Drug Supply by Ration Kits. Report of an Evaluation
(1991; 96 pages)

A number of developing countries have adopted a national drug policy with the objective of improving the availability and rational use of drugs. Nevertheless, to make sufficient quantities of essential drugs available to the population remains a problem in many countries, because the supply chain from the centre to the periphery contains many weak links. Poor planning, inadequate funds, insufficient transport, lack of supply management, and interception by hospitals of drugs intended for peripheral health facilities are only some of the many problems that may jeopardize, a reliable drug distribution system. Consequently, in rural areas in the Third World, and even in countries with an established national drug policy, shortages of essential drugs are the rule rather than the exception. In a WHO report on the world drug situation it was estimated that between 25 and 40% of the world population (between 1500 and 2300 million people) have insufficient access (physical and/or economic) to even the most basic essential drugs. Moreover, misuse of those drugs that are available cannot be prevented by an essential drugs policy alone, since essential drugs are also frequently used irrationally and inappropriately.

One way in which it has been tried to improve the drug supply to rural facilities has been to pack the drugs in sealed ration kits. In itself this principle is not new; army operations and emergency relief organisations have used drug kits for a long time. It is however relatively new to calculate the contents in such a way as to match regular needs of the receiving institution. Facilities are then no longer receiving drugs according to their demands, but strictly according to their estimated workload. The objective of this system is to supply as exactly as possible those drugs that are needed in appropriate quantities, thus avoiding both shortages and waste. A second objective is to promote a more rational prescribing of drugs by means of a "forced selection of essential drugs, in quantities that would prevent over-prescribing...

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