Improving Primary Care Pharmaceutical Use
Pharmaceuticals play a critical role in health services in developing countries, and form one essential, multidimensional cornerstone of primary health care.(Gish 1979, d=Arcy 1984, van der Geest 1990) To improve access to effective drug therapies, since the early 1970's the World Health Organization Action Programme on Essential Drugs (WHO/DAP) and other international organizations have established and supported national essential drugs programs (EDPs). Until the mid-1980's, these EDPs tended to emphasize improved systems for selection, procurement, and distribution of safe and effective drugs, but paid little attention to the actual quality of drug utilization.(WHO 1987, Quick 1991) A key meeting that began to address this imbalance was the 1985 WHO Nairobi Conference of Experts which raised many important political issues related to national drug policies, essential drug lists, national production, quality assurance, drug promotion, and rational prescribing. However the report from this meeting and the subsequent WHO Guidelines for Developing National Drug Policies (WHO 1988) continued to stress improved access to quality drugs.
In 1989, the International Network for the Rational Use of Drugs (INRUD) was established with seed support from WHO and the Pew Charitable Trusts, and later core funding by the Danish International Development Assistance (DANIDA). INRUD is comprised of multidisciplinary, multi-institutional groups in 10 African and Asian countries1 with support groups in US, Europe, and Australia.2 The network members have worked collaboratively to develop standard methods and indicators for measuring drug use in developing countries,(WHO 1993, Hogerzeil 1993, INRUD 1997) and to develop and test interventions to improve the use of medicines.(Ross-Degnan 1992) In addition INRUD and WHO/DAP have organized a series of regional training courses to spread these methods and approaches. During the past decade, other organizations such as the Applied Diarrheal Diseases Research project and the WHO Child Health Division have supported interventions to improve quality of
1 Bangladesh, Ghana, Indonesia, Nepal, Nigeria, Philippines, Tanzania, Thailand, Uganda, Zimbabwe
2 Management Sciences for Health and Harvard Medical School in the US, Karolinska Institutet in Sweden, University of Newcastle in Australia, WHO/DAP and the WHO Child Health Division in Switzerland