In 1997, the first International Conference on Improving the Use of Medicines (ICIUM) presented and discussed interventions from around the world that aimed to promote appropriate use of medicines. It concluded that a successful intervention should:
• focus on a specific problem
• address the underlying factors
• use a problem-solving approach
• repeat the intervention
• be interactive
• provide feedback to prescribers
• be followed by monitoring and supervision
• develop peer group commitments or guidelines.
In 2001, the percentage of patients receiving antibiotics was 60-100% in Cambodia and approximately 70% in Lao PDR, while injection use in both countries ranged from 60-100%. A review by WHO indicated that monitoring and supervision of medicines use in the two countries did not incorporate problem-solving approaches, and was neither generating prescriber, commitment to nor setting specific targets for improved medicines use. In other words, the precepts recommended by ICIUM were not being comprehensively followed.
Following the ICIUM recommendations, and working with the Ministries of Health in Cambodia and Lao PDR, WHO introduced and fieldtested an innovative monitoring, training and planning strategy (MTP) for improving rational use of medicines. A group of providers identifies medicines use problems, quantifies them using suitable indicators, identifies their possible causes, and selects appropriate solutions. They then implement the chosen solutions using available scientific information and other resources, and measure their (hopefully) improved performance. Additionally, the group of providers holds a regular monthly meeting to monitor the levels of the defined problem, discuss improvements made and target levels of improvement for the following month.
The percentage of patients receiving antibiotics at Hinboune District Hospital, Cambodia, fell immediately after implementation of the monitoring, training and planning strategy
The MTP strategy was field-tested in Cambodia and Lao PDR in a number of, mostly provincial, hospitals (6 in Cambodia and 8 in Lao PDR), and later expanded to district hospitals (21 district hospitals in Lao PDR). Evaluation of implementation in the pilot hospitals showed that it was effective in improving medicines practices and that hospitals can adopt the strategy easily. The Ministries of Health in Lao PDR and Cambodia are now seeking to extend use of this strategy to additional provincial and district hospitals, with donor support.
MTP was earlier adopted by the WHO Collaborating Center for Research and Training on Rational Drug Use in Yogyakarta, Indonesia, for implementing rational medicines use interventions in Indonesia.