How to Investigate the Use of Medicines by Consumers
(2004; 98 pages) View the PDF document
Table of Contents
View the documentAcknowledgements
View the documentPreface
Open this folder and view contents1. Why study medicines use by consumers
Close this folder2. What influences medicines use by consumers
View the document2.1 Introduction
View the document2.2 The household level
View the document2.3 The community level
View the document2.4 The health institution level
View the document2.5 The national level
View the document2.6 The international level
Open this folder and view contents3. How to study medicines use in communities
Open this folder and view contents4. Prioritizing and analysing community medicines use problems
Open this folder and view contents5. Sampling
Open this folder and view contents6. Data analysis
Open this folder and view contents7. Monitoring and evaluating rational medicines use interventions in the community
View the documentBack cover
 

2.6 The international level

Drug use by consumers is also influenced by factors at the international level including:

Global trade regulation and access to drugs

Globalization and the international regulation of trade have important consequences for health policy. Concerns about the consequences of globalization and international trade agreements and what were described as the ‘non-level playing field’ on which they were developed, were first raised at the 1996 World Health Assembly. The lack of financial access to patented HIV/AIDS medicines in developing countries and alliances between health and development groups in both developed and developing countries have brought these issues to the forefront of national and global agendas.

The World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) obliges all WTO Member States to provide 20 years of patent protection for medicines. Industrialized countries should have implemented TRIPS by 1996, developing countries had to introduce national regulation on intellectual property by the year 2000 and least developed countries have until 2016 to do so. The 2001 meeting of the World Trade Organization in Doha acknowledged that access to medicines should have primacy over commercial interests (see Médecins Sans Frontières, 2003).

Donor support

Over the past decade there has been a shift in donor support away from vertical programmes, such as essential drugs programmes, and towards health reform and sector-wide approaches. Health reform policies affect local-level implementation of essential drugs programmes. They generally promote collaboration with the private sector, the introduction of user fees and decentralization of health care decision-making, including pharmaceutical procurement and supply.

There have been several recent efforts to mobilize resources in order to increase access to specific, greatly needed medicines and vaccines in developing countries. Examples of this trend include the Global Alliance for Vaccines and Immunisation (GAVI), the Medicines for Malaria Venture public-private partnership to enhance malaria drug supply and the Global Fund for HIV, TB and Malaria. These initiatives can potentially increase access in developing countries to urgently needed medical technologies.

An interagency committee including a wide range of NGOs and UN agencies has published the second edition of Guidelines for Drug Donations (WHO/EDM/PAR/99.4) which aim to ensure appropriate supply and rational use of donated medicines.

Global consumer advocacy

As is the case at the national level, consumer advocacy at the global level is vital for rational drug use. Consumer organizations operating in the global arena lobby for rational medicines policies within the formulation of world health policies. They monitor the adoption and implementation of international agreements. Such groups also publicize inappropriate or harmful activities carried out by the pharmaceutical industry. The global advocacy movement also supports national organizations in their campaigns for structural change and rational drug use.

The Internet

The Internet is a very important source of information on health and medicines for people who can access it. It also serves as a tool for advocacy and networking. However, its lack of borders and regulation also makes it a popular way to promote drugs on industry-sponsored web sites and sites containing material on specific health conditions. WHO has published guidelines to help consumers (and health workers) find reliable information on the Internet (WHO, 1999).

Table 1 overleaf gives an overview of the main factors influencing drug use by consumers, according to their level of influence. You can add factors to this list based on local discussions and your own analysis of what influences consumers’ drug use in your own country.

References

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Hardon A, Le Grand A (1993). Pharmaceuticals in communities. Practices, public health consequences and intervention strategies. Bulletin 330. Amsterdam, Royal Tropical Institute.

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Table 1. Main factors influencing drug use by consumers

LEVEL OF INFLUENCE

FACTORS

Household

• Perceived need for drugs
• Ideas about efficacy and safety
• Uncertainty resulting in poly-pharmacy
• Division of drug consumption roles
• Cost of medicines
• Literacy levels
• The power of medicines

Community

• Drug use culture
• Drug supply system
• Information channels

Health institution

• Extent to which health workers are consulted
• Quality of health worker prescribing
• Quality of the consultation
• Quality dispensing
• Regular supply
• Cost of medicines

National

• Implementation of essential drugs policy
• Drug promotion
• Financing and reimbursement
• Consumer advocacy
• The media
• Public education

International

• Health consequences of global trade agreements
• Donor support for essential drugs programmes
• Global consumer advocacy
• The Internet

References continued

Le Grand A, Sringernyuang L (1989). Herbal drugs in primary health care. Amsterdam, Royal Tropical Institute.

MSF (2003). Doha derailed: a progress report on TRIPS and access to medicines. Médecins Sans Frontières Briefing for the 5th World Trade Organization Ministerial Conference, Cancún 2003.

Mintzes B (1998). Blurring the boundaries. New trends in drug promotion. Amsterdam, Health Action International Europe.

Mintzes B (2002). Women and drug promotion: the essence of womanhood is now in tablet form. WHO Essential Drugs Monitor, 2002, 31:2.

Nyazema NZ (1984). Towards better patient drug compliance and comprehension: a challenge to the medical and pharmaceutical services in Zimbabwe. Social Science and Medicine 18(7):551-4.

Rasmussen ZA et al. (1996). Enhancing appropriate medicine use in the Karakoram Mountains. Community drug use studies. Amsterdam, Het Spinhuis.

Sanz E (2003). Concordance and children´s use of medicines. British Medical Journal 327: 858-60.

Senah KA (1997). The popularity of medicines in a rural Ghanaian community. Community drug use studies. Amsterdam, Het Spinhuis.

Townsend A, Hunt K, Wyke S (2003). Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use. British Medical Journal 327:837-840.

Trap B, Hansen EH, Hogerzeil HV (2002). Prescription habits of dispensing and non-dispensing doctors in Zimbabwe. Health Policy and Planning 17(3):288-95.

van der Geest S (1998). Use and misuse of pharmaceuticals: anthropological comments. In: Streefland P, ed. Problems and potentials in international health: transdisciplinary perspectives. pp. 195-221. Amsterdam, Het Spinhuis.

van Trigt AM (1995). Making news about medicines [Ph.D thesis]. University of Groningen, Enschede, Febo.

Ugalde A et al. (1986). Do patients understand their physicians? Prescription compliance in a rural area of the Dominican Republic. Health Policy and Planning 1(3):250-259.

Watson R (1995). A participatory evaluation of the implementation of the WHO ethical criteria for medicinal drug promotion in multiple countries: Australian results. Melbourne, La Trobe University.

WHO (1988). WHO ethical criteria for medicinal drug promotion. Geneva, World Health Organization.

WHO (1998). WHO ethical criteria for medicinal drug promotion: a strategy for review and assessment of effectiveness. Geneva, World Health Organization. WHO/DAP/1998. (Draft document).

WHO (1999). Guidelines for drug donations. 2nd ed. Geneva, World Health Organization. WHO/EDM/PAR/99.4.

WHO (1999). Medical products and the Internet. Geneva, World Health Organization. WHO/ EDM/QSM/99.4.

WHO (2000). Progress in essential drugs and medicine policy, 1998-1999. Geneva, World Health Organization. WHO/EDM/2000.2.

WHO and HAI (2003). Medicine prices: a new approach to measurement. Geneva, World Health Organization and Health Action International. WHO/EDM/PAR/2003.2.

 

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