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CITATION: Presented at the International Conference on Improving Use of - page 26 / 51





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Improving Primary Care Pharmaceutical Use

treatment of other health problems, or on long-term patterns of community drug use.  For example, does CHW use of the WHO ARI protocol increase overall community use of antibiotics and encourage the development of antibiotic resistance?


There is great potential in innovative approaches to prescribing improvement based on group process among health workers.  However, it appears that individual involvement in defining treatment norms may not be enough to improve practice; group commitment to standards by the staff at a health facility or continuing involvement in peer monitoring may motivate and sustain change.


Effective supervision using indicators or simple protocols, and monthly audit and feedback of performance indicators, can be effective for improving specific practices.  It is unclear to what extent these changes are internalized, or to what extent staff will return to previous practices when monitoring systems are no longer in place.

What do we not yet know?

Unfortunately, what we do not know about how to improve drug use in developing countries far exceeds what we know.  There are many crucial issues about which we need to generate more experience and evidence.


Much more attention needs to be paid to improving the use of medicines in adult populations.  In part, this means shifting the focus in interventions to include important chronic illnesses such as tuberculosis, sexually transmitted diseases, diabetes, and hypertension.  The lack of work on improving treatment of malaria is striking, given its importance as a cause of mortality and morbidity in both adults and children.


There is a glaring lack of experience in trying to improve drug use among private practitioners.  We need to identify which private sector practices can realistically be improved, and what strategies work to improve them.  We know there are great differences in the public and private sector practices of practitioners who work in both settings; it would be useful for a start to know to what extent improvements in public sector practice resulting from interventions carry over into private practice.  To work in the private sector, there will need to be new approaches to measurement, since the types of clinic records used to measure changes


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