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Annual Report 2002 - Essential Drugs and Medicines Policy: Supporting Countries to Close the Access Gap
(2003; 20 pages) [French] [Spanish] View the PDF document
Table of Contents
View the documentDeveloping a monitoring culture to improve impact
View the documentTraditional and complementary medicine: putting policy into action
View the documentKey country support in Africa and Eastern Mediterranean
View the documentWHO Collaborating Centres: supplying active support for medicines work
View the documentHow is TRIPS affecting access to medicines?
View the documentDevelopment of the essential drugs concept over the past 25 years
View the documentMeasuring access to antimalarials
View the documentStrengthening regional and national bulk procurement
View the documentLearning from successful supply systems
View the documentWorking out the cost of medicines
View the documentSupporting MDG target on access to essential medicines
View the documentCommon guideline for evaluating new medicines in Baltic countries
View the documentNGO toolkit for improving access to HIV/AIDS treatment
View the documentHarmonizing medicines regulation in the Americas
View the documentGood manufacturing practice in China: rapid progress
View the documentPharmacovigilance: detecting and reporting adverse drug reactions
View the documentVariations in prescribing information in 26 countries
View the document10th ICDRA: an international basis for medicines regulation
View the documentFighting poor-quality drugs
View the documentImproving medicines use in hospitals in Cambodia and Lao PDR
View the documentWHO-India Essential Drugs Programme: multiplying impact
View the documentOman: improving antibiotic use in primary health care

Improving medicines use in hospitals in Cambodia and Lao PDR

In 1997, the first International Conference on Improving the Use of Medicines (ICIUM) presented and discussed interventions from around the world that aimed to promote appropriate use of medicines. It concluded that a successful intervention should:

• focus on a specific problem
• address the underlying factors
• use a problem-solving approach
• repeat the intervention
• be interactive
• provide feedback to prescribers
• be followed by monitoring and supervision
• develop peer group commitments or guidelines.

In 2001, the percentage of patients receiving antibiotics was 60-100% in Cambodia and approximately 70% in Lao PDR, while injection use in both countries ranged from 60-100%. A review by WHO indicated that monitoring and supervision of medicines use in the two countries did not incorporate problem-solving approaches, and was neither generating prescriber, commitment to nor setting specific targets for improved medicines use. In other words, the precepts recommended by ICIUM were not being comprehensively followed.

Following the ICIUM recommendations, and working with the Ministries of Health in Cambodia and Lao PDR, WHO introduced and fieldtested an innovative monitoring, training and planning strategy (MTP) for improving rational use of medicines. A group of providers identifies medicines use problems, quantifies them using suitable indicators, identifies their possible causes, and selects appropriate solutions. They then implement the chosen solutions using available scientific information and other resources, and measure their (hopefully) improved performance. Additionally, the group of providers holds a regular monthly meeting to monitor the levels of the defined problem, discuss improvements made and target levels of improvement for the following month.

The percentage of patients receiving antibiotics at Hinboune District Hospital, Cambodia, fell immediately after implementation of the monitoring, training and planning strategy

The MTP strategy was field-tested in Cambodia and Lao PDR in a number of, mostly provincial, hospitals (6 in Cambodia and 8 in Lao PDR), and later expanded to district hospitals (21 district hospitals in Lao PDR). Evaluation of implementation in the pilot hospitals showed that it was effective in improving medicines practices and that hospitals can adopt the strategy easily. The Ministries of Health in Lao PDR and Cambodia are now seeking to extend use of this strategy to additional provincial and district hospitals, with donor support.

MTP was earlier adopted by the WHO Collaborating Center for Research and Training on Rational Drug Use in Yogyakarta, Indonesia, for implementing rational medicines use interventions in Indonesia.


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