(2004; 98 pages)
In developing countries, medicines may account for 30-40% of health expenditure. Many of these payments are made by individuals purchasing medicines for self-medication and only rarely on prescription. Understanding how and why consumers make the choices they do is the critical first step to intervening to ensure that these precious resources are spent as safely and productively as possible.
This manual is a successor to the 1992 WHO publication, How to Investigate Drug Use in Communities, a small but important book that has been reprinted eight times. A year later came How to Investigate Drug Use in Health Facilities. Since then numerous courses have been held and many studies undertaken, with valuable experience gained in understanding the use of medicines in health facilities and communities. This manual’s authors have been leaders in the movement to better understand and improve medicines use in the community.
Study methods have been developed and adapted for use in different environments. They are no longer the sole province of social scientists with advanced training but can be used by many different people interested in this subject. The manual aims to bring these methods and approaches to community-based organizations, consumer groups, health workers and health system researchers. By understanding medicine use practices, focused, effective interventions can be designed, implemented and evaluated. To add further impetus, a companion volume is in preparation - How to Improve the Use of Medicines in Communities, describing how to plan and implement such interventions.
Since 1992, when the first manual was published, the world of medicines use has changed dramatically. At that time, the major concerns were treatment of acute diseases, misuse of injections and antibiotics, and wasted spending on ineffective tonics and vitamin preparations. In 2004, some of these concerns remain, particularly the misuse of antibiotics, however, injection rates have declined and many consumers are more aware of the issues relating to tonics and vitamins. But today new challenges exist! Chronic diseases such as AIDS and TB need long-term therapy, with all of the difficulties of ensuring adherence to that therapy. TB programmes have used Directly Observed Therapy (DOT) with variable success in differing environments. Treating AIDS is even more difficult, with lifelong therapy to be taken at least twice a day. Understanding what can be done in the community to help patients take all of their medicines will be crucial for ensuring the success of treatment and preventing the emergence of resistance.
This manual provides a practical guide to the methods that can be used to:
• investigate the use of medicines by consumers to identify problems
• design interventions, and
• measure changes.
Readers are encouraged to “learn by doing”. Health workers are trained to diagnose and treat individual patients. The manual aims to help health workers and many others to go beyond the individual and to study the community as a focus. By understanding why people take medicines as they do, it is possible to design interventions which are sensitive to the particular beliefs, practices and needs of that community.
Although resources and the capacity to do studies are limited in many settings, it is hoped that this book will encourage readers to undertake research on medicines use pratices, if only on a small scale, and to report the results. The editor of the WHO journal the Essential Drugs Monitor is keen to receive such reports with a view to publication.
WHO is grateful to the authors who have drafted, field tested and revised this manual. We also appreciate the many comments that we have received from reviewers and from participants in Promoting Rational Drug Use in the Community Courses and the 2nd International Conference on Improving Use of Medicines, who have made suggestions on previous drafts. We welcome further suggestions and examples of instruments used that could be included in future revisions. Please send these to firstname.lastname@example.org or to the address below.
Dr Richard Laing
World Health Organization
Department of Essential Drugs and Medicines Policy
Avenue Appia, 1211 Geneva 27, Switzerland