Title: The Role of a Comprehensive Pharmaceutical Sector Development Programme in Improving Rational Use of Drugs: The Ghana Example
Author Name: DavidOfori-Adjei
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Presenter Name: DavidOfori-Adjei
Authors: Ofori-Adjei D,Gyansa-Lutterodt M, Asiama D, Dodoo A, Aboagye-Nyame F, Osafo E, Arhinful D
Institution: Ghana National Drugs Programme and INRUD-Ghana
Problem Statement:In 1994, a comprehensive review of the pharmaceutical sector was undertaken aimed at producing a master plan for the development of the sector. In 1997, the Ghana National Drugs Programme (GNDP) was initiated for the implementation of the master plan over a five year period. The goal of the GNDP was to ensure that all people in Ghana have access to effective, safe and affordable medicines of good quality in both public and private sectors and that the medicines are used rationally. A major focus of the master plan was the promotion of the rational use of drugs.
Objectives: To analyse the changes in drug use indicators in the public sector since the initiation of the GNDP.
Design: Retrospective analysis of three major drug use indicator surveys.
Setting and Population: Prescribing indicators were measured at both primary and secondary health care facilities as part of pharmaceutical sector surveys carried out in collaboration with MSH (1993), GNDP (1998) and with WHO (2002). The health facilities selected in all the studies were representative of the ecological zones of the country.
Intervention: The core activity of the GNDP is the promotion of the rational use of drugs. The GNDP facilitated the development and implementation of the National Drugs Policy, development and distribution of evidence-based Standard Treatment Guidelines (STGs) and set up a training programme for clinical pharmacy and Drugs and Therapeutics Committees. The GNDP institutionalised the promotion of rational use of drugs (RUD) by training and establishing RUD focal persons for each of the 10 regions in the country.
Outcome Measures: Average number of drugs/encounter; % prescription with an antibiotic; % prescription with an injection; % drugs prescribed on the Essential Drugs List (EDL); % drugs dispensed; % drugs adequately labelled; % adequate knowledge about prescribed drugs; and availability of treatment guidelines.
Results: There was no difference in the indicators for 1993 and 1998. Comparing 1993/1998 data with that of 2002 showed a reduction in the average number of drugs (4.3 to 3.5), % antibiotic (46.6% to 42.5%), % injection (55.7 to 33.5), % dispensed (86% to 91.2%) and an increase in the availability of treatment guidelines (73% to 90%). There was worsening in the labelling of drugs (12% to 0.18%) and no change in prescribing according to the EDL (95% and 94.2%).
Conclusions: The data suggest an improvement in the prescribing indicators between 1998 and 2002. The deterioration in labelling could be attributed to the lack of attention of the GNDP on dispensing and clear guidelines on labelling, and these must be corrected.
Study Funding: Studies funded by: Government of Ghana, Royal Netherlands Embassy (Ghana), WHO and Management Sciences for Health/United States Agency for International Development