Dr Jonathan D Quick

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Essential drug concept and the role of WHO in the
promotion of rational drug use

Dr Jonathan D Quick Director, Essential Drugs and
Medicines Policy World Health Organization Interna
tional Paediatrics Association, September, 2001
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Essential drug concept and the role of WHO in the
promotion of rational drug use
Impact of irrational use
Effective interventions
WHO's role
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Essential drug concept and the role of WHO in the
promotion of rational drug use

• WHO indicators of RDU
• drug per encounters
• antibiotics
• injections

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The number of drugs per prescription varies from
1.3 to 4.3 per primary care encounters
Irrational use
Number of drugs per prescription
Date from Quick et al, 1997, Managing Drug Supply
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Over-prescribing is costly - and spending on
child health is highly cost sensitive
Irrational use
Drugs are the largest health expenditure for poor
households
Source Azerbaijan - UNICEF-Bamako Technical
Report No. 35 Bangladesh 1995 - National
Accounts 1996/97 Mali (1986) - Diarra K and
Coulibaly S. Financing of recurrent health costs
in Mali. Health Policy and planning 1990,
5(2)126-138
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30 to 60 of PHC patients treated with
antibiotics- perhaps twice what is clinically
needed
Irrational use
of primary care patients receiving antibiotics
Date from Quick et al, 1997, Managing Drug Supply
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Resistance to common pathogens is everywhere on
the rise - S. pneumonia
Irrational use
Summarized by WHO/GPV
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Up to 56 of primary care patients receive
injections - over 90 may be medically unnecessary
Irrational use

• 15 billion injections per year globally
• half are with unsterilized needle and syringe
• by age 2 children in some countrieshave received
  up to 20 injections

of primary care patients receiving injections
Chart date from Quick et al, 1997, Managing Drug
Supply
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Unsafe injection is a major health hazard -
factors are overuse of injections, re-use without
sterilisation, contamination
Irrational use

• Infections attributable to unsafe injection
• of cases Annual number Paediatric
• (all ages) (millions) rates
• Hepatitis B 33 21.6 34-61
• Hepatitis C 42 2.0 up to 68
• HIV 2 0.1

Population attributable fractions Source
Hauri, Armstrong, Hutin, 2001 (provisional result)
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Irrational use of drugs is a widespread hazard to
health - other examples
Irrational use

• 25-75 antibiotics in teaching hospitals are
  inappropriate
• over 2/3 of antibiotics without prescription in
  many countries
• 90 of consumers buy 3-days supply of antibiotics
  or less
• private providers use 80 different TB regimens
• 50 of people worldwide fail to take medicines
  correctly

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Essential drug concept and the role of WHO in the
promotion of rational drug use
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Standard treatment guidelines (STGs) - reduce ARI
mortality when effectively implemented
Effective interventions
Source WHO/CDS/CSR/DRS/2001.9
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Injection use in Indonesia has been dramatically
reduced through a combination of interventions
Effective interventions
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Antimalarial treatment in Kenya has become more
prompt and appropriate through shopkeeper training
Effective interventions
Southern zone
Northern zone
Source Marsh et al, 2001
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Actions to improve use of medicines - consider
effectiveness and feasibility (Health Policy
Planning, 2001)
Effective interventions

• Recommended approaches
• Standard treatment guidelines
• Essential drugs list based on treatments of
  choice
• Hospital pharmacy and therapeutics committees
• Problem-based pharmacotherapy training
• Problem-based in-service and continuing education
• Promising approaches
• Interactive group process among providers and
  consumers
• Pharmacist and drug seller training
• Consumer involvement in public education

Laing et al, 2001, Health Policy and Planning
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Essential drug concept and the role of WHO in the
promotion of rational drug use
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Modernizing the essential drugs concept
-Creating a WHO Essential Drugs Library

• WHO Model List of Essential Drugs
• 11th model list
• 306 drugs

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The Guide to Good Prescribing - widely applied
tool for developing systematic prescribing
practices
WHO's role

• addressed a real need
• training in good prescribing
• based in a WHO collaborating centre
• developed through a participatory process
• professionals from 30 countries, 15 WHO offices
• field-tested in 7 countries
• widely publicized - actively followed-up
• translation into 18 languages
• adopted by teaching institutions worldwide
• training teachers - WWW - adaptation

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Promoting rational drug use - WHO guidelines,
training, information support - some examples
WHO's role

• Promoting rational drug use - INRUD - WHO - MSH -
  regional courses Africa, Asia, Latin America

• Ethical criteria for medicinal drug promotion -
  truthfulness in all promotional activities

• Global strategy for containing antimicrobial
  resistance - active roles for all stakeholders

• WHO model formulary and model prescribing
  information - active roles for all stakeholders

• Monographs on selected medicinal plants -
  information/evidence on availability, efficacy,
  safety

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WHO's role
Expanding access to WHO information http//www.who
.int/medicines/
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Summary - Essential drug concept and the role of
WHO in the promotion of rational drug use
Irrational use has serious health and economic
effects - under-treatment, resistance, spread of
disease
Effective interventions exist - treatment
guidelines, essential drugs lists, focused
training
WHO supports countries, professional bodies, NGOs
- guidelines, training, information, technical
support
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