The reorganization, further development and strengthening of the national pharmaceutical system in Malawi is part of a large World Bank programme of assistance to the social sector. To implement the pharmaceutical component, the Malawi Essential Drugs Programme (MEDP) was established in 1988 as an integral part of the activities of the Ministry of Health Pharmaceutical Services Department, with WHO as the executing agency. Funding support was also provided by the Netherlands Government.
A most important part of the activities to be implemented under the MEDP is human resource development, both of pharmaceutical and clinical personnel. The focus of activities for the latter is aimed at improving therapeutic skills and drug utilisation practices.
The production of up-to-date reference materials, relevant to the Malawi situation, was recognised as a key requirement in the training, both formal and in-service, of these cadres. Of these reference materials, a set of therapeutic guidelines or standard treatment guidelines was regarded as being of prime importance.
Although several excellent therapeutics/prescribing reference materials are available from other countries, e.g. British National Formulary (BNF), Essential Drugs List for Zimbabwe (EDLIZ), the development of a national guide for a particular country has many distinct advantages:
• treatments in the guide refer only to drugs on the national essential drugs list (in our case, the Malawi Standard Drug List). This may not include many of the drugs available in developed countries but may include others, such as those for treatment of tropical conditions;
• therapies can be tailored to suit local experience, practices and requirements. For example, in Malawi:
- the recommended route for administration of rabies vaccination is intradermal (i/d) because of the significant savings possible compared with intramuscular administration (i/m). In the USA the i/m route is still recommended.
- due to the high level of malarial resistance to chloroquine and the high cost of other alternatives, oral sulfadoxine/pyrimethamine combination (SP) is now the recommended first line treatment for uncomplicated malaria. It is made freely available from all drug outlets without prescription. In most other countries, this drug is only available on prescription;
• it may be possible to ensure the availability of the locally produced guide to all prescribers at low unit cost, compared with the costs of procuring texts from abroad;
• by involving local prescribers, pharmacists and health administrators in the production of the guide, a high level of consensus may be reached. The guide thereby acquires local credibility and authority and prescribers are much more likely to accept it and be committed to using it;
• applicability to the local health situation can be ensured by only including information relevant to national morbidity patterns and treatment practices;
• local production of the guide permits the establishment of systematic review and updating procedures.