Evidence-based pharmacy in developing countries
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Many
developing nations A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreeme ...
have developed national drug policies, a concept that has been actively promoted by the
WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...
. For example, the national drug policy for
Indonesia Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...
drawn up in 1983 had the following objectives: * To ensure the availability of drugs according to the needs of the population. * To improve the distribution of drugs in order to make them accessible to the whole population. * To ensure efficacy, safety quality and validity of marketed drugs and to promote proper, rational and efficient use. * To protect the public from misuse and abuse. * To develop the national pharmaceutical potential towards the achievements of self-reliance in drugs and in support of national economic growth. To achieve these objectives in Indonesia, the following changes were implemented: * A national list of essential drugs was established and implemented in all
public sector The public sector, also called the state sector, is the part of the economy composed of both public services and public enterprises. Public sectors include the public goods and governmental services such as the military, law enforcement, inf ...
institutions. The list is revised periodically. * A
ministerial decree A ministerial decree or ministerial order is a decree by a ministry. With a ministerial decree the administrative department is delegated the task to impose a formal judgement or mandate. Ministerial decrees are usually imposed under the authority ...
in 1989 required that drugs in public sector institutions be prescribed generically and that Pharmacy and Therapeutics committees be established in all
hospitals A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
. * District hospitals and
health center A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. Typical services covered are family pr ...
s have to procure their drugs based on the essential drugs list. * Most drugs are supplied by three
government A government is the system or group of people governing an organized community, generally a state. In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government is ...
-owned companies. *
Training Training is teaching, or developing in oneself or others, any skills and knowledge or fitness that relate to specific useful competencies. Training has specific goals of improving one's capability, capacity, productivity and performance. I ...
modules have been developed for drug management and rational drug use and these have been rolled out to relevant personnel. * The central drug laboratory and provincial quality control laboratories have been strengthened. * A major
teaching hospital A teaching hospital is a hospital or medical centre that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located ...
has developed a program on rational drug use, developing a hospital formulary, guidelines for rational
diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
and treatment guidelines for the rational use of
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
. *
Generic drugs A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active c ...
have been available at affordable costs to
low-income groups Income is the consumption and saving opportunity gained by an entity within a specified timeframe, which is generally expressed in monetary terms. Income is difficult to define conceptually and the definition may be different across fields. For ...
.


