The problems and potential solutions related to rational drug use are complex. The government should therefore take a leadership role in developing a clear policy on how to promote rational drug use. This policy should lead to a comprehensive national programme to promote rational drug use by health workers and consumers, covering both public and private sectors. Its implementation should be part of the national master plan. The high economic cost of irrational drug use justifies a large investment in budgetary and human resources.
Investigating the problems before interventions are planned
Before any strategies are developed it is essential to identify, measure and understand the problems. There are a variety of tools and methods available which can help in this. The WHO manual How to investigate drug use in health facilities59 presents a useful and simple screening method for identifying and measuring the quality of prescribing and dispensing. This standardized method has been used in over 40 countries and allows for a comparison between countries and regions, and for monitoring the effect of interventions.
Other methods may use aggregated information, combining drug procurement and morbidity data. Investigating practices at retail drug outlets can provide valuable information about private sector practices and consumer behaviour. Standardized methods for studying drug use in the community are also available.60 Qualitative research methods can then be used to help understand why a problem exists and how it might best be changed. Investigating the nature, scale and cause of a problem is vital because it helps in the choice and design of strategies.
WHO and the International Network for the Rational Use of Drugs (INRUD) organize international training courses on promoting rational drug use, which focus on methods of studying and selecting strategies to improve drug use. The course module can be used and adapted to national needs. A new (2000) WHO international training course specifically focused on public education is also available. The course covers how to study drug use in the community, prioritize problems and select effective channels of intervention.
Combining approaches to achieve maximum impact
It is recommended that a combination of educational, managerial and regulatory strategies is used. The activities should be planned in such a way that they act to reinforce one another. Rules and regulations may exist, but they may have little impact if the target groups are not educated and informed and if management and supervision systems are not in place. Complementary measures and a combination of strategies that work should be identified for different target groups.
Evaluation and selection of approaches
Careful monitoring and evaluation are needed for policy-makers to determine which approaches and strategies work best, or whether strategies may have to be changed. Standardized indicators are available for this purpose. It is also important to recognize that negative outcomes provide useful information as well.