Monitoring and evaluation of the national pharmaceutical situation has not always been a regular activity of ministries of health in Africa. To promote a culture of monitoring, WHO is building capacity in health ministries and with relevant stakeholders, such as WHO country staff and NGOs. The WHO Operational Package for Monitoring and Assessing Country Pharmaceutical Situations contains Level I and Level II indicators, and over the last year it has been used to evaluate the pharmaceutical situation in 11 African countries.
Level I indicators are collected using a short questionnaire, and are used to assess existing structures and processes in a national pharmaceutical system, including implementation of the components of national medicines policies. Level II indicators focus on outcomes at facility and household levels, and although they rely on field surveys they can be collected without extensive human or financial resources. Focused surveys are conducted at five central/district medicines warehouses, 30 public health facilities, 30 private pharmacies/drug outlets, and 900 households spread across five districts/regions per country. Level II indicators focus on access, quality and rational use of medicines. At the household level, information is also collected on patients’ care-seeking behaviour and barriers to accessibility of medicines.
Preliminary reports are being finalized in the countries where the Operational Package has been implemented, and in the coming months national stakeholder workshops will be held to analyse and discuss the data and plan interventions that will help strengthen national capacity and improve access to medicines. Preliminary results have already been used by the countries concerned to develop plans for specific interventions for 2003 and for 2004-2005. Plans centre on improving selection, availability and affordability of medicines, including those for HIV/AIDS, through advocacy, policy development and capacity building. By this exercise, WHO hopes to encourage countries to incorporate monitoring into their programmes, enabling evidence based planning, development and implementation of national medicines policies.
Mali, provides one example of a country already taking action, as the Level II survey there revealed that adherence to the national standard treatment protocol for non-bacterial diarrhoea in children was 0.5%, even though 70% of facilities had a copy of the standard treatment guidelines available. Only 47% of children with nonbacterial diarrhoea were given ORS, while 78% received an antibiotic and 68% were given other medicines. Mali has identified rational selection of medicines and training of prescribers and dispensers as priority areas for interventions. Training courses on rational selection and use of medicines are part of WHO’s work to build capacity in these areas, and this year WHO has helped to organize courses in Kigali (held in June) and Algiers (being held in September), with representatives from Mali participating in both.
Figure 1. Country survey results on adequacy of labelling and patient knowledge of prescribed medicines
Figure I shows data obtained from exit interviews with patients dispensed medicines at public health facilities in four countries. Based on the results, these countries have identified the need to train pharmaceutical supply managers and dispensers at health facilities. This training will focus on improving labelling practices and information for patients, to ensure that patients know the correct dosage and the duration of their treatment, and that this information is written on the label of all dispensed medicines.