Encouraging rational prescribing

One of the first challenges is to promote and develop rational prescribing, and a number of international initiatives exist in this area. WHO has actively promoted rational drug use as one of the major elements in its Drug Action Programme. In its publication ''A Guide to Good Prescribing'' the process is outlined as: * define the
patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other hea ...
's problem * specify the therapeutic objectives * verify whether your personal treatment choice is suitable for this patient * start the treatment * give information, instructions and warnings * monitor (stop) the treatment. The emphasis is on developing a logical approach, and it allows for clinicians to develop personal choices in medicines (a personal formulary) which they may use regularly. The program seeks to promote appraisal of evidence in terms of proven efficacy and safety from controlled
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
data, and adequate consideration of quality, cost and choice of competitor drugs by choosing the item that has been most thoroughly investigated, has favorable pharmacokinetic properties and is reliably produced locally. The avoidance of combination drugs is also encouraged. The routine and irrational use of injections should also be challenged. One study undertaken in Indonesia found that nearly 50% of infants and children and 75% of the patients aged five years or over visiting government health centers received one or more injections. The highest use of injections was for
skin disorders Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different de ...
,
musculoskeletal The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system prov ...
problems and
nutritional deficiencies Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
. Injections, as well as being used inappropriately, are often administered by untrained personnel; these include drug sellers who have no understanding of clean or
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
techniques. Another group active in this area is the International Network for the Rational Use of Drugs (INRUD). This organization, established in 1989, exists to promote rational drug use in developing countries. As well as producing training programs and publications, the group is undertaking research in a number of member countries, focused primarily on changing behavior to improve drug use. One of the most useful publications from this group is entitled ''Managing Drug Supply''. It covers most of the drug supply processes and is built up from research and experience in many developing countries. There a number of case studies described, many of which have general application for pharmacists working in developing countries. In all the talk of rational drug use, the impact of the
pharmaceutical industry The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...
cannot be ignored, with its many incentive schemes for doctors and pharmacy staff who dispense, advise or encourage use of particular products. These issues have been highlighted in a study of
pharmaceutical sales representative Pharmaceutical sales representatives (formerly detailmen) are salespeople employed by pharmaceutical companies to persuade doctors to prescribe their drugs to patients. Drug companies in the United States spend ~$5 billion annually sending r ...
(medreps) in Mumbai. This was an observational study of medreps' interactions with
pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links healt ...
, covering a range of neighborhoods containing a wide mix of social classes. It is estimated that there are approximately 5000 medreps in Mumbai, roughly one for every four doctors in the city. Their salaries vary according to the employing organization, with the multinationals paying the highest salaries. The majority work to performance-related incentives. One medrep stated "There are a lot of companies, a lot of competition, a lot of pressure to sell, sell! Medicine in India is all about incentives to doctors to buy your medicines, incentives for us to sell more medicines. Even the patient wants an incentive to buy from this shop or that shop. Everywhere there is a scheme, that's business, that's medicine in India.' The whole system is geared to winning over confidence and getting results in terms of sales; this is often achieved by means of gifts or invitations to symposia to persuade doctors to prescribe. With the launch of new and expensive antibiotics worldwide, the pressure to sell with little regard to the national essential drug lists or rational prescribing. One medrep noted that this was not a business for those overly concerned with morality. Such a statement is a sad reflection on parts of the pharmaceutical industry, which has an important role to play in the development of the health of a nation. It seems likely that short-term gains are made at the expense of increasing problems such as antibiotic resistance. The only alternatives are to ensure practitioners have the skills to appraise medicine promotion activities or to more stringently control pharmaceutical promotional activities.


Rational dispensing

In situations where medicines are dispensed in small, twisted-up pieces of brown paper, the need for patient instruction takes on a whole new dimension. Medicines should be issued in appropriate containers and labelled. While the patient may be unable to read, the healthcare worker is probably
literate Literacy in its broadest sense describes "particular ways of thinking about and doing reading and writing" with the purpose of understanding or expressing thoughts or ideas in written form in some specific context of use. In other words, hum ...
. There are many tried-and-tested methods in the literature for using pictures and diagrams to aid
patient compliance In medicine, patient compliance (also adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as m ...
. Symbols such as a rising or setting sun to depict time of day have been used, particularly for treatments where regular medication is important, such as cases of
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
or
leprosy Leprosy, also known as Hansen's disease (HD), is a long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the nerves, respiratory tract, skin, and eyes. This nerve damag ...
. Poverty may force patients to purchase one day's supply of medicines at a time, so it is important to ensure that
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
are used rationally and not just for one or two days' treatment. Often, poor patients need help from
pharmacists A pharmacist, also known as a chemist ( Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instru ...
to understand which are the most important medicines and to identify the items, typically
vitamins A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutrien ...
, that can be missed to reduce the cost of the prescription to a more manageable level.


