Most leading causes of death and disability in developing countries can be prevented, treated, or at least alleviated with cost-effective essential medicines. Despite this fact, hundreds of millions of people do not have regular access to essential medicines. Many of those who do have access are given the wrong treatment, receive too little medicine for their illness, or do not use the medicine correctly.
MDS-3 addresses practical ways in which government policy makers, essential medicines program managers, nongovernmental organizations (NGOs), donors, and others can work to ensure that high-quality essential medicines are available, affordable, and used rationally. Medicines are of particular importance because they can save lives and improve health, and they promote trust and participation in health services. They are costly, and special concerns make medicines different from other consumer products. Moreover, substantive improvements in the supply and use of pharmaceuticals are possible.
Within a decade after the first modern pharmaceuticals became available, efforts began to ensure their widespread availability. From the mid-1950s to the mid-1970s, basic pharmaceutical management concepts began to evolve in countries as diverse as Cuba, Norway, Papua New Guinea, Peru, and Sri Lanka. In 1975, the World Health Organization (WHO) defined essential medicines as those medicines that meet the health needs of the majority of the population. In 1982, Management Sciences for Health published the first edition of Managing Drug Supply, which incorporated the essential medicines concept and has become known as the seminal guide to managing pharmaceuticals in developing countries. Over the last thirty years, countries have acquired considerable experience in managing pharmaceutical supply. Broad lessons that have emerged from this experience include the following -
- National medicine policy provides a sound foundation for managing pharmaceutical supply.
- Wise medicine selection underlies all other improvements.
- Effective management saves money and improves performance.
- Rational medicine use requires more than medicine information.
- Systematic assessment and monitoring are essential.
Although much has been achieved, challenges remain -
- Achieving financial sustainability through greater efficiency and financing mechanisms that increase availability while ensuring equity (financing options include public financing, health insurance, voluntary and other local financing, and donor financing)
- Improving efficiency in public pharmaceutical supply through strategies that build on public-sector strengths while incorporating greater flexibility and competitiveness
- Changing the behavior of providers, patients, and the public to promote effective, safe, and economical prescribing, dispensing, and patient use of medicines
- Reorienting the role of government to improve the availability, affordability, and rational use of medicines in the private sector, which supplies 60 to 90 percent of the medicines consumed in many developing countries
- Regulating safety, efficacy, and quality through adoption and enforcement of legislation and regulations that ensure that all medicines meet basic quality standards
MDS-3 is organized around the four basic functions of the pharmaceutical supply management framework -
These functions are supported by a core of management support systems -
- Planning and administration
- Organization and management
- Information management
- Human resources management
Effective pharmaceutical management rests on a policy and legal framework that establishes and supports the public commitment to essential medicines supply and is influenced by economic issues (Part I of this manual). Other major sections of the manual are devoted to each of the main functions of the pharmaceutical management framework (Part II) and management support (Part III).
This manual provides concepts and approaches that can produce measurable health improvements through greater access to and more rational use of medicines. Governments, private organizations, donors, and others who use this manual must provide the will and the resources to put these concepts and approaches into action.