It may be easy to establish a DTC, with a list of core and additional members, all with different expertise, objectives and functions, but it may be very difficult to ensure that it functions effectively. Success will depend on having strong and visible support from the senior hospital management and abiding by the principles listed below.

2.1.1 A multidisciplinary approach sensitive to local politics

DTC activities will involve different cadres of health professional, who will have different experiences, beliefs, skills, practices, motivations and status. Often a DTC must manage conflict arising between clinicians and the pharmacy or administration concerning prescribing restrictions that result from the implementation of agreed guidelines. Such conflicts can be reduced if staff are convinced of the need for, and benefits of, change and there is strong institutional commitment with the support of people in authority. Wide representation on the DTC and documenting and disseminating decisions taken to correct problems in the use of medicines helps to convince health-care workers. Everyone who contributes should be acknowledged.

2.1.2 Transparency and commitment to good service

The success of a DTC will depend upon its being active, working regularly in a consistent direction and making sound decisions in a transparent way. This is especially important in medicine selection and procurement policies. The people involved should not be influenced by inappropriate drug advertisements, promotional activities or personal financial interests. All committee members should be required to sign a ‘declaration of interest’ (see annex 2.1). Such a declaration can bind members to the working principles and ethics of the DTC, and to their roles and responsibilities to other health-care staff, the hospital management and the community.

2.1.3 Technical competency

A DTC must have the appropriate technical competence. Members will have different competencies and the DTC process of discussion and appraisal of drug use issues is a good way to educate members in areas outside their expertise. Good science and evidence (if possible) must be the basis of all DTC decisions.

2.1.4 Administrative support

Administrative support is very important, as otherwise a DTC may not be able to implement its decisions. Administrative support can provide the executive authority needed to gain the cooperation of senior medical staff. The administration can also provided the funds needed to undertake many of the DTC’s activities.