Developing Essential Drugs Policies

A Guide for NGOs





created by

Health Action International (HAI)-Europe

in collaboration with an

international NGO working group

April 1998



This document may be reprinted without permission.

However, credit should be given to HAI-Europe.


Contents

Background

1. Introduction

2. Developing Essential Drugs Policies for NGOs

3. Where to Obtain Additional Information

4. Key Resources

5. Acknowledgements



Background

This introduction to non-governmental organisation (NGO) drug policies is the result of the work of an NGO Working Group (see Acknowledgements) that saw the need to clarify a number of issues surrounding essential drugs in NGO work. The specific goals of the group were to:

* ensure that internationally agreed standards are translated into appropriate terms for NGOs;

* highlight the components of drug policy that will ensure a sustainable supply of safe and effective drugs and their proper use;

* encourage regular policy review;

* discuss some of the problems and dilemmas which NGOs face in this area;

* provide information about organisations, networks, training opportunities and documentation to support development and implementation.

A first draft of this paper was widely circulated and used during 1996 and 1997. This revised version includes many suggestions from NGOs and individuals who reviewed or used the earlier draft.



1. Introduction

This booklet is an introduction to essential drug policies for NGOs working on health service delivery in developing regions. It is intended for NGO staff working in policy and management positions at regional- or country-levels who could develop and implement an essential drugs policy for their organisation. This booklet is not a comprehensive guide to policy development, nor does it seek to provide the information necessary to develop and manage pharmaceutical projects or programmes.

Section one sets out the basic principles of the essential drugs concept. Section two outlines the key considerations that NGOs should address in developing their own essential drugs policies. It also includes questions that donors should consider in supporting NGO work in pharmaceutical supply. Sections three and four contain a list of contact organisations and references that will enable NGOs to get additional information and technical support.

An essential drugs framework

In 1977, the World Health Organization (WHO) published the first WHO Model List of Essential Drugs. This original list identified some 220 essential drugs that a country could use to meet the majority of its people's health problems calling for drug solutions. Since that time, the list has been updated on a regular basis and, when necessary, expanded. It serves as a model for countries in developing their own national lists. At the same time, an essential drugs list is just a starting point. It needs to be developed together with other policies to ensure that essential drugs are effectively managed and used.

For the past 20 years, WHO has advised countries to base their drug policies on the essential drugs concept. This concept stresses the selection of drugs to meet real public health needs. WHO emphasises that all drugs chosen should be safe, effective, affordable and of acceptable quality. The essential drugs concept implies efficient management of the drug supply and rational use. To date, 51 countries have developed and adopted national drug policies based upon the WHO model and three dozen more countries are in the process of doing so. In addition, more than 140 countries now use an essential drugs list.



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

- The Use of Essential Drugs, WHO (1990)



Strengthening NGO effectiveness

Essential drugs policies are based on the WHO essential drugs list and concept. These policies provide the framework for an adequate supply of safe and effective drugs of good quality, at a reasonable price and help to ensure that they are properly prescribed and used. Policies based on the WHO essential drugs concept can help to ensure that scarce resources are well spent and that the best possible use is made of money, medicines and human resources. Essential drugs policies provide a framework which helps to ensure wide access to effective and safe drugs of good quality at low cost.

The essential drugs concept is not only useful at the national level. Its combination of ideas on correct treatment and good management can also be used by local programmes, by hospitals and by NGOs as a framework for developing specific policies for organisations or programmes.

Essential drugs policies based on the WHO concept can also enable NGOs to use their limited resources to manage drugs effectively and meet priority needs. An essential drugs policy can help NGOs provide improved information, education and training, as well as more efficient supply, storage and distribution of drugs. While many NGOs have advocated the adoption of the WHO essential drugs concept by governments, only a few have integrated it systematically into their own practice.

