INEFFICIENT and irrational use of drugs is a widespread problem at all levels of health care. Inefficiencies and irrational use tend to be greatest in hospitals, which is particularly worrying as resources are scarce and prescribers in communities often copy hospital prescibers. Use of medicines could be greatly improved and wastage reduced if some simple principles of drug management and use were followed. However, it is difficult to implement these principles because staff from many different disciplines are involved, and there is often no forum for them to work together in developing and implementing appropriate drug policies.

A drug and therapeutics committee (DTC) provides a forum to bring together all the relevant people to work together to provide better health care delivery. In many developed countries, a well functioning DTC has been shown to be very effective in hospitals at addressing drug use problems. However, in many countries DTCs do not exist and in others they do not function effectively. Often DTCs are not functional due to lack of local expertise or a lack of incentives.

WHO is publishing Drug and Therapeutics Committees: a practical guide. This manual aims to provide practical guidance to doctors, pharmacists, hospital managers and other professionals who may be serving on DTCs and/or who are concerned with how to improve the quality and cost efficiency of therapeutic care. The manual covers:

• roles and responsibilities of a DTC

• structure and functions of a DTC

• managing the formulary process

• assessing new drugs for the formulary

• ensuring drug safety and quality

• tools to investigate drug use including aggregate methods and prescription audit

• strategies to promote the rational use of drugs

• use of antimicrobials and injections

• how to get a DTC started or to function better.

The guidance provided in this manual is aimed at all kinds of DTC - whether in public or private hospitals and at all levels - from district level to tertiary referral level. Since health systems in countries vary widely, not all the information included in this manual will be relevant for all DTCs. However, the materials are arranged so that readers should easily find the information relevant to their circumstances.

This manual has been produced by the Department of Essential Drugs and Medicines Policy, WHO Geneva, in collaboration with the USAID-funded Rational Pharmaceutical Management Plus Program of Management Sciences for Health, Boston, USA. The manual was developed in conjunction with the development of a new international training course on drug and therapeutics committees and also building on experiences gained from pilot projects conducted in Zimbabwe and Indonesia.

Copies are available from the Department of Essential Drugs and Medicines Policy, WHO, 1211 Geneva 27, Switzerland.

WHO would be very happy to receive comments which may be sent to edmdoccentre@who.int