The essential drugs concept

The essential drugs list concept was developed from a report to the 28th
World Health Assembly The World Health Assembly (WHA) is the forum through which the World Health Organization (WHO) is governed by its 194 member states. It is the world's highest health policy setting body and is composed of health ministers from member states. Th ...
in 1975 as a scheme to extend the range of necessary drugs to populations who had poor access because of the existing supply structure. The plan was to develop essential drugs lists based on the local health needs of each
country A country is a distinct part of the world, such as a state, nation, or other political entity. It may be a sovereign state or make up one part of a larger state. For example, the country of Japan is an independent, sovereign state, while ...
and to periodically update these with the advice of experts in
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
,
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
, pharmacology, pharmacy and drug management. Resolution number 28.66 at the Assembly requested the
WHO Director-General The director-general of the World Health Organization (WHO) is the chief executive officer of WHO and the principal advisor to the United Nations on matters pertaining global health. The director general is elected by and answers to the World Heal ...
to implement the proposal, which led subsequently to an initial model list of essential drugs (WHO Technical Series no 615, 1977). This model list has undergone regular review at approximately two-yearly intervals and the current 14th list was published in March 2005. The model list is perceived by the WHO to be an indication of a common core of medicines to cover most common needs. There is a strong emphasis on the need for national policy decisions and local ownership and implementation. In addition, a number of guiding principles for essential drug programs have emerged. * The initial essential drugs list should be seen as a starting point. * Generic names should be used where possible, with a cross-index to
proprietary name A brand is a name, term, design, symbol or any other feature that distinguishes one seller's good or service from those of other sellers. Brands are used in business, marketing, and advertising for recognition and, importantly, to create a ...
s. * Concise and accurate drug information should accompany the list. * Quality, including drug content
stability Stability may refer to: Mathematics *Stability theory, the study of the stability of solutions to differential equations and dynamical systems ** Asymptotic stability ** Linear stability ** Lyapunov stability ** Orbital stability ** Structural sta ...
and
bioavailability In pharmacology, bioavailability is a subcategory of absorption and is the fraction (%) of an administered drug that reaches the systemic circulation. By definition, when a medication is administered intravenously, its bioavailability is 100%. Ho ...
, should be regularly assessed for essential drug supplies. * Decisions should be made about the level of expertise required for drugs. Some countries make all the drugs on the list available to
teaching hospital A teaching hospital is a hospital or medical centre that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located ...
s and have smaller lists for district hospitals and a very short list for
health center A healthcare center, health center, or community health center is one of a network of clinics staffed by a group of general practitioners and nurses providing healthcare services to people in a certain area. Typical services covered are family pr ...
s. * Success depends on the efficient supply, storage and distribution at every point. * Research is sometimes required to settle the choice of a particular product in the local situation.


The model list of essential drugs

The model list of essential drugs is divided into 27 main sections, which are listed in
English English usually refers to: * English language * English people English may also refer to: Peoples, culture, and language * ''English'', an adjective for something of, from, or related to England ** English national ide ...
in alphabetical order. Recommendations are for drugs and presentations. For example, paracetamol appears as tablets in strengths of 100 mg to 500 mg, suppositories 100 mg and
syrup In cooking, a syrup (less commonly sirup; from ar, شراب; , beverage, wine and la, sirupus) is a condiment that is a thick, viscous liquid consisting primarily of a solution of sugar in water, containing a large amount of dissolved sugars ...
125 mg/5ml. Certain drugs are marked with an asterisk (previously a ៛), which denotes an example of a therapeutic group, and other drugs in the same group could serve as alternatives. The lists are drawn up by consensus and generally are sensible choices. There are ongoing initiatives to define the evidence that supports the list. This demonstrates the areas where RCTs ( randomized controlled trials) or systematic reviews exist and serves to highlight areas either where further research is needed or where similar drugs may exist which have better supporting evidence. In addition to work to strengthen the evidence base, there is a proposal to encourage the development of Cochrane reviews for drugs that do not have systematic review evidence. Application of NNTs ( numbers needed to treat) to the underpinning evidence should further strengthen the lists. At present, there is an assumption among doctors in some parts of the world that the essential drugs list is really for the poor of society and is somehow inferior. The use of NNTs around
analgesics An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...
in the list goes some way to disprove this and these developments may increase the importance of essential drugs lists.


