UNHCR Drug Management Manual, 2006. Policies, Guidelines, UNHCR List of Essential Drugs
(2006; 228 pages)

Abstract

Drug ordering from countries in which UNHCR works is not always appropriate or efficient. There are many examples of poor prescribing practices, purchase of drugs of dubious quality, orders unrelated to actual needs, poor drug storage and distribution, and irrational drug prescribing. In addition, local purchase may not be indicated, and there is limited data on stock ruptures, wastage, and other supply management elements. Centrally, UNHCR has developed an Essential Drugs List (EDL) to meet the immediate minimum drug needs for a basic refugee health care system. With an annual expenditure of more than $2 million US, there is an urgent need to address essential drugs management in UNHCR. This has led to an updating of the UNHCR EDL and to this manual. The 2006 UNHCR EDL is based on the 2005 WHO Model List of Essential Medicines and will be updated every 2 years as is the WHO list. This manual is a revision of the UNHCR Essential Drugs Manual (1989) and is the result of literature research, field visits, participation at conferences, and correspondence with experts. The manual is for the use of UNHCR’s health partners, and for UNHCR health programme officers who supervise drug procurement in the field. It is meant to be a practical tool for field staff of UNHCR and partners with the aim of improving drug management in all parts of the drug management cycle.

Given that drug management is not a new concept, this manual is not meant to introduce new ideas. It is, rather, a compilation of best practices based on references from other sources. The majority of materials are taken from: the second edition of Managing Drug Supply (MSH in collaboration with WHO), Guidelines for the Storage of Essential Medicines and Other Health Commodities (John Snow, Inc./DELIVER in collaboration with WHO) and various WHO publications. A complete list of references is given at the end of each chapter.

The manual consists of:

  1. Guidelines that explain drug management concepts and their rationale, and
  2. Standard Operational Procedures (SOPs) that are action-oriented and guide users step-by-step through certain drug management questions such as consumption-based quantification.

The essential drugs policy should be a standard document available for all staff of UNHCR and partners. It indicates minimum standards in drug management and the institutional commitment of UNHCR. The chapter on drug selection aims to assist senior staff of UNHCR and health partners with the selection of the most cost-effective medicines relevant to the local situation. The development and use of an essential drugs list and treatment guidelines are hereby emphasized.

The drug procurement chapter seeks to provide insights into best practices in drug procurement by UNHCR and by partners. Although classic procurement principles apply, issues that make drug procurement different from procurement of other commodities are listed in the 12 drug procurement principles. Obtaining medicines of good quality at an affordable price in a timely fashion is the key objective of drug procurement. General UNHCR procurement regulations also apply to drugs and medical supplies and hence need to be used in conjunction with these specific drug procurement guidelines.

The drug distribution chapter includes a section on medical store management which is probably the most practical and straight-forward chapter and can be used to train storekeepers with various educational backgrounds in a variety of settings. The chapter regarding rational drug use aims to introduce concepts of investigating and improving drug use rather than providing a comprehensive "how to" manual.

The chapter on quality assurance applies to the whole drug management cycle as drug quality assurance is a cross-cutting issue, which applies not only to procurement (Obtaining good quality drugs), but also to distribution (Verifying and maintaining quality of drugs) and use (Monitoring drug quality). Everyone can contribute to drug quality assurance, regardless of one’s job description or situation. The quality assurance chapter is the most technical chapter with specific details outlined in the corresponding Standard Operational Procedures at the end of the manual...

 
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