Countries receiving substantial WHO support in 2002 included Afghanistan, Somalia, South Africa and Uganda. In both Afghanistan and Somalia, pharmaceutical support was an important element of health system reconstruction. In South Africa, intensive WHO support facilitated sound implementation of the country's national drug policy. In Uganda, the results of a WHO-assisted pharmaceutical situation analysis were used to reorient access and rational use activities.
Afghanistan: rebuilding the pharmaceutical sector
The arduous process of reconstructing Afghanistan's health system is now under way. WHO made a preliminary assessment of the pharmaceutical sector in early 2002. Shortly afterwards, it recruited a national programme officer to assist the Ministry of Public Health (MoPH) on pharmaceutical issues.
Key MoPH/WHO activities in 2002 included:
• creation of a department of pharmaceuticals within MoPH
• staffing of the department of pharmaceuticals
• selection of essential medicines focal points in 20 provinces of Afghanistan
• creation of a national drugs and therapeutics committee
• adaptation and adoption of WHO Guidelines for Drug Donations
• process of updating and revising national essential medicines list started, via consultation with health professionals in Kabul, the regions, provincial hospitals and health centres
• review of Afghanistan's generic medicines law
• further development of standard treatment guidelines.
Framework agreement with Iran
Evidently, building national pharmaceutical capacity is a long-term process, but collaboration with Iran will greatly facilitate it. A framework agreement between Afghanistan's Ministry of Public Health and Iran's Ministry of Health was signed in 2002, under which Iran will provide a training programme for staff of the Afghan drug regulatory authority, the national quality control laboratory and the faculty of pharmacy.
Somalia: long-term development follows emergency
Constant civil war in Somalia destroyed almost all the country's public health services. A WHO situation analysis was carried out in 2001. It described the lack of a national drug policy, the poor condition of the country's medical stores, overuse of antibiotics and injections, and a pharmaceutical supply system that was completely dependent on donations. But WHO now has an office in Hargeisa and in 2002 started to work with the national authorities to lay the groundwork for health sector development.
A national drug policy (NDP) workshop was held and a strategy for NDP implementation was agreed upon. This includes setting up a national steering committee and NDP secretariat, establishing a national medicines regulatory authority, and publishing and disseminating national donor guidelines and an updated national essential medicines list.
WHO also worked closely with national authorities to re-establish Somalia's medicines distribution system. The immediate goal was defined as creating a unified pharmaceutical policy among the many NGOs and international organizations currently providing health care in Somalia. The long-term goal will be to create an integrated essential medicines system for the whole country, responsibility for which can later be passed to the national government.
South Africa: comprehensive support sees results
In December 2002, the South Africa Drug Action Programme (SADAP) concluded six years of intensive support for implementation of South Africa's National Drug Policy. SADAP was a project attached to the South African Department of Health, funded by the South African Department of Health and the United Kingdom Department for International Development.
Much was achieved during the six years. SADAP supported the South African Government throughout its involvement in the highly contentious international debate surrounding essential medicines, patents and affordability of medicines. SADAP also generated widespread understanding of the rationale and operation of an essential medicines list in terms of health policy-making and management, and contributed to the successful production and dissemination of standard treatment guidelines, particularly at primary health care level. Additionally, a number of workshops on medicines supply management - which trained over 700 pharmaceutical assistants - were held. These were an important contribution towards developing norms and standards for procurement, stock control, distribution, financing and staffing.
In late 2002, the Department of Health created the Pricing Working Group, preparatory to establishing the Pricing Committee, mandated by the 1997 Medicines Act 90. WHO will provide technical advice to the Pricing Working Group during 2003.
Uganda: from assessment to action
Medicines advisers are national professional officers with specialized pharmaceuticals expertise. Their brief is to help monitor country pharmaceutical sectors, assist countries in identifying priorities, and coordinate WHO pharmaceutical assistance. In 2002, medicines advisers began work in 11 WHO Country Offices in the African Region, including Uganda.
The medicines adviser in Uganda, WHO's Regional Office for Africa and WHO Headquarters assisted the Ugandan Ministry of Health (MoH) in carrying out a baseline survey to assess Uganda's pharmaceutical situation. The assessment helped build capacity in monitoring and also created an evidence base for developing collaborative work plans. Collaboration between the MoH and the WHO Country Office for Uganda led to significant achievements in the pharmaceutical sector in three of WHO's key medicines areas: access, rational use, and quality and safety.
The 2002 pharmaceutical situation assessment in Uganda revealed that availability of key medicines varied two-fold among public health facilities and five-fold among medicines warehouses
In terms of access, the situation assessment revealed that availability of key medicines varied nearly twofold among public health facilities and five-fold among district warehouses. To improve this situation, district drug managers were trained in drug information management, and National Medical Stores personnel and district drug managers were trained in the selection and procurement of essential medicines and medical supplies. Under Uganda's decentralization policy, districts are required to procure medicines according to their local needs. The WHO Country Office and MoH therefore supported districts in switching to a needs-based system for essential medicines procurement. Outstanding success has been achieved in this area, with 53 out of the 56 districts (95%) placing orders for essential medicines and supplies according to their local quantified needs for the first quarter of 2003.
In the area of rational use, the WHO Country Office supported the MoH to develop the National HIV-ART Treatment & Care & Implementation Planning Guidelines for scaling up HIV/AIDS care and support in the country. Support was also provided for dissemination of HIV/AIDS information and the setting up of the National Drug Information Centre. One of the major findings of the national assessment of the pharmaceutical sector was high use of antibiotics and injections in health facilities. Accordingly, the MoH/WHO work plan includes strategies for promoting rational use of drugs to reverse this trend.
To help ensure the quality and safety of medicines, WHO provided support for setting up a database system at the National Drug Quality Laboratory (NDQCL). This was in addition to procuring chemicals for use by NDQCL in analysing medicines samples.