DENNIS ROSS-DEGNAN

D. Ross-Degnan

FIVE hundred leading researchers and policy-makers from the international health community will meet in Chiang Mai, Thailand, at the end of March 2004, to discuss and plan interventions to improve use of medicines in resource-poor settings (see Monitor 32). The Second International Conference on Improving Use of Medicines (ICIUM 2004) comes seven years after the first, which produced the first state of the art consensus on interventions to improve drug use in non-industrialised countries. It also defined evidence-based recommendations for programme implementation and a global research agenda to fill gaps in knowledge. This research agenda was conceptualised as a five-year plan. Based on that plan, the partner organizations have supported 31 interventions and policy analyses under the auspices of the Joint Research Initiative on Improving Use of Medicines. These studies will form a core of presentations at ICIUM 2004.

Since 1997, the area of essential medicines has advanced considerably, but has also encountered several difficult new challenges. Under pressure from international banks and facing spiralling health care costs, many governments have reconsidered the financial viability of centrally-organized, publicly-delivered health services, including the provision of affordable medicines. The period has been marked by various innovations in health reform, decentralisation, and a rapidly expanding private health sector. New financing schemes to support access to essential medicines have been explored in many settings. At the same time, spurred on by the development of new global initiatives to address the catastrophic epidemics of HIV, TB and malaria, the issues of access to and appropriate use of antimicrobials have taken on new prominence in global public health thinking. An increased global flow of antimicrobials brings with it, however, the twin threats of growing rates of antimicrobial resistance and rising prices for alternative antimicrobials to treat resistant infection. In developing countries, where resources are often scarce, these mounting threats can be daunting.

Building consensus

ICIUM 2004 aims to build an up-to-date international consensus on strategies for implementing effective and innovative interventions for improving medicine use; and to define a new global research agenda relevant to current conditions and unfolding developments in international health. Conference products will include:

• a review of previous and current initiatives to improve medicine use, producing materials to be disseminated widely through electronic media and print publication;

• an expert consensus on which interventions are successful in various settings and strategies for implementation;

• a defined, prioritised global research agenda within each of the Conference topic areas to fill gaps in knowledge of what works and barriers to improvement;

• a strategy for implementing this research agenda and disseminating its findings.

The Conference will concentrate on six major focal areas, each of which will be discussed during half-day sessions (see Figure 1). In addition, there will be opening and closing half-day sessions to introduce the major themes of the Conference and to summarise the discussions within the six focus areas respectively.

A one-hour plenary session will open each half-day focal area. In each plenary, two or three speakers will present on key issues of medicines use, relevant to the half-day focus area. Guest speakers include leaders within WHO, international academic institutions, and ministries of health. For example, one key plenary session will focus on the perspectives of country health ministers on use of medicines issues.

ICIUM 2004 will allow for "meetings within a meeting" of groups of researchers and policy-makers who share common interests in specific topics in the use of medicines. These groups, referred to as topic tracks, are organized around an illness (malaria, HIV/AIDS, tuberculosis), a population group (children, adults with chronic illness), and/or a policy area (antimicrobial resistance, access to essential medicines).

After the plenary presentations, participants will break into topic-specific groups. Each breakout session will last for two hours. The first hour will generally consist of four or five brief oral presentations (accepted or invited abstracts) or an alternative presentation (for example, a roundtable discussion) to develop the issues to be covered in the session. During the second hour of each session, Conference rapporteurs working with track coordinators will summarise discussions in the session according to a defined set of criteria (key lessons learned, recommendations for action, research needs). These topic-specific summaries will be fed systematically into an overall conference summary.

Archive of presentations

ICIUM 2004 will have three major outputs: an archive of state of the art research; consensus recommendations for programme implementation and research; and a summary conference report and journal publication.

One innovation of the 1997 International Conference on Improving Use of Medicines was the creation of a permanent archive of all conference presentations. Participants were requested to prepare all presentations (including oral presentations) as posters using a standardised size and format, and these presentations were scanned and captured in electronic form. This archive, widely used for teaching and research, is available on the WHO web site (http://www.who.int/medicines/organization/par/icium/icium.shtml) and is distributed in teaching courses of the International Network for Rational Use of Drugs.

ICIUM 2004 will again capture all Conference presentations in electronic form. Presentations that are submitted prior to the Conference will be burned on CDs and distributed to all participants so that they can have them as a permanent record.

Figure 1
Structure of ICIUM 2004

Recommendations and research agenda

The first ICIUM Conference was most successful in developing a coherent summary of the state of the art and an agenda for post-conference research. ICIUM 2004 will duplicate this successful process using a structured web-based reporting system. A rapporteur will sum-marise each session using a structured reporting format. In the final session of the conference, a broad summary of lessons, recommendations, and key questions will be given. The edited collection of the daily summaries will form the basis for the overall conference recommendations and global research agenda.

Following the 1997 ICIUM conference, WHO prepared a special issue of the Monitor focusing on improving use of medicines, available at: http://www.who.int/medicines/library/monitor/edm_23_e.pdf

Following ICIUM 2004, WHO will again prepare special coverage in the Monitor. To extend thinking about improving use of medicines beyond the traditional audience, ICIUM 2004 will also seek to publish its key presentations, recommendations, and research agenda more widely in scientific journals.