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Rational Use of Injections within National Drug Policies

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Title: Generic SIGN Presentation Subject: Unsafe Injection Practices Author: SIGN secretariat Last modified by: Yvan Hutin Created Date: 7/8/1997 10:15:43 PM – PowerPoint PPT presentation

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Title: Rational Use of Injections within National Drug Policies


1
Rational Use of Injections within National Drug
Policies
  • World health organisation Essential Drugs and
    Medicines Policy Safe Injection Global
    Network Cairo October 2000

2
A National Drug Policy
  • Expresses the goals and objectives set by a
    government for the pharmaceutical sector and
    identifies the main strategies for achieving
    them.
  • it is the documented framework within which the
    activities of the pharmaceutical sector are
    prioritised and coordinated
  • it should specify the roles of the public and
    private sectors and all stakeholders and is
    concerned with efficiency, equity, and
    sustainability

3
Every country needs a national drug policy
because of
  • (1) medical reasons
  • 25-40 of the world population has no access to
    drugs
  • up to 50 of the worlds drugs may be used
    inappropriately
  • (2) cost reasons
  • drugs are 20-40 of health budgets - antibiotics
    injections are most expensive

4
Goals of a national drug policy
  • to set objectives and identify priorities for
    action and gain government commitment for these

5
Objectives
  • to make essential drugs available and affordable
    to those who need them
  • to ensure the safety, efficacy and quality of all
    medicines provided to the public
  • to improve prescribing and dispensing practices
    and to promote the correct use of medicines by
    health workers and the public

6
The problem of unsafe inappropriate injections
  • Overuse
  • 5-48 of outpatients received injections in 12
    developing countries
  • Inappropriate use
  • 22-80 of injections were found to be unnecessary
    in 3 developing countries
  • Unsafe use
  • 40 of sterilised needles and syringes in
    Tanzania showed bacterial contamination

7
The consequences of unsafe inappropriate use
  • Children aged 2years in Zaire averaged 24
    injections and HIV seropositivity was associated
    with injection frequency
  • 39-57 of the population in Moldova received an
    injection over 1 year and 50 of cases of
    Hepatitis B were associated with injection use
  • 75 of children with paralytic polio in India
    received an unnecessary injection just before
    onset of paralysis

8
Developing a national drug policy
  • Organise the policy process - MOH is the most
    appropriate lead agency
  • Identify and analyse the problems - involve all
    stakeholders
  • Set goals and objectives - aimed at the highest
    priority problems
  • Draft the policy, circulate and revise it
  • Obtain formal endorsement for the policy and
    launch the policy

9
Implementing a national drug policy
  • Depends on political will, resources, shared
    values between the NDP and powerful interest
    groups, economic situation, technical expertise,
    and committed people
  • Policies often fail due to lack of political
    will, lack of resources and corruption

10
Comparative analysis of national drug policies,
WHO/DAP/97.6 (1)
  • A study in 12 countries (Bulgaria, Chad,
    Colombia, Guinea, India, Mali, Philippines, Sri
    Lanka, Thailand, Vietnam, Zambia, Zimbabwe) to
    evaluate NDP effectiveness.
  • all countries had drug regulatory authorities
    with mandates which included drug registration
    and inspection
  • most countries had established structures, but
    implementation was not always working, and
    monitoring and evaluation was rarely done
  • it was much easier to improve drug availability
    than to change drug use behaviour

11
Comparative analysis of national drug policies,
WHO/DAP/97.6 (2)
  • generic policies resulted in lower cost of
    treatment in the public sector
  • withdrawal of irrational drugs led to less
    irrational use
  • good quality assurance led to better acceptance
    of generics, prescribing, dispensing
  • good registration had a positive impact on drug
    use
  • an appropriate financing system led to better
    prescribing
  • procurement through tender led to better drug
    availability
  • public sector training led to better prescribing
    in the public sector as compared to the private
    sector.

12
Role of national drug policies to reduce unsafe
inappropriate injections (1)
  • Government commitment to safer more appropriate
    injections may be secured through the body
    responsible for the NDP (national drug authority,
    MOH).
  • A national task force a subcommittee of the NDP
    body - could coordinate an initial assessment of
    unsafe inappropriate injections and an action
    plan to improve use
  • The national drug policy can reduce unsafe
    inappropriate injections by
  • (1) Selection of appropriate injectable drugs and
    equipment
  • e.g. public sector EDL, market withdrawal of
    inappropriate injections

13
Role of national drug policies to reduce unsafe
inappropriate injections (2)
  • (2) Increasing availability of appropriate
    injections and alternatives to injections
  • (3) Reducing inappropriate availability through
    effective registration of drugs and dispensing
    outlets
  • (4) Ensuring appropriate training on the use of
    injections for healthcare workers
  • (5) Encouraging appropriate public education
    concerning injections
  • (6) Regulation and monitoring of promotional
    activities and material
  • (7) Establish functional drug and therapeutic
    committees
  • (8) Identify and eliminate economic incentives
    that encourage over-use of injections

14
Components of a National Drug Policy (1)
  • Legislations and Regulations
  • drug regulatory authority
  • drug registration and licensing
  • pharmaceutical quality assurance
  • postmarketing surveillance (drug efficacy and
    safety)
  • regulation of prescription and distribution
  • Drug Selection, EDL
  • criteria (efficacy, safety, quality, cost) and
    process
  • Supply
  • Local production, procurement, distribution,
    storage

15
Components of a National Drug Policy (2)
  • Rational Drug Use by providers consumers
  • Objective drug information - formulary, bulletin
  • Controlled promotional activities
  • Economic strategies for drugs
  • role of government in the pharmaceutical market
  • public drug financing mechanism
  • pricing policies e.g. retailer margins, producer
    prices
  • Human resource development
  • role of health professions
  • HRD development plan
  • education, pre- in-service training

16
Successful interventions to reduce unsafe and
inappropriate injections (1)
  • Interactional group discussions in Indonesia
  • Hadiyono, Suryawati, et al, SSM, 1996,
    42(8)1177-83
  • RCT of the effect of interactional group
    discussions, each lasting 1-2 hours and including
    6 prescribers and 6 patients over a 4-week
    period. Data from 100 prescriptions per facility,
    3 months pre- and post intervention.

patients
Intervention
Control
prescribed
(n 12)
(n 12)
injections
Pre-intervention
69.5
75.6
Post-intervention
42.3
67.1
Change
-27.2
-8.5
17
Successful interventions to reduce unsafe and
inappropriate injections (2)
  • Treatment and Sterility Guidelines in Tanzania
  • Gumodoka et al, TMIH, 1998, 3(4)291-6
  • Pre-post study on the effect of local development
    and introduction of guidelines for treatment and
    sterilisation in 66 health facilities.

Indicator of injection use
Pre-
Post-
Change
patients prescribed
injections
23
10
-13
patients that received
avoidable injections
16
6
-10

sterilis. needles
contaminated
44
22
-22
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