The figures and results reported below are based on replies to questions which were put only to recipients. All but the last were closed questions.

Improvement in donations meeting needs

Twenty-three of the 51 responding recipients (45%) reported that donations now better meet their needs, while only 2 out of 51 (4%) reported a deterioration. Eight out of 14 government organizations (57%) reported an improvement, followed by 10 out of 25 nongovernmental organizations (40%) and 5 out of 12 individual health care institutions/health workers/prescribers (42%).

Improvement in shelf-life

Twenty-two out of 51 recipients (43%) reported that the remaining shelf-life of donations had improved, and 3 out of 51 (6%) reported a deterioration. There were differences between recipient categories, with 8 out of 14 government organizations (57%), 11 out of 25 nongovernmental organizations (44%) and 3 out of 12 individual health care institutions or health workers (25%) reporting an improvement.

Improvement in packaging and labelling

Twenty-one out of 53 recipients (40%) reported that the packaging and labelling of donated drugs had improved, while 1 out of 53 (2%) reported a deterioration. There was a difference between recipient categories, with 8 out of 15 government organizations (53%), 9 out of 25 nongovernmental organizations (36%) and only 4 out of 13 individual health care institutions or health workers (31%) reporting an improvement.

Easier to refuse, return or destroy unwanted donations

Twenty-eight out of 53 recipients (53%) felt that the Guidelines had made it easier to refuse unwanted donations. Government organizations (62%) were slightly more in agreement than nongovernmental organizations (50%) and individual health care institutions/health workers/prescribers (50%).

Shorter distribution time

Three recipients reported an improvement in distribution time and a reduction in the period between drugs' reception, selection and distribution to final users.

Discussion

The questionnaires specifically inquired about the link between the introduction of the Guidelines and any change in donation practice. The replies therefore represent the respondents' perception of this link, but do not constitute a proof of causality.

In the open questions, about one-third of respondents reported non-specific benefits from the Guidelines. Approval of a practical and ethical framework for donations, improved communication and awareness, and the establishment of donation standards were most frequently quoted as benefits.

In closed questions, approximately 40% of recipients reported an improvement in particular aspects, such as donations meeting expressed needs, duration of shelf-life and packaging and labelling. However, significantly fewer individual health institutions and health workers reported an improvement compared with government and nongovernmental organizations. The different rating among recipients is interesting. It could be the result of a pipe-line effect (the time it takes for the "better donations" to reach the end-users, with older donations still being received by more peripheral recipients). It could also be related to better appreciation of the importance of the shelf-life issue by the national planners, compared with the end-users.