Once again the urgent need to improve the quality of drug donations worldwide has been underlined, this time by participants at a European Expert Seminar on Appropriate Drug Donations in Leiden, the Netherlands, in June 1999. Representatives from 60 organizations in 16 countries met to share experience and to discuss effective strategies for awareness raising and for promoting good donation practice.

Participants heard that, despite the efforts made by health ministries in recipient countries, WHO and other international governmental and nongovernmental agencies in the field to promote good donation practices, reports indicate that large quantities of donated medicines are unusable and wasted. About 30% of drugs are donated directly by countries, and not coordinated through programmes by international agencies. In Albania, for example, only an estimated 20% of the donated medicines have been channelled through appropriate coordination structures. Tons of medicines to treat cholera and acute diarrhoea are stockpiled, while medicines for non communicable and chronic diseases are in great need.

A familiar pattern...

This same situation was repeated in October 1998, in Central America after Hurricane Mitch, one of the worst natural disasters in history. In Honduras alone, more than 1.5 million people were affected. The health infrastructure was devastated -23 of the 30 hospitals had their water distribution system either partially or completely destroyed; 123 health clinics suffered serious damage and 68 were destroyed. According to a representative from the Pan-American Health Organization (PAHO), there was a massive response from the international community.

“In Honduras, we found that despite the good intentions of many charitable organizations, inappropriate donations were received. For example, drug information was in unknown languages; many donations had expired or were about to expire; and some did not correspond to the country’s disease patterns” the PAHO representative reported. As a result, she told participants, drugs and medical equipment are being stored in a temporary warehouse, and valuable time that could be spent more effectively elsewhere has to be given to sorting the donations.

The recent events in the Balkans and Central America highlight the need for implementation of the WHO interagency guidelines, according to conference organizers. Developed three years ago, they were revised in March 1999.

“Drug donations in emergency situations are essential, but they can cause as much harm as they can do good”, according to Mark Raijmakers of WEMOS, a Dutch-based NGO concerned with international health issues. “With the Kosovo crisis, we have the opportunity to bring the problems to light and underscore the need for appropriate donations. We simply cannot risk repeating the mistakes that were made in the past”.

Among other issues discussed was how to overcome recipient countries’ fears that they will receive no more donations if they turn away inappropriate medicines. The seminar also highlighted that often it is not doctors but other medical staff, such as nurses, who deal with donated drugs and that training should take account of this. Disposal of inappropriate drugs in recipient countries is another major concern. As one participant pointed out, expired pharmaceuticals turn into chemical waste, with all of the associated costs and potential health threats to the area.

Awareness campaign...

The seminar organizers, WEMOS, DIFAM and PIMED (NGOs from the Netherlands, Germany and France respectively) used the occasion to launch a Europe-wide awareness campaign. This is designed to inform national governments and donors of the urgent need to implement the WHO Guidelines for Drug Donations. A new web site is available -http://www.drugdonations.org

For further information contact: Mark Raijmakers, Wemos Foundation, P.O. Box 1693, NL-1000 BR Amsterdam, the Netherlands. Tel: + 31 20 468 8388, fax: + 31 20 468 6008, e-mail: pharmaceuticals@wemos.nl

Still a lot of work to do - participants at the European Expert Seminar on Appropriate Drug Donations (Courtesy of the Wemos Foundation. © Fotoflex Nederland)

Two videos promote good donation practice

As part of the increasing efforts to improve drug donations, an educational video has been released. Making drug donations better with care presents the interagency guidelines for drug donations, paying special attention to alternatives for the donation of medicines that have been unused or returned to pharmacies or hospitals. The 15-minute video is especially targeted at small-scale aid organizations that want to know more about good donation practices.

Making drug donations better with care, developed by the Dutch Wemos Foundation, is part of the awareness-raising campaign of the Committee on Drug Donations in the Netherlands, which Wemos coordinates. Dutch and English language versions of the video are available, and a Spanish translation is in preparation. Parts of the video will be shown on the following web site: www.drugdonations.org

Drug donations also feature in another new video, Partners in healing, produced by the Pharmaceutical Programme of the World Council of Churches and Community Initiatives Support Services International. However, this video drama also covers other issues connected with drug management and supply, such as the need for staff training, the value of hospital pharmacotherapeutic committees and the advantages of revolving drug funds. Filmed at a hospital in Nairobi, Partners in healing is a training tool which aims to promote discussion, particularly among those concerned with pharmaceutical management at hospital level. Teaching notes for use with the 50-minute video are in preparation.

Partners in healing is available from: Community Initiatives Support Services International, PO Box 73860, Nairobi, Kenya. Tel: + 254 2 445020, fax: + 254 2 440306. Price: Sw.fr. 10 (a concessionary rate may be available on application).

Making drug donations better with care is available from: Wemos Foundation, P.O. Box 1693, NL-1000 BR Amsterdam, the Netherlands. Tel: + 31 20 468 8388, fax: + 31 20 468 6008, e-mail: pharmaceuticals@wemos.nl Price: Euro 10 (approximately US$10), excluding mailing costs.

Promoting good donation practice in Kosovo

A WHO audit of humanitarian drug donations received in Albania during May 1999 revealed serious quality problems¹. It was estimated that 50% of the drugs coming into the country during the Kosovo refugee crisis were inappropriate or useless and would have to be destroyed.

The assessment of all donations received in May by the Albanian State Drug Distribution Authority revealed that 400,000 tablets and 1,200 large volume intravenous fluids were already expired upon receipt. Two million tablets, 85,000 vials for injection and 16,000 tubes of cream for external use will expire before the end of 1999. Fifty per cent of donation lists mentioned trade names only, many unknown to local health professionals. Only 28% of drug donations were packed in the large-quantity units recommended by international guidelines and 18% contained small packs of free samples or drugs returned to pharmacies. A few donations raised the suspicion that some pharmaceutical companies were using the humanitarian crisis to rid themselves of unwanted stockpiles, a practice known as “inventory purging”.

The Albanian health authorities relaxed import controls in April 1999. This was done to speed up the entry of urgently needed drugs and medical supplies for the 460,000 Kosovar refugees, and to meet the continuing needs of the rest of the Albanian population. Even before the refugee crisis, the Albanian health care system depended heavily on drug donations. The country could cover only 20% of the drug and medical supply needs of its hospitals. Efficient administrative procedures aimed at controlling the quality of incoming drug donations were in place. WHO's audit analysed donor compliance with national and international drug donation guidelines.

Clear advice for donors

As the preferred destination for drug donations now shifts to Kosovo itself, good coordination of drug donations from the outset will be crucial to avoid duplication, waste and the arrival of yet more unneeded and inappropriate drugs. Once again donors are urged to adhere strictly to the international guidelines for drug donations².

For further information contact: WHO Humanitarian Assistance Project Office, Commission for Humanitarian Aid, Ministry of Health, Boulevard Bajram Curri, Tirana, Albania. Tel: + 355 42 71 831 or + 355 42 72 522.

References

1. WHO. Press release 9915, EURO/15/99, 30 June 1999. Copenhagen: World Health Organization, Regional Office for Europe.

2. WHO. Guidelines for drug donations, 2nd ed. Geneva: World Health Organization: 1999.