How to Develop and Implement a National Drug Policy (Second Edition)
(2001; 96 pages) [French] [Spanish] View the PDF document
Table of Contents
View the documentContributors
View the documentAbbreviations and acronyms
View the documentPreface
Open this folder and view contentsPart I: How to develop and implement a national drug policy
Close this folderPart II: Key components of a national drug policy
Open this folder and view contents4. Selection of essential drugs
Open this folder and view contents5. Affordability
Open this folder and view contents6. Drug financing
Open this folder and view contents7. Supply systems
Open this folder and view contents8. Drug regulation
Close this folder9. Rational use of drugs
View the document9.1 Why is it important to promote rational use?
View the document9.2 Challenges
View the document9.3 Planning for activities to promote rational use of drugs
View the document9.4 Core strategies to improve drug use
View the document9.5 Educational strategies
View the document9.6 Managerial strategies to promote rational drug use
View the document9.7 Regulatory strategies to promote rational drug use
View the document9.8 Promoting rational drug use in the private sector
Open this folder and view contents10. Research
Open this folder and view contents11. Human resources development
Open this folder and view contents12. Monitoring and evaluation
View the documentReferences
View the documentSelected WHO publications and documents of related interest
View the documentBack cover
 

9.2 Challenges

Complexity of the issue

The factors that influence drug use are many and interrelated. Changing complex practices that are embedded in cultural and social beliefs and shaped by knowledge, attitudes, infrastructure and economic interests is very difficult. No single approach is likely to work, and some interventions may produce unintended effects. A combination of strategies tailored to the needs of the different groups and different environments is needed.

Conflicting interests

Policies to promote rational use are often controversial and may be opposed for various reasons. Prescribers, and particularly those who also dispense, may have a financial interest in prescribing more drugs or drugs with the highest profit margins; they may resent any interference with their freedom to prescribe. They may also derive a certain status from prescribing many newly marketed or expensive drugs. Pharmacists and drug sellers have a financial interest in increasing the volume of their business; producers want to increase their sales and their marketing practices may conflict with the goals of rational use. Consumers and prescribers may believe that interventions to encourage rational use are intended to cut costs rather than to improve therapy. It is important to identify and consider all these various interests, which are basic barriers to change.

Lack of independent information

In many countries there is little or no access to regular, up-to-date drug information, and health workers and consumers are almost entirely dependent on commercial sources of information. As a result the prescribers and consumers in most developing countries are poorly informed. Even where prescribers and consumers have access to independent drug bulletins, drug information centres and other sources of information, they are also exposed to a huge volume of commercial information. This information imbalance is a serious constraint on policies to promote the rational use of drugs.

Inappropriate drug promotion

Drugs have a potential not only for benefit but also for harm, and their promotion therefore requires special controls to protect the public. Inappropriate promotion of medicinal drugs remains a problem in both developing and developed countries.

Problems relate to scientific accuracy and balance of information, improper inducements to prescribers or dispensers, lack of full product information, misleading presentations by medical representatives, and promotional activities disguised as educational or scientific exercises.

Unrestricted availability of prescription drugs

In many countries medicines that require medical supervision and a prescription are freely available from drug sellers and pharmacies. This can lead to inappropriate use and to delays in the correct diagnosis and treatment. Unrestricted availability can also contribute to the emergence of drug resistance, drug interactions and adverse effects, and inefficient use of scarce household resources.

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