The review has also shown that some governments or regulatory agencies have sometimes applied the interagency guidelines, or their own, in a rather inflexible manner, for example by refusing to make exceptions to the minimum shelf-life when an exception would have been justified. Also, it has become clear that in some countries the process of customs clearance of donated drugs is unacceptably long, leading to unnecessary delays and loss of effective shelf-life.

The quality of supply management of donated drugs is likely to be linked to the quality of drug supply management in general. In this regard, WHO is giving technical assistance to a large number of developing countries. An extra effort could be made to specifically focus on the management of donations; and more specific technical advice on good donation practice could be included in the next version of the interagency guidelines (although the main principles are already present). WHO may need to give special attention to nongovernmental organizations' drug management practices.

It is not clear what can be done with central governments that do not request technical advice or management assistance, or that even actively discourage a rapid handling of drug donations intended for sections of their population with which they consider themselves at war (for example, Chechnya and Southern Sudan). In these cases the obstruction is probably political rather than technical, and is likely to continue with or without guidelines.