Communicating clear messages

The impact of pharmaceutical representatives and the power of this approach has led to the concept of
academic detailing Academic detailing is "university or non-commercial-based educational outreach." The process involves face-to-face education of prescribers by trained health care professionals, typically pharmacists, physicians, or nurses. The goal of academic de ...
to provide clear messages. A study by Thaver and HarphamThaver IH, Harpharm T (1997) Private practitioners in the slums of Karachi: professional development and innovative approaches for improving practice. In: Bennett S, McPake B, Mills A (eds) ''Private Health Providers in Developing Countries: serving the public interest?'' Zed Books, London & New Jersey. described the work of 25 private practitioners in area around
Karachi Karachi (; ur, ; ; ) is the most populous city in Pakistan and 12th most populous city in the world, with a population of over 20 million. It is situated at the southern tip of the country along the Arabian Sea coast. It is the former c ...
. The work was based on assessment of prescribing practices, and for each practitioner included 30 prescriptions for
acute respiratory infection Influenza-like illness (ILI), also known as flu-like syndrome or flu-like symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. These include fever, shivering, chills, malaise, dry cough, l ...
s (ARIs) or
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
in children under 12 years of age. A total of 736 prescriptions were analysed and it was found that an average of four drugs were either prescribed or dispensed for each consultation. An antibiotic was prescribed in 66% of prescriptions, and 14% of prescriptions were for an
injection Injection or injected may refer to: Science and technology * Injective function, a mathematical function mapping distinct arguments to distinct values * Injection (medicine), insertion of liquid into the body with a syringe * Injection, in broadca ...
. Antibiotics were requested for 81% of diarrhea cases and 62% of ARI cases. Of the 177 prescriptions for diarrhea, only 29% were for oral rehydration solution. The researchers went on to convert this information into clear messages for academic dealing back to the doctors. The researchers went on to implement the program and assessed the benefits. This was a good piece of work based on developing messages that are supported by evidence.


Drug donations

It is a natural human reaction to want to help in whatever way possible when face with human disaster, either as a result of some
catastrophe Catastrophe or catastrophic comes from the Greek κατά (''kata'') = down; στροφή (''strophē'') = turning ( el, καταστροφή). It may refer to: A general or specific event * Disaster, a devastating event * The Asia Minor Catastro ...
or because of extreme poverty. Sympathetic individuals want to take action to help in a situation in which they would otherwise be helpless, and workers in difficult circumstances, only too aware of waste and excess at home, want to make use of otherwise worthless materials. The problem is that these situations do not lend themselves to objectivity. There are numerous accounts of tons of useless drugs being air-freighted into disaster areas. It the requires huge resources to sort out these charitable acts and often the drugs cannot be identified because the labels are not in a familiar language. In many cases, huge quantities have to be destroyed simply because the drugs are out of date, spoiled, unidentifiable, or totally irrelevant to local needs. Generally, had the cost of shipping been
donate A donation is a gift for charity, humanitarian aid, or to benefit a cause. A donation may take various forms, including money, alms, services, or goods such as clothing, toys, food, or vehicles. A donation may satisfy medical needs such as ...
d instead, then many more people would have benefited. In response to this, the WHO has generated guidelines for drug donations from a consensus of major international agencies involved in
emergency relief Emergency management or disaster management is the managerial function charged with creating the framework within which communities reduce vulnerability to hazards and cope with disasters. Emergency management, despite its name, does not actuall ...
. If these are followed, a significant improvement in terms of patient benefit and use of
human resources Human resources (HR) is the set of people who make up the workforce of an organization, business sector, industry, or economy. A narrower concept is human capital, the knowledge and skills which the individuals command. Similar terms include ...
will result.


WHO guidelines for drug donations 2005


Selection of drugs

* Drugs should be based on expressed need, be relevant to disease pattern and be agreed with the recipient. * Medicines should be listed on the country's essential drugs list or WHO model list. * Formulations and presentations should be similar to those used in the recipient country.


