Several drug use studies with these and other indicators have been performed in different countries. Some of the initial surveys only studied a small number of facilities with a limited number of indicators. The results of most of the earlier studies are summarized in Annex 3.
By examining these data it is possible to get an impression of the range of experiences in different countries. Excluding two countries with high figures, the average number of drugs ranges from 1.3 to 2.2. The Yemen study attempted to estimate the “correct” value for that country on the basis of morbidity patterns and therapeutic guidelines. The figure for average number of drugs was 1.4. For antibiotics, apart from two values, all are between 29% and 43%. The Yemen study suggested a theoretical need of 22.7%.
What is striking about injectables is the considerable variation between countries from 0.2% to 48%. The indicator for percentage injections decreased in the Nigeria and Indonesia field tests when data were collected prospectively rather than retrospectively. This may indicate that health workers know that they should not give as many injections as they do. For Yemen the ideal figure was estimated to be 17.2%.
The figures for percentage of drugs prescribed by generic name are encouraging, in that they show that it is possible to reach high levels of generic prescribing. Levels as high as 82% or 94% offer hope to countries with lower levels. In most countries, consultation times range between 2.3 and 3.5 minutes, which is a short time to provide an adequate clinical interaction. Drug availability varies between countries, but in all studies, significant stock-outs existed.
Two studies have tried to quantify the effect of interventions. In Yemen three indicators were used for a comparison between a project area and a control area in which no activities had taken place. The number of drugs per encounter in the project area was 1.5 (compared to 2.4); the percentage of antibiotics 46% rather than 67%, and the number of injections 22% rather than 45%4. In Uganda the impact of training on drug use patterns was quantified. The study showed a decline in the use of injections (50.1% to 41.3%), an improvement in ORS use in diarrhoea (52.4% to 89.1%) and a reduction in antidiarrhoeal drug use (60.4% to 38.5%)5.
By comparing indicator values with results from other countries and to previous local studies it is possible to measure the impact of an intervention, and better identify areas of concern on which further action should be concentrated.