The costs of inefficient drug management are high, while the benefits in terms of better and more cost-effective treatment can be considerable. The potential gains extend beyond the scope of individual NGOs. If more NGOs were to implement the essential drugs concept it would be easier to organise joint services. In Kenya, Nigeria and India, for example, specialised units already undertake joint procurement, training and support for NGOs. Such groups can also link together internationally to gather information and influence policies affecting the welfare of the people they serve.



Advantages of Having an Essential Drugs Policy

One NGO's Experience

ECHO International Health Services is an NGO, non-profit, medical supply agency which supplies US$4 million worth of pharmaceutical supplies each year for use by other NGOs and national governments around the world. Its staff members have found that developing a clearly stated drugs policy has several advantages:

Uses limited resources well

It helps to protect the end users from financial exploitation and misuse of scarce resources.

Promotes rational drug use messages

Such a policy facilitates discussions with clients and donors on the rational use of drugs in various health care settings, often allowing either much better value for the money available or a reduction in budget requirements.

Assists the development of standards

It helps to encourage the use of standard treatment protocols and rational prescribing policies.

Eliminates confusion

The policy can be clearly stated to clients and donors so that there is no confusion about how ECHO is prepared to help.

Provides clear guidelines for decision making

It justifies the rejection of inappropriate requests or donations even when clients or donors are not willing to engage in a discussion of the reasons behind the policy.

Suggests appropriate funding activities

Using this type of policy as a framework helps ECHO to advise donors who have collected funds but are not sure what kind of drugs to send.

Contributes to sound financial decisions

It provides a solid basis for financial decisions about which products to offer, which should take priority and which are most likely to be in demand or available at lower cost.

-Compiled by Carolyn Green, Senior Pharmaceutical Adviser,

ECHO International Health Services, United Kingdom



2. Developing Essential Drugs Policies for NGOs

Policies based on the essential drugs concept should match the circumstances and needs of different organisations. They must be clear and practical and should be useful in planning, implementing and evaluating health projects. They should take into account the fact that drug supply is a complex process and each stage of the process needs to be critically examined and well managed. The scope and detail of the policy guidelines will depend on the nature of the NGO involved and the answers given to the following questions:

In what way is the NGO involved in supplying drugs or providing funding for drugs?

What type of training and advocacy work does the NGO carry out regarding drugs and drug policy?

Does the organisation already have a drug policy? Does it need review?

This section identifies and describes key considerations that should be the basis of discussions to develop overall drug policies and essential drugs policy guidelines that are appropriate to an NGO's mandate. The process of developing an essential drugs policy will be different for each NGO. It will depend on the scope and scale of the organisation's operations. For example, an NGO involved in operational work at the country level will need to have detailed systems in place to deal with each component of a drug policy. Ensuring that policies are in line with, and supportive of, national essential drug policies is important. Partnership, collaboration and cooperation are essential for successful policy implementation.

For NGOs providing drugs or funding for drugs to partner organisations in other countries, the policy may be based largely on the need to assess requests for funds and evaluate the implementation of projects. A series of questions are provided at the end of the section that are designed to help NGO and other types of donors assess funding requests using an essential drugs framework.

Assessing needs

Drug policies should reflect overall health priorities and objectives. If drugs are provided without knowledge of the national/regional policy it is possible that the aid provided will undermine national policy or national regulations. In addition, an assessment of the specific local health needs will determine which drugs are selected. If drugs are purchased or provided without adequate knowledge of local health needs there is every chance that money will be wasted on inappropriate drugs and incorrect dosages or quantities. The WHO Drug Action Programme on Essential Drugs (DAP) has details of all national drug policies and publishes a regularly updated list of therapeutic guidelines and national essential drugs lists. In addition information about simple methods of estimating drug requirements can be obtained from the WHO-DAP. (See section 3 for details.)

Drug selection

As well as saving on costs, working with a limited list of essential drugs makes it easier both to quantify needs and to procure and manage drugs more efficiently. Staff members are better able to understand the drugs they are prescribing because there are fewer of them. The limited number also makes it easier for them to communicate this understanding to each other and to patients. An essential drugs list provides a firm foundation on which to introduce standard treatment guidelines, and for training and evaluation of performance.

