1. Testing for initial quality should be given high priority. Routine testing of new suppliers is recommended.
2. Even in the case of manufacturers with a proven good record, selective sampling of particular drugs is recommended. This study suggests that epinephrine injection, ampicillin injection and retinol tablets could be good markers for intrinsic quality problems. Other drugs should be considered according to the specific relevance in the country. The inclusion of tetracycline capsules or doxycycline capsules is advisable.
3. The prequalification of suppliers is recommended. This is considered essential in the case of ergometrine injection. Every batch should be tested upon receipt (at least a visual discoloration test).
4. Specifications at the time of tendering should include an adequate (but proven acceptable) shelf-life, and detailed packaging requirements and special labelling as relevant.
Occasional field sampling of drugs suspected to be vulnerable (such as ergometrine injection or other injectable in liquid formulation) is justified; "worst case" samples should be sought. The general testing of samples at the facility level is not recommended.