Quality assurance (QA) and shelf life

* Drugs should be from a reliable source and WHO certification for
quality Quality may refer to: Concepts *Quality (business), the ''non-inferiority'' or ''superiority'' of something *Quality (philosophy), an attribute or a property *Quality (physics), in response theory * Energy quality, used in various science discipl ...
of pharmaceuticals should be used. * No returned drugs from patients should be used. * All drugs should have a
shelf life Shelf life is the length of time that a commodity may be stored without becoming unfit for use, consumption, or sale. In other words, it might refer to whether a commodity should no longer be on a pantry shelf (unfit for use), or no longer on a ...
of at least 12 months after arrival in the recipient country.


Presentation, packing and labelling

* All drugs must be labelled in a language that is easily understood in the recipient country and contain details of generic name, batch number,
dosage form Dosage forms (also called unit doses) are pharmaceutical drug products in the form in which they are marketed for use, with a specific mixture of active ingredients and inactive components (excipients), in a particular configuration (such as a ca ...
, strength, quantity, name of
manufacturer Manufacturing is the creation or production of goods with the help of equipment, labor, machines, tools, and chemical or biological processing or formulation. It is the essence of secondary sector of the economy. The term may refer to ...
, storage conditions and
expiry date An expiration date or expiry date is a previously determined date after which something should no longer be used, either by operation of law or by exceeding the anticipated shelf life for perishable goods. Expiration dates are applied to selecte ...
. * Drugs should be presented in reasonable pack sizes (e.g. no sample or patient starter packs). * Material should be sent according to international
shipping Freight transport, also referred as ''Freight Forwarding'', is the physical process of transporting commodities and merchandise goods and cargo. The term shipping originally referred to transport by sea but in American English, it has been ...
regulations with detailed packing lists. Any storage conditions must be clearly stated on the containers, which should not weigh more than 50 kg. Drugs should not be mixed with other supplies.


Information and management

* Recipients should be informed of all drug
donations A donation is a gift for charity, humanitarian aid, or to benefit a cause. A donation may take various forms, including money, alms, services, or goods such as clothing, toys, food, or vehicles. A donation may satisfy medical needs such as b ...
that are being considered or under way. * Declared value should be based on the
wholesale price Wholesaling or distributing is the sale of goods or merchandise to retailers; to industrial, commercial, institutional or other professional business users; or to other wholesalers (wholesale businesses) and related subordinated services. In ...
in the recipient country or on the wholesale world
market price A price is the (usually not negative) quantity of payment or compensation given by one party to another in return for goods or services. In some situations, the price of production has a different name. If the product is a "good" in the ...
. * Cost of international and local
transport Transport (in British English), or transportation (in American English), is the intentional movement of humans, animals, and goods from one location to another. Modes of transport include air, land ( rail and road), water, cable, pipelin ...
,
warehousing A warehouse is a building for storing goods. Warehouses are used by manufacturers, importers, exporters, wholesalers, transport businesses, customs, etc. They are usually large plain buildings in industrial parks on the outskirts of cities, tow ...
, etc., should be paid by the donor agency unless otherwise agreed with the recipient in advance.


