Producing National Drug and Therapeutic Information - The Malawi Approach to Developing Standard Treatment Guidelines
(1994; 49 pages) View the PDF document
Table of Contents
View the documentAcknowledgements
Open this folder and view contentsIntroduction
Open this folder and view contentsMSTG 1 (First edition)
Close this folderMSTG 2 (Second edition)
View the documentReview of MSTG 1 and development of MSTG 2
View the documentEditing and preparation for printing
View the documentPrinting
View the documentDistribution
Open this folder and view contentsIntroducing the new edition
View the documentFeedback
View the documentUse in drug utilisation and prescription monitoring
Open this folder and view contentsFuture plans
Open this folder and view contentsAppendices


Joint distribution of the MSTG 2 together with the Malawi Presciber’s Companion (MPC) began as soon as the first batch of copies of each became available. The MPC, which had been several years in development, covered health centre and patient management, including history taking, diagnosis and summaries of treatment. It was thus, as intended, a natural companion volume for the MSTG 2. Simultaneous introduction of both volumes was intended to enhance this link.

Tip #14:

A good layout for the text and an attractive presentation of the publication facilitates use and enhances acceptability

Factors to be considered include:

• the size of the publication, which should be related to its intended use, i.e. as a pocket guide or desk-top reference;

• the type and size of the fonts used, both for the body (main) text and for chapter and section headings;

• the use of text enhancement features such as bullets, boxes, shading, underlines, bold and upper case (capital) letters to highlight certain words, sentences or blocks of text;

• the inclusion of a comprehensive table of contents and index, and the use of extensive cross-referencing and headers or footers showing section or chapter names, to facilitate the location of information on particular topics;

• the use of tables, graphs or drawings/photographs, etc. to summarise information or illustrate certain points in the text;

• careful design of the cover to give a good appearance to the publication. In this respect the use of colours, special types of font and a suitable cover illustration should be considered along with the type of cover material to be used.

If time permits and particularly where criticism has been received on the appearance, ease of use, etc. of a first (or previous) edition, it would be worthwhile carrying out pilot (field) testing of alternative layouts and presentations of the publication to determine which is the most acceptable to the intended target group.

The target audience for both publications was basically the same as that for MSTG 1, with the major exception that now, being prescribers in their own right, all nurses were to receive a personal copy of each publication. Previously, although nurses had been prescribing for many years, particularly at peripheral health centres during periods of absence of medical assistants, they did not have any official status or responsibilities as prescribers. However as a result of developments in the MEDP prescriber training programme, nurses were officially accepted as prescribers and were thus now included in the target audience. This, together with the overall increase in the number of relevant health professionals since MSTG 1 was produced in 1990 and a significant increase in the number of those undergoing training (including medical students at the newly established College of Medicine), necessitated the increase in copies required from the previous 5,000 to 9,000. As it turned out, even this was to prove inadequate (see below and Tip #7).

Distribution channels were similar to those used for MSTG 1 (see earlier) with Central Medical Stores taking an active role in distributing the bulk of copies to regions for onward distribution. The system generally worked efficiently, but took longer than expected due to intermittent problems with availability of spare transport capacity to carry the relatively large loads (weight and volume) of the two publications.

As with MSTG 1, a covering letter was sent out to the main distribution centres with:

• a summary of the development of, and the improvements in, the new edition of the MSTG;

• a description of the development, aims and uses (in conjunction with the MSTG) of the MPC;

• the distribution arrangements, including details of the numbers of copies and target audience involved;

• a contact address for return of excess copies or requests for additional copies;

• a reminder that the documents would be used as resource materials in the forthcoming prescriber training activities, which would be assisted and funded by the MEDP.

Articles about the new edition of the MSTG and MPC appeared in the Malawi Drug Bulletin with requests for prescribers to contact MEDP if they had not received copies by the end of October.

Unlike MSTG 1, some active follow-up of distribution was carried out in the form of telephone contact with major institutions and distribution centres. The prescriber training team checked whether individual prescribers had received copies. A questionnaire was sent out in February 1994 to all District Health Officers and hospital superintendents. Information was sought regarding the status of distribution of the MSTG 2 (and MPC) and whether additional copies were required. Over 60% response to the questionnaire was obtained and most districts and hospitals had received and distributed their allocated copies of the documents.

However, soon after the planned distribution had been completed, telephoned and written communication from several institutions and individuals, and anecdotal evidence collected during field visits by the MEDP prescriber training team, indicated that, in some cases, either insufficient or no copies of the documents had been received. Investigations revealed that:

• distribution had sometimes not been carried out as recommended. In some cases distribution had not been started (with copies still awaiting forwarding from distribution centres such as regional health offices or district hospitals), in others it had not been completed, and in a few cases distribution had gone beyond the recommended target audience.

• figures for copies required for the large (central) hospitals had been significantly underestimated by the hospital administration(s).

• there had been a large increase in the planned intake of most health training institutions since the estimates were prepared. As this version of the MSTG was planned to cover student intakes up to and including 1995, the total requirements for health training institutions had to be revised.

It thus became necessary to arrange for a further 3,000 copies to be printed to ensure that all persons requiring copies would receive them while still leaving a healthy contingency amount (approximately 10% of the total) available in case of further unexpected demand. This was arranged with the same printer who produced the copies at cost of USD 1.59. This represented a 10% increase in the cost per copy mainly due to the increased cost of the print materials required. Printing of these additional copies commenced in late November 1993 and was completed by mid-January 1994.

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