National essential drugs lists, where they exist, should guide the choice of drugs. Where no national list exists, the most recent version of WHO's Model List of Essential Drugs can be used (see section 4). Different levels of the health care system have different requirements. Provincial or district-level facilities will require a fuller list whereas 20 or 30 drugs might be selected for use at the primary health care level. Where drug supply is extremely limited, the WHO Emergency List can be adapted for use at the primary level. Details of this list can be found in WHO's New Emergency Health Kit (see section 4). These two documents are invaluable resources.

Procurement

Choose Generics

In general, drugs on the essential drugs list should be generic products; any exceptions to this rule should be justified. Generic drugs are no longer patented. Their risks and benefits are well understood because they have been tried and tested over many years. Because they are not sold under patent they are also usually cheaper than brand-name drugs.

The use of generic names should be encouraged at all stages of procurement, distribution, prescribing and use. Using generic names avoids the possibility of confusion leading to duplication of active ingredients when several drugs are used at the same time. They also simplify training, enabling staff and patients to better recognise and understand the drugs they use.

Bulk Packaging

Bulk packages are much cheaper than small packs but they cannot be used in all circumstances.

Location of Manufacture

This can be a difficult problem for those involved in choices about drug purchasing. If a local industry is producing good quality drugs at competitive prices then that may be a strong reason to purchase drugs locally. However, problems can arise if either the prices are not competitive or if the quality of the locally produced products is in doubt. Drugs which do not meet the required quality standards should not be bought simply to support local manufacturing. Fortunately, a growing number of national and international NGO, low-cost suppliers are an excellent source of reasonably priced drugs of acceptable quality.

Assessing quality

The quality of drug manufacturing is difficult to assess and requires the work of professionals. Some manufacturers, local or foreign, produce drugs with little regard for quality or real costs. Poor control in the manufacturing process can easily produce drugs that do not meet acceptable standards. If the quality of drugs available on the open market is not reliable and if insufficient attention is paid to quality assurance then substandard drugs may be bought which could be dangerous and/or useless.

Factory inspections and laboratory testing are part of systems to assure quality. Laboratory testing has a useful role in quality assurance, but it is expensive, time consuming and often the necessary facilities are not available. It is important therefore to incorporate other aspects of quality assurance.

Get to know your suppliers and exchange information with other NGOs. Every effort should be made to buy drugs from an established, experienced, low-cost supplier. This may be a central medical store, a recognised NGO supplier or a reliable commercial company. The WHO operates a certification scheme which can be used to obtain information about manufacturers and whether or not a drug is used in the country of manufacture.

In general, it is risky to buy drugs on the open market especially from unknown suppliers. It is useful to check where each drug was manufactured and ask to see a sample before making a purchase. The quality of the labelling may help you to know whether the drugs are fake or not - look out for slight spelling mistakes, odd looking addresses and extra labels pasted over old ones. If you have any suspicions do not buy the goods.

Always inspect newly purchased drugs and carry out some basic tests to help identify substandard products. Re-check the labels and ensure that the following are clearly legible: generic name, manufacture and expiry dates, batch numbers, storage requirements, manufacturer's name and address. Check the contents for appearance, looking out for breakages, discoloration, excessively powdery tablets or capsules, injection solutions that are cloudy when they should be clear and so on. Staff should also identify inadequate or damaged packaging. Do the contents of the package look fit for use? Labels should be checked to see if the generic name, the expiry date, and the name and address of the supplier are legible. Is adequate information supplied?

Management, storage and distribution of drugs

Inadequate attention to the management of drugs can result in heavy financial losses. Inventory mistakes leading to understocking or overstocking can be very expensive. The distribution network often develops in a somewhat haphazard way. With better planning of storage points and transport, and with improved inventory control and record keeping, waste in terms of drugs and other supplies, transport and staff