Indicators contained in the manual can be used as they are; every effort has been made during their development to ensure that they are relevant to most situations and countries and that they provide a comprehensive view of a national drug policy. Their use in 12 countries in 1995 and 1996 confirmed that they are applicable to various socioeconomic contexts and to different pharmaceutical policies. However, it is expected that managers will sometimes need to adapt the indicators to match national circumstances. The indicators can be adapted in several ways.

First, countries may have additional objectives, beyond those specified above, such as the development of national pharmaceutical production or the integration of traditional medicine. In this case, supplementary indicators could be developed at country level. This development should be preceded by careful identification of the objectives and strategies, in order to select indicators that will provide useful information about the effectiveness of policy implementation.

Second, national managers of drug policy may wish to adapt the normative standards suggested in the indicators to take into account the country's specific priorities. Each country, according to its political structure and level of socioeconomic development, will be at a different stage of formulation and implementation of its national drug policy, and will have its own priorities. This manual proposes provisional standards for process and outcome indicators. The team responsible for applying the indicators should review these standards carefully, to be certain that they correspond to the national context and the drug policy's targets and goals.

Third, national managers may wish to have more detailed information on certain aspects of the drug policy; in this case, they can subdivide the indicators. For instance, the indicators that refer to prescribers in general can be made more specific by adapting them to the various groups of prescribers. However, it is important not to forget that the main objective is to evaluate and monitor progress in implementing the policy and not to follow all the activities in detail.

Fourth, because of the differences between countries, some indicators will be of greater relevance than others. Some sections of the manual will thus be best applied selectively to specific problems. Alternatively, national managers may decide that some indicators in this manual are not appropriate for their country or policy.

Finally, experience suggests that developed countries may also be able to use this approach for defining indicators. In such cases, the list of indicators⁴ may be used as a model and adapted to fit the national context.

⁴ The Government of Australia has adapted the approach contained in this manual to develop its own indicators: Development of a manual of indicators to measure the effect of initiatives under the quality use of medicine arm of the national medicinal drug policy, Department of Human Services and Health, Australia, September 1994.