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Highlights of the Year 2000 in Essential Drugs and Medicines Policy
(2001; 12 pages) [French] [Spanish] View the PDF document
Table of Contents
View the documentPolicy: Vital for health systems development
View the documentAccess: Framework for collective action
View the documentQuality and safety: Information for action
View the documentRational use: Action at all levels of care
View the documentContacts
 

Policy: Vital for health systems development

Direct policy and technical support to countries was strengthened to better support Member States in this critical area of health systems development. This included creating a five-person essential drugs and medicines policy unit in the Regional Office for Africa and initiating a process to select WHO national essential drugs advisers for seven African countries. In the Americas, 17 full-time professionals are now working on essential drugs issues.

Armenia, Azerbaijan, Bolivia, Brazil, Chad, China, Colombia, Costa Rica, Egypt, Georgia, Guatemala, Jamaica, Kyrgysztan, Laos, the former Yugoslav Republic of Macedonia, Mongolia, Namibia, Oman, Pakistan, Papua New Guinea, Peru, Romania, South Africa, Swaziland, Tajikistan and Yemen were among the countries who received sup-port for national drug policy development and implementation. Additionally, a comprehensive national drug policy monitoring system was established in Cambodia, Chad, Kyrgyzstan, Mongolia, Namibia and several of India’s largest states (Box 1).

Box 1: Monitoring to improve national drug policy performance

Evaluating the impact of national drug policy (NDP) formulation and implementation is part of WHO’s assistance to countries. The aim is to provide information and feedback to improve NDP performance. Core indicators have now been identified and are being used in some countries. In Cambodia, NDP monitoring is providing feedback for improving access to and use of medicines. In Namibia, indicators and targets were identified for each component of the country’s NDP implementation plan. An operational package has also been developed and is being used in Chad.

In Chad, the official NDP document and implementation plan were approved and adopted in 1998. As can be seen, strategies to improve public sector financing, drug pricing and management of drug donations have improved access to essential drugs for the population. The two indicators, “% of key drugs available in health facilities” and “stock-out duration of key drugs”, are being closely observed since fluctuations may indicate reduced access to essential drugs. Other indicators show that although Chad’s standard treatment guidelines were updated, no improvements have been observed in antibiotic and injection use. This is particularly worrying given that a public education campaign in rational drug use was carried out. A meeting on rational drug use to discuss the results and identify strategies is scheduled for 2001. Work in Chad is the result of cooperation between the Chad Government, WHO and the World Bank, and bilateral assistance.

Core indicators monitored in Chad

1995

2001

Access

% of population with access to essential drugs

46% (1999)

60%

% of medicine dispensed to patient at health facility

88%

89%

Public per capita expenditure on drugs

US$ 0.04

US$ 0.12

% of key drugs available in health facilities

80%

70%

Stock-out duration of key drugs

41 days

59 days

Affordability (cost to treat pneumonia/food basket):

 

public pharmacies

18%

6%

 

private pharmacies

82%

39%

Implementing drug donation guidelines

NA

Yes

Rational drug use

Average number of drugs/prescription

2

2.4

% antibiotics use

56%

54%

% injection use

23%

29%

Essential drugs list < 5 years

Yes

Yes

% of drugs prescribed that are on essential drugs list

91%

97%

Standard treatment guidelines < 5 years

No

Yes

% doctors’ offices with standard treatment guidelines

61%

47%

Essential drugs concept included in medicine/pharmacy curricula

No

Yes

Public education campaign on rational drug use

No

Yes

NA not applicable

   

Capacity to develop and implement national drug policy was increased by international two-week courses - one in Lebanon and another in Brazil - and by a regional workshop in the Philippines. At a meeting in Vienna, policy-makers and drug regulators of the Newly Independent States reviewed progress and next steps in pharmaceutical reform for their region.

Anglophone and francophone network meetings for essential drugs programme managers were held in South Africa and Togo and resulted in further strengthening of the African Intensified Essential Drugs Programme. In the Americas, national essential drugs programme managers met in Panama to revise activities in light of the WHO Medicines Strategy.

Other means of tackling policy issues included the Director-General’s round-table process with the research-based pharmaceutical, generic drug and self-medication industries, and public-interest nongovernmental organizations (NGOs). The round tables have led to work on increasing access to antimalarials, improving drug quality, combating counterfeit drugs, developing drug price survey methodology, and documenting and critically evaluating drug promotion. Work on traditional medicine policy was also expanded, including efforts to validate this type of health care (Box 2).

Box 2: Achievements in traditional medicine

Traditional medicine is an accessible and affordable health care resource for many developing country populations, and increasingly used in developed countries. However, although promising evidence of efficacy exists for some products and practices, substantial work is needed to assess efficacy adequately.

In 2000, the WHO Strategy for Traditional Medicine 2001-2005 was drafted to enable traditional medicine to play the most appropriate role in health care delivery. Additionally, WHO organized a meeting of the African Forum in Harare, Zimbabwe, to strengthen the role of traditional medicine in health systems in Africa.

Traditional medicine activities undertaken in 2000 focused on investigating and promoting effective and safe treatment with traditional medicine. They included: support for three national clinical studies on herbal antimalarials; drafting of a Technical Update for HIV/AIDS Programme Managers on Clinical Validation of Traditional Medicine in cooperation with UNAIDS; publication of General Guidelines for Methodologies on Research and Evaluation of Traditional Medicines; and organization of a meeting in Jamaica on regulation of herbal medicines by Headquarters and the Regional Office for the Americas, and by the African Regional Office of a regional workshop in Antananarivo, Madagascar on evaluation of traditional medicines.

Other activities included an inter-regional workshop in Thailand, organized by Headquarters and the Eastern Mediterranean, South-East Asian and Western Pacific Regional Offices on intellectual property rights in the context of traditional medicine, and country support to Burkina Faso, China, Ethiopia, Mongolia, Namibia, Pakistan, Papua New Guinea, Samoa, Singapore, Syria, Viet Nam and Zambia.


Use of traditional medicine for primary health care is extensive in many developing countries

At international level, work to coordinate pharmaceuticals policy and activities continued via the Interagency Pharmaceutical Coordination (IPC) group and through closer collaboration with the European Commission. The IPC group now includes all four United Nation agencies most concerned with access, quality and rational use of pharmaceuticals (UNFPA, UNICEF, UNAIDS, WHO) and the World Bank. In 2000, IPC met twice and started to develop interagency guide-lines for accepting drug price discounts or donations of single-source pharmaceuticals.

 

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