Three reasons can be given to explain why drugs need to be managed properly. Firstly, drugs are part of the link between the patient and health services. Consequently, their availability or absence will contribute to the positive or negative impact on health. Secondly, poor drug management, particularly in the public sector of developing countries, is a critical issue, but major improvements are possible that can save money and improve access. Finally, drugs are no longer the responsibility of health workers only. Political, economic, financial and traditional considerations have become so crucial in health care that it has become imperative to look at drugs and health care from these perspectives.
All of these factors contribute to appropriate financial expenditure, avoid wastage, increase access and ensure that drugs are properly used. As is inherent within the Bamako Initiative, proper drug management may also be a source of revenue, which can be used to cater for other health care needs and in particular for disadvantaged populations.
Diagram 1 Drug Management Cycle
Source: Managing Drug Supply. MSH/WHO, Kumanian 1997.
The selection of drugs for use at health centres is usually determined at the national level by the Ministry of Health and is based on a number of factors. After determination of the quantities required, based on price, delivery conditions and quality, the selected drugs go through a procurement process. After storage and distribution, the use of the drugs requires prescribing, packaging, dispensing and counselling. These tasks require qualified health workers or other relevant personnel with appropriate skills and attitudes. Management support tools are important for the acquisition of relevant skills in drug management.