Evidence-based pharmacy practice

While modern practices, including the development of
clinical pharmacy 230px, A hospital pharmacist is checking a liquid solution. Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease pr ...
, are important, many basic issues await significant change in developing countries. * Medicines can often be found stored together in
pharmacological Pharmacology is a branch of medicine, biology and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous (from within the body) molecule which exerts a biochemica ...
groups rather than in alphabetical order by type. * Refrigerator space is often inadequate and refrigerators unreliable. * There are different challenges, such as ensuring that termites do not consume the outer packages and labels or that storage is free of other
vermin Vermin ( colloquially varmint(s) or varmit(s)) are pests or nuisance animals that spread diseases or destroy crops or livestock. Since the term is defined in relation to human activities, which species are included vary by region and enterp ...
such as rats. * Dispensary packaging and labelling can be woefully inadequate and patients leave with little or no understanding of how to take medicines which may have cost them at least one week's earnings. * Medicines are often out of stock, not just for a few hours but for days or even weeks, particularly at the end of the
financial year A fiscal year (or financial year, or sometimes budget year) is used in government accounting, which varies between countries, and for budget purposes. It is also used for financial reporting by businesses and other organizations. Laws in many ...
. *
Protocols Protocol may refer to: Sociology and politics * Protocol (politics), a formal agreement between nation states * Protocol (diplomacy), the etiquette of diplomacy and affairs of state * Etiquette, a code of personal behavior Science and technology ...
and
standard operating procedures A standard operating procedure (SOP) is a set of step-by-step instructions compiled by an organization to help workers carry out routine operations. SOPs aim to achieve efficiency, quality output, and uniformity of performance, while reducing misc ...
are rarely found. * Even when graduate pharmacists are employed, they often have little opportunity to perform above the level of
salesperson Sales are activities related to selling or the number of goods sold in a given targeted time period. The delivery of a service for a cost is also considered a sale. The seller, or the provider of the goods or services, completes a sale in r ...
, simply issuing medicines and collecting payment. For example, several hospital pharmacies in Mumbai, India, are open 24 hours per day for 365 days per year but only to function as
retail outlets Retail is the sale of goods and services to consumers, in contrast to wholesaling, which is sale to business or institutional customers. A retailer purchases goods in large quantities from manufacturers, directly or through a wholesaler, and t ...
selling medicines to
outpatients A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
or to relatives of inpatients who then hand over the
medicines A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and re ...
to the nursing staff for administration.


Conclusions

Evidence is as important in the developing world as it is in the developed world. Poverty comes in many forms. While the most noticed are
famine A famine is a widespread scarcity of food, caused by several factors including war, natural disasters, crop failure, population imbalance, widespread poverty, an economic catastrophe or government policies. This phenomenon is usually accompani ...
and poor
housing Housing, or more generally, living spaces, refers to the construction and assigned usage of houses or buildings individually or collectively, for the purpose of shelter. Housing ensures that members of society have a place to live, whether i ...
, both potent killers, medical and knowledge poverty are also significant.
Evidence-based Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indiv ...
practice is one of the ways in which these problems can be minimized. Potentially, one of the greatest benefits of the
internet The Internet (or internet) is the global system of interconnected computer networks that uses the Internet protocol suite (TCP/IP) to communicate between networks and devices. It is a '' network of networks'' that consists of private, pub ...
is the possibility of ending knowledge poverty and in turn influencing the factors that undermine
wellbeing Well-being, or wellbeing, also known as wellness, prudential value or quality of life, refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimately good ''for'' this person, what is in th ...
. Essential drugs programs have been a major step in ensuring that the maximum number benefit from effective
drug therapy Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term ''medical ther ...
for disease.


See also

*
Essential medicines Essential medicines, as defined by the World Health Organization (WHO), are the medicines that "satisfy the priority health care needs of the population". These are the medications to which people should have access at all times in sufficient a ...
*
WHO Model List of Essential Medicines The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health ...
*
Department of Essential Drugs and Medicines The mission of the Department of Essential Drugs and Medicines of the World Health Organization is "to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for mil ...
*
Campaign for Access to Essential Medicines The Campaign for Access to Essential Medicines is an international campaign started by Médecins Sans Frontières (MSF) to increase the availability of essential medicines in developing countries. MSF often has difficulties treating patients becaus ...
*
Evidence-based practice Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indiv ...
*
Universities Allied for Essential Medicines Universities Allied for Essential Medicines (UAEM) is a student-led organization working to improve access to and affordability of medicines around the world, and to increase research and development of drugs for neglected tropical diseases. Supp ...


References


Useful sources of information

The following is a list of useful publications from the WHO Department of Essential Drugs and Medicines Policy about essential drugs programs.


