list or equivalent to WHO essential drugs. Only 482, or 16% of a total of 3021 cited drugs were essential drugs or equivalent to an essential drug. The proportion for each company ranged from a low of 5.4% to a maximum of 39.0%. A high proportion, 41.7%, of the 2539 non-essential drugs cited in the compendia contained two or more active ingredients, compared to only 9.5% of the essential drugs. The results indicate that European pharmaceutical companies have yet to focus their drug marketing efforts in developing countries on the essential drugs recommended by the WHO. The ethical responsibility of the pharmaceutical companies is discussed, particularly in respect to their sales on the private market.

Africa↗
PubMedDate not supplied

[Centralized purchasing of essential drugs, a priority for the health care systems of developing countries].

Health sector reform is a key priority of many governments throughout the world. Drug supply systems are a major element of public health policy design in Africa, where 90% of drugs are imported. The WHO Essential Drugs Program and the UNICEF sponsored Bamako Initiative have, since the late 1980s, promoted the rational use of essential drugs and attempted to ensure a sustainable drug supply through the implementation of cost recovery schemes and quality assurance mechanisms in public health services. A new market for drugs is emerging within this framework and there is growing competition for its control. Government medical stores are all too often bankrupt and the private sector is expensive, catering mainly for the middle to upper classes of urban areas. An intermediate alternative. Essential Drugs Purchasing Offices (EDPOs), has been proposed to balance social objectives and economic constraints. Some of the experimental strategies have given promising results. However, their implementation raises a number of questions: What is the role of the EDPO? Should it promote public health issues in general or focus purely on drug availability? What is the most appropriate legal status? Public or private? For profit or not? How should the investment capital be structured? In drugs or in funds? With ample provision or a tight budget? How should drug purchases be managed? Where should drugs be purchased? How much? How often? According to which procedures? How should the distribution of drugs be organized? Supplying everyone? Pushing supplies or pulling purchasers in? The answers to these questions, analysis of the reasons for success and failure and the dissemination of the information gathered should identify priorities for action and future research and define a framework for expansion. These are the objectives of the "Concerted Action for the Development of EDPO in Sub-Saharan African Countries" which is supported by the European Union (DG XII).

Africa↗
PubMed2003

Public and private sector responses to essential drugs policies: a multilevel analysis of drug prescription and selling practices in Mali.

Many African countries have introduced cost recovery mechanisms based on the sale of drugs and measures aimed at improving drug supply. This study compares prescribing and selling practices in Mali, in 3 cities where the public sector contributes differentially to the supply of drugs on the market. Multilevel models are used to analyse the content and cost of 700 medication transactions observed in 14 private and public legal points of sale. Results show that the objective of improving access to drugs seems to have been achieved in the sites studied. Costs of prescriptions were lower where public health services had been revitalized. Affordable generic drugs were accessible and widely used, even in the private sector. However, measures intended to rationalize the prescription and delivery of drugs did not always have the desired effect. While agents in the public sector tended to prescribe fewer antibiotics, injectables, or brand-name drugs, the data confirm the virtual absence of advice concerning the use or the side effects of the drugs in both public and private sectors. In addition, data supported the notion that the public and private sectors are closely intertwined. Notably, availability of drugs in the public sector contributed to diminishing the prices charged in the private sector. Similarly, the use that agents in the public sector made of the opportunities afforded by the presence of the private pharmaceutical sector provided another illustration of interrelatedness. Finally, the data showed that the presence of a private sector, which has not been affected by measures aimed at rationalizing prescription and sales practices, limits the effects of measures implemented in the public sector. More assertive policies, based on strategies encompassing actors in the private sector, are needed to increase the safety and effectiveness of prescription and sales practices.

Community Health Centers↗
PubMed1982

The multinational drug companies in Zaire: their adverse effect on cost and availability of essential drugs.

An analysis of the types and costs of drugs imported by seven multinational pharmaceutical companies in Zaire, an underdeveloped country in Africa, reveals that three-fourths of the drugs consisted of expensive and nonessential items. The prices of essential drugs (24 percent of their total imports) were much higher than those of available generic sources (average difference of 300 percent). The importation of nonessential drugs and high prices paid for essential drugs exacerbate the scarcity of needed items because of Zaire's limited supply of hard currency. In addition, two drug firms imported and promoted the sale of aminopyrone-dipyrone analgesic-antipyretics, drugs now rarely used in Western industrialized countries because of potentially fatal complications. Thus, in Zaire, the multinational pharmaceutical industry has an adverse effect on the availability and cost of drugs, as well as on the pattern of drug usage.

Costs and Cost Analysis↗
PubMed1987

Economics of essential drugs schemes: the perspectives of the developing countries.

Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.

Developing Countries↗
PubMed1993

Perception of hospital pharmacists/dispensing personnel of the essential drugs concepts (EDC) in Zimbabwe.

The perception of hospital pharmacists/dispensing personnel on the essential drugs concept in Zimbabwe was prospectively evaluated. To this end, 100 ad hoc questionnaires were mailed to the health professional cadre around the country in October 1989. 54 health centres responded and these consisted of 4 central hospitals, 3 provincial, 22 general and district, 14 rural hospitals, 7 private hospitals/clinics and 4 city polyclinics. These health centres serve an estimated population of 6 million people. Of the dispensing personnel, 22% had been trained in their respective health professions after 1983, i.e. after the introduction of the essential drug concept. 65% of the respondents had a working knowledge of the essential drugs concept. Pharmacists and pharmacy technicians made up 59% of the dispensing personnel, while nurses accounted for 32%. Significantly all respondents used the Essential Drug List for Zimbabwe hand book and they thought the concept is a good one.

Attitude of Health Personnel↗
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↗
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↗