Inefficient and irrational use of medicines is a widespread problem at all levels of health care (Hogerzeil 1995). Per capita wastage from inefficiencies and irrational use tends to be greatest in hospitals; this is particularly worrisome since resources are scarce and prescribers in communities often copy hospital prescribers. Many of these sources of wastage could be reduced if some simple principles of drug management and use were followed. However, it is difficult to implement these principles because staff from many different disciplines are involved in different aspects of drug management and use. Often there is no forum for these different disciplines to work together in developing and implementing appropriate drug policies.
In hospital settings, a drug and therapeutics committee (DTC) provides a forum to bring together all the relevant people to work jointly to improve health-care delivery. As such, a DTC may be regarded as a tool for promoting more efficient and rational use of medicines. In many developed countries, a well-functioning DTC has been shown to be one of the most effective structures in hospitals able to address drug use problems (Weekes and Brookes 1996). However, in many developing countries DTCs do not exist and in others they do not function effectively.
A DTC involves its members in a great deal of work. It may be easy to identify members, roles and functions for a DTC, but it is much more difficult to develop and implement strategies to change medicine use practices. DTCs will not, therefore, work unless the staff involved are motivated and prepared to make the effort. A DTC can only work in health systems where there are:
• sufficient staff who understand and are able to undertake the necessary work
• incentives (for example recognition, allocated work time for DTC activities) for the professional staff involved
• accountability of the hospital and its staff for the money they spend on medicines and the quality of care that they provide.
This manual aims to provide practical guidance to doctors, pharmacists, hospital managers and other professionals who may be serving on DTCs, or who are concerned with how to improve the quality and cost efficiency of care. The manual covers:
• general principles, strategies and activities that can be adopted to improve the quality and cost efficiency of care
• what the roles and responsibilities of a DTC should be and how these may be achieved.
The guidance provided in this manual is aimed at all kinds of DTC - whether in public or private hospitals and at all levels, from district level to tertiary referral level. Since health systems in different countries vary widely, not all the information included in this manual will be relevant for all DTCs. Where certain information is only relevant to higher levels of health care, this has been indicated in the text.
This manual has been developed by the Department of Essential Drugs and Medicines Policy, WHO, Geneva, in collaboration with the USAID-funded Rational Pharmaceutical Management Plus Programme of Management Sciences for Health, Boston, USA. The draft was developed in a participatory way, building on the course materials used in international training courses on DTCs and on experiences gained from pilot projects conducted in Zimbabwe and Indonesia.
The words ‘drugs’ and ‘medicines’ are used interchangeably in the text.
We would be very happy to receive comments, which may be sent to:
Department of Essential Drugs and Medicines Policy
World Health Organization
20 Avenue Appia
1211 Geneva 27
Fax: +41 22 791 4167