Improving Primary Care Pharmaceutical Use
Asia. Thirty‑five (59.3%) of all studies identified, and 25 (56.8%) of the more recent studies, were conducted in Asian countries. African countries were the sites of 5 interventions (31.3%) prior to 1991, and 9 studies (20.5%) reported since that time. Latin America lags far behind the other two continents in generating experience in this area; only one Latin American study to improve drug use was reported prior to 1991, and only 6 studies (13.6%) have been carried out since then.
Types of intervention tested
Interventions were classified according to the predominant strategy they employed to influence the use of medicines. Of course, not all interventions that use the same intervention modality - for example, a training seminar - are similar. Interventions may be applied with different levels of intensity and sophistication, and many interventions employ multiple strategies. Despite this, classifying the reported interventions by their main strategy provides some idea about the range of techniques that have been tested to improve use of medicines. The distribution of studies by intervention type is shown in Figure 1.
The great majority of interventions (38 of 59, or 64.4%) can be characterized as predominantly educational in nature. Over half of these educational interventions (20 of 38) used training courses, seminars, or workshops to influence some aspect of drug treatment by health workers. The remaining 18 educational interventions included in this review can be described as community case management (CCM) approaches, typically involving training of community health workers in appropriate diagnosis and treatment of a key child health problem, often combined with community sensitization and education, active community-based case finding, and parallel training of facility‑based health workers. Twelve CCM studies investigated the impact of training CHWs to manage acute respiratory infections (ARI) on reduced mortality of children under five; six CCM interventions targeted diarrhea in under‑fives, measuring either improvements in treatment or reductions in diarrhoea‑related mortality. A single study examined the effects of community case management of malaria. Most CCM interventions were either supported directly by the WHO Child Health Division, or were indirectly influenced by the priority which WHO/CHD attached to improved community management of ARI and diarrhea.