General publications

* ''Essential Drugs Monitor'' - periodical issued twice a year, covering drug policy, research, rational drug use and recent publications. * ''WHO Action Programme on Essential Drugs in the South-East Asia Region'' - report on an Intercountry Consultative Meeting, New Delhi, 4–8 March 1991. 49 pages, ref no SEA/Drugs/83 Rev.1.


National drug policy

* ''Report of the WHO Expert Committee on National Drug Policies'' - contribution to updating the WHO Guidelines for Developing Drug Policies. Geneva. 19–23 June 1995. 78 pages, ref no WHO/DAP/95.9. * ''Guidelines for Developing National Drug Policies'' - 1988, 52 pages, . * ''Indicators for Monitoring National Drug Policies'' - P Brudon-Jakobowicz, JD Rainhorn, MR Reich, 1994, 205 pages, order no 1930066.


Selection and use

* ''Rational Drug Use: consumer education and information'' - DA Fresle, 1996, 50 pages, ref no DAP/MAC/(8)96.6. * ''Estimating Drug Requirements: a practical manual'' - 1988, 136 pages, ref no WHO/DAP/88.2. * ''The Use of Essential Drugs. Model List of essential drugs'' - updated every two years. Currently 14th edition, 2005. The list is available at: www.who.int/medicines * ''Drugs Used in Sexually Transmitted Diseases and HIV Infection'' - 1995, 97 pages, . * ''Drugs Used in Parasitic Diseases (2e)'' - 1995, 146 pages, . * ''Drugs Used in Mycobacterial Diseases'' - 1991, 40 pages, . * ''Who Model Prescribing Information: Drugs Used in Anaesthesia'' - 1989, 53 pages, . * ''Guidelines for Safe Disposal of Unwanted Pharmaceuticals In and After Emergencies'' - ref no WHO/EDM/PAR/99.4.


Supply and marketing

* ''Guidelines for Drug Donations'' - interagency guidelines, revised 1999. Ref no WHO/EDM/PAR/99.4. * ''Operational Principles for Good Pharmaceutical Procurement'' - Essential Drugs and Medicines Policy / Interagency Pharmaceutical Coordination Group, Geneva, 1999. * ''Managing Drug Supply'' - Management Sciences for Health in collaboration with WHO, 1997, 832 pages, . * ''Ethical Criteria for Medicinal Drug Promotion'' - 1988, 16 pages, .


Quality assurance

* ''WHO/UNICEF Study on the Stability of Drugs During International Transport'' - 1991, 68 pages, ref no WHO/DAP/91.1.


Human resources and training

* ''The Role of the Pharmacist in the Health Care System'' - 1994, 48 pages, ref no WHO/PHARM 94.569. * ''Guide to Good Prescribing'' - TPGM de Vries, RH Henning, HV Hogerzeil, DA Fresle, 1994, 108 pages, order no. 1930074. Free to developing countries. * ''Developing Pharmacy Practice: a Focus on Patient Care'' - 2006, 97 pages, World Health Organization (WHO) and International Pharmaceutical Federation (FIP)


Research

* ''No 1 Injection Practices Research'' - 1992, 61 pages, ref no WHO/DAP92.9. * ''No 3 Operational Research on the Rational Use of Drugs'' - PKM Lunde, G Tognoni, G Tomson, 1992, 38 pages, ref no WHO/DAP/92.4. * ''No 24 Public Education in Rational Drug Use: a global survey'' - 1997, 75 pages, ref no WHO/DAP/97.5. * ''No 25 Comparative Analysis of National Drug Policies'' - Second Workshop, Geneva, 10–13 June 1996. 1997, 114 pages, ref no WHO/DAP/97.6. * ''No 7 How to Investigate Drug Use in Health Facilities: selected drug use indicators'' - 1993, 87 pages, order no 1930049.


External links


WHO Medicines Policy and Standards, Technical Cooperation for Essential Drugs and Traditional Medicine

WHO Global Medicines Strategy: Countries at the Core
2004-2007 {{Evidence-based practice Pharmacy Evidence-based practices