Drugs in larger numbers (or bulk supplies) can be obtained from different sources. These include:
• government stores
• private pharmacies and wholesalers
• non-profit or low-cost international suppliers
• donors and supporters
• direct from drug companies
• local shops and markets.
When buying drugs, it is important to consider the following points:
Competitive price. You should compare prices of different reliable suppliers. It is important to remember that the cost of a drug is more than just the price you pay for the actual medicine. For example, there are 'hidden costs' such as transport, time, customs duty and taxes.
Good quality. Drugs should be of good quality and guaranteed to be effective and fit for use.
Continuous supply. Regular supplies of drugs are necessary, not just for long-term treatments such as TB, but also for a group's credibility, since people will not come if drugs are often unavailable. It is important to find suppliers who can guarantee regular supplies of frequently used drugs.
Delivery time. This can be anything from a few hours (if buying from a local pharmacy) to several months (if buying from overseas). If drugs are not delivered in time, it will make it much more difficult for a group to do its job, and some people's health may worsen as a result.
Long shelf life. When buying a large quantity of one drug, it is important to ensure that the drug will not expire before it is used. Always tell the supplier what shelf life you want - for example, two years. Make sure the supplier tells you the expiry date before you confirm the order. It is best never to buy drugs with a short shelf life, even in an emergency, because they may expire before they can all be used. The shelf life is the amount of time available before a drug expires.
When there are few funds available, donations of drugs and medical equipment can represent very important resources for HIV/AIDS-related treatment work, but only if they are carefully controlled and the donor clearly understands the needs of recipients. Practical experiences with donations often show that they can be inappropriate, costly and even dangerous if they are not managed properly.
When using donated drugs, it is important to think about some serious questions.
Are the drugs the ones you requested? Sometimes, drugs are sent without the donor asking first what is really needed. Recipients may have to be diplomatic and negotiate supplies of really helpful drugs instead of what the donor can get hold of or thinks might be useful.
Can further supplies be obtained? For example, if you have received a three-month supply of an antiretroviral drug, what will you do when it runs out? Interrupting treatment will increase the chances of drug resistance, which may reduce the benefits of further treatment with antiretroviral drugs.
How will the side-effects of the drugs be monitored? Most antiretroviral drugs cause side-effects that are unpleasant or even dangerous. Some of these need to be monitored with complicated tests, such as liver function tests. Many health facilities do not have the equipment or expertise to carry these out.
Which drug would be the most beneficial? If you have a choice about which drugs are donated, think about which would give your patients the greatest benefit. For example, you may think a supply of an antiretroviral drug would be the most beneficial, but there are problems with these drugs. So, you may find that a drug to treat infections (such as fluconazole) would be of greater value.
It is important to establish good two-way communication between the donor and the recipient. Recipients should let donors know what they need, and not be afraid to say 'no' if something inappropriate is offered or sent. Donors should listen carefully to what the intended recipients tell them and act accordingly.
The recipient should inform the donor about:
• which drugs and equipment they require;
• what alternatives would be acceptable if the exact drug or equipment is not available;
• what quantities are needed or how many people they are meant to help;
• what language would be most helpful on labels and instructions; and
• what, if anything, has been wrong with previous donations, and how they could be improved in the future.
The donor should bear in mind the following:
• Send drugs that are on the country's essential medicines list. If there is no national list, the WHO essential medicines list should be followed. • If specialist drugs, such as antiretrovirals, are sent, they should be sent only to people whose doctors are skilled in treating HIV/AIDS.
• The recipient must know in advance which drugs are being sent and in what quantity.
• The drugs should have at least one year of shelf life when they are received, since donations can take several months to arrive.
• Donations should be labelled in a language that the recipient understands.
• Equipment should come with instructions and information about spare parts.
Advantages and disadvantages of drug donations
Advantages of drug donations |
Disadvantages of drug donations |
• Donated drugs and equipment can provide access to treatment that would otherwise not be possible, either because of lack of funds or because the drugs are unavailable in a particular country.
• Donations can free up funds to be used in other ways - for example, to buy other drugs or equipment. |
• The donated drugs may not be required because you already have plenty in stock.
• The drugs are not on your essential medicines list, so you may not have enough information or experience to use them effectively and safely.
• The drugs you receive are out of date, or they only have a short shelf life and cannot be used before they expire.
• Donated equipment is often sent without instructions or spare parts.
• Donations can cause unwanted and unexpected costs to recipients, such as import duties, transport costs, disposal costs for unwanted items, and time and labour to separate useful items from the unwanted ones.
• The drugs may be labelled in a language you do not understand so you may not know what they are or how to use them. |
Participatory group activity
Aim
To identify the advantages and disadvantages of donations of HIV/AIDS-related drugs.
Instructions
1. Explain the aim of the activity.2. Divide participants into three groups.
3. Ask each group to identify the advantages and disadvantages of receiving a donation of different kinds of HIV/AIDS-related drugs. For example:
Group 1: donation of antiretrovirals
Group 2: donation of drugs labelled in a foreign language
Group 3: donation of drugs close to their expiry date.
4. Ask each group to develop a list of strategies that they could use to improve the donation in future.5. Bring everybody back together and ask the groups to present their results. Encourage the participants to ask each other questions and to make comments.
6. Facilitate a group discussion about what has been learned from the activity, based upon questions such as:
• On the whole, are there more advantages or disadvantages to donations of HIV/AIDS-related drugs? • How can an NGO/CBO/PLWHA group refuse a donation while maintaining a good relationship with the donor?
Facilitators' notes
• Encourage participants to think critically about the disadvantages of donations rather than taking an 'any help is good help' approach. • Encourage participants to focus on how they can create an active partnership with the donors of drugs, rather than being the passive recipients of support.
Example
At a skills-building workshop, NGO/CBO participants brainstormed about the advantages and disadvantages of donations of certain types of HIV/AIDS-related drugs.
Antiretrovirals
Advantages |
Disadvantages |
Ways to improve the donation |
• We don't have to pay.
• The drugs can prolong the lives of people living with HIV/AIDS.
• The drugs allow the patient to continue working. |
• The supply is not sustainable.
• Limited amounts of the drugs are sent.
• If they are new drugs, we have no guidelines for using them.
• Need to have access to clinical support. |
• Ask donors to give us training in using the drugs.
• Ask for constant and adequate supplies.
• Ensure access to clinical services. |
Drugs labelled in a foreign language
Advantages |
Disadvantages |
Ways to improve the donation |
• We don't have to pay.
• It means we have some drugs to give to patients. |
• We can't understand instructions.
• We don't know how to use the drugs.
• It takes time to find someone to translate. |
• Ask for good-quality drugs with a long shelf life.
• Overcome language problem by asking the donor to translate the information.
• Ask donors to use English. |
Drugs close to their expiry dates
Advantages |
Disadvantages |
Ways to improve the donation |
• We get the drugs free.
• We don't have to look for drugs or purchase them.
• It helps us to provide treatment. |
• The drugs are not of good quality or very effective.
• The drugs may not be finished before their expiry date and cannot be kept for a long time.
• The patient may feel unhappy and worry about using the drugs. |
• Check the expiry dates before receiving the drugs.
• Have an agreement with the donor to send drugs with a long shelf life.
• Make arrangements to dispense the drugs as fast as we can. |
Afterwards, the facilitator led a group discussion about what had been learned from the activity. For example, participants agreed that NGOs/CBOs need to build strong two-way relationships with donors, so that they can be honest with them and get the type of drugs that are most useful.
Reference: Adapted from a workshop on access to HIV-related treatment, Khmer HIV/AIDS NGO Alliance and the International HIV/AIDS Alliance, Cambodia, May 2001.
Chargement en cours...
