promoting rational drug use in the community

Promoting Rational Drug Use in the Community

Setting the Scene The Essential Drugs Concept

Setting the scenePromoting Rational Drug Use in the Community

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Session Objectives

History essential drugs -public health context

Main components of national drug policy

Main actors and their roles Trends and challenges


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Drug Policy and Use Understood in the Context of :

Changing ideas about health and health care Development of the pharmaceutical industry The development of modern pharmacotherapy Pharmacy: herbal medicines patent remedies Chemical innovation during the 19th century Increased understanding of germs and bacteria

– major steps forward in 20th


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0

0,5

1

1,5

2

2,5

3

3,5

4

year

deat

h ra

te p

er 1

000

Decline in TB (UK)Nuffield Provincial hospitals trust


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Deaths of children under 15 attributed to scarlet fever,diphtheria, whooping cough, measles in England and Wales

0

2000

4000

6000

year

child

ren

dea

th p

er m

illio

n


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Early Landmarks in Drug Development 1941 penicillin 1943 chloroquine 1944 streptomycin 1948 tetracyline and chloramphenicol 1954 sulphonylureas (diabetes) 1955 first trials oral contraceptives


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Miracles Turn to Disasters:

1930s sulphanilamide scandal resulted in the establishment of US FDA

1960s thalidomide (8000 children in 46 countries seriously handicapped)

1950 - 1970s diethylstilbestrol 1970s clioquinol caused widespread

neurologic disease in Japan


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Major Challenges Became Evident

Access Proper and safe use Harness drug development to

peoples’ need


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Problems in Providing Access to Medicine

Differences between rich and poor countries

Differences between urban and rural populations

Proliferation of brand name products Lack of information/evidence about

therapeutic value


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Essential Drugs

Essential Drugs are those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms. (WHO)


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Primary Health Care

Education (health problems/control prevention Promotion of food supply and nutrition Adequate supply of safe water/basic sanitation Maternal and child health care (including family

planning) Immunisation against major infectious diseases Prevention-control of locally endemic diseases Appropriate treatment common diseases and injuries Provision of essential drugs


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National Drug Policy

Determine standards and values to guide actions in the drug sector

Define global objectives Identify which strategies to meet these objectives


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Steps in the development of NDP Organise the process Identify the main problems Detailed situation analysis Set goals and objectives for policy Draft text of policy Circulate and revise ...process

important Secure endorsement Launch


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Components of National Drug Policy

Selection of drugs Affordability Drug financing Supply systems Regulation and quality assurance Rational use Research Human resource development Monitoring and evaluation


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Objectives South Africa NDP

Health objectives– Availability essential drugs– Ensure drug safety, efficacy, quality– Ensure good dispensing/prescribing– Promote rational use through provision

of necessary training, education and information

– Promote the concept of individual responsibility for health, preventive care and informed decision-making


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Economic objectives– Lower cost of drugs in private and public

sectors– Promote the cost-effective and rational

use of drugs– Establish a partnership between

government bodies and private providers

– Optimise the use of scarce resources

Objectives of the South African National Drug Policy


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Objectives of the South African National Drug Policy

Development objectives– Improve knowledge, efficiency, management

skills– Reorient medical, pharmacy and paramedical

education– Support the development of local industry and

local production of essential drugs– Promote the acquisition, documentation and

sharing of knowledge and experience


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Interests of Different Stakeholders

National governments Pharmaceutical industry International organisations Health professionals Ngos Consumers Insurers


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Current Trends and Challenges

Reduced role of government– Reductions in public sector spending exacerbate

access problems – Social solidarity and support to the public sector

is less of a priority – More difficult to control and regulate – Move from public to private has been

accompanied by reduced government regulatory control of pharmaceuticals (eg Latin America)

– Focus on private/public partnership can disrupt priority setting


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Increased role of the private sector (The private sector includes private pharmacies drug

sellers, private not-for-profit ngos and the informal or illegal sector)

– many drugs exchange hands through market stalls or are sold again after being prescribed

– private sector harder to regulate/control /influence than public sector

– Improving drug use and implementing ED concept in the informal and illegal sectors is hard


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Trends and challenges

Promotion to prescribers and consumersMassive increase in dtca (relaxation of

regulations worldside)

137 million US$ on Claritin 93 million US$ Viagra*: to improve sexual

perfomance 75 million US$ on Xenical*: to reduce weight 57 million US$ on Zyrtec 54 million US$ on Zyban*: to quit smoking


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Changing relationships between professionals and consumers– Changing consumer expectations– Increased access to information– Tendency to look for technological

solutions to medicalise problems


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Changing morbidity and mortality patterns– Epidemiological transition– HIV/AIDS– Tuberculosis– Drug resistance


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Current trends and challenges

HIV AIDS – access to medicines Access to and appropriate use of

ARVs (antiviral market in 2002 over 10 billion and predictions for 17 billion by 2008

6 million in urgent need of ARV treatment in developing countries – about 400,000 being treated

Prequalification WTO


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400,000 people on treatment: 7% coverage

0

10

20

30

40

50

60

%

Source: UNAIDS/WHO, 2004

Antiretroviral therapy coverage for Antiretroviral therapy coverage for adults, adults,

end 2003 end 2003

Africa Asia Latin America and the Caribbean

Eastern Europe and Central Asia

North Africa and Middle East

2004 Report on the Global AIDS Epidemic (Fig 33)


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Source: UNAIDS/WHO, 2004

2 000

4 000

6 000

8 000

10 000

12 000

14 000

0

Pri

ce U

S$

Jun00

Oct00

Feb01

Apr01

Dec00

Nov00

Jul01

Mar03

Sep98

Aug98

Jul98

Oct03

Jun98

Sep03

Jan01

May01

Aug01

Mar10

Jun01

Launch of Acceleratin

g

Access Initia

tive (A

AI)

Negotiatia

tions with

R & D Pharma with

in AAI

Generic companies’ o

ffer of p

rice re

duction to

Uganda

Further p

rice re

ductions by AAI companies

Further d

iscussion with generic

companies

Negotiatio

ns by Willia

m J. Clinton

Foundation with

4 generic companies

Mar01

Apr01

Oct03

Jun01

May01

Feb01

Jan01

Dec00

Nov00

Jul01

600700800900

1 0001 1001 200

500

Pri

ce U

S$

400300200100

0

Prices (US$/year) of a first-line Prices (US$/year) of a first-line antiretroviral regimen in Uganda: antiretroviral regimen in Uganda:

1998−2003 1998−2003

2004 Report on the Global AIDS Epidemic (Fig 34)


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Millenium Development Goals – shared agenda but fragmented response WHO estimated scaling up to meet

targets needs at lease 77 billion by 2007

Variety of global inititiatives to increase resources – Global fund, Clinton fund, Gates fund.....

Coordination often lacking and country priority setting an issue


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Essential medicines concept – no less relevant – new strategy 2004 -2007

Additional emphasis on access Changed selection of list Role of traditional medicine Country support strengthened Focus on financing and supply

systems Consumer education for rational

drug use (PRDUC and country follow up)


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Summary

Double problem - poor access and irrational use

Health and drug policy inextricably linked Essential drug policy key public health

concept National drug policy framework crucial Many stakeholders/different interests Many new challenges and threats – HIV

AIDS

promoting rational drug use in the community

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