In 1985, WHO defined rational use of medicines as requiring that "patients receive medications appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time, and at the lowest cost to them and their community" (11). Since then, the International Network for the Rational Use of Drugs (INRUD) has been formed and much work has been undertaken by WHO, INRUD and other organizations in order to develop and use indicators for monitoring medicine use and to initiate intervention studies to promote rational use.

The impact of these efforts is, however, not very well known. WHO is currently developing a database on the rational use of medicines, the main objective of which is to provide a general overview of existing drug use patterns in primary health care settings in developing countries over time, and to study the impact of different types of interventions on improving the use of medicines. This type of information is vital for developing a global multifaceted strategy for the promotion of rational use of medicines and for assisting regions and countries seeking to prioritize their own activities in this area.

Work has already started on identifying relevant published and unpublished studies from both INRUD and WHO sources, and entering the pertinent data (e.g. prescriber and facility type, disease pattern, methodology, outcome indicators) into the database. The data will be analysed by country and region, and over time (1990-2003), and then used to assess the impact of different kinds of interventions to promote the rational use of medicines. The database has been designed so as to be compatible with other WHO databases; this will allow future analysis of the impact of health systems and policies on the rational use of medicines.

At the time of the present meeting, 1160 articles from the INRUD bibliography covering the period 1997-2001 had been screened, and from these, 92 data records extracted and entered into the database. A preliminary analysis of the data will be presented at the International Conference on Improving Use of Medicines (ICIUM) in 2004 and is intended as an advocacy tool for promoting rational use of medicines in the developing world. Future work includes entering data for earlier years and a systematic analysis of the full data set. There are also plans to expand the scope of the database to include such information as hospital-based drug use, self-medication, patients' adherence to treatment and diagnostic accuracy. The database will be made available to interested researchers and policy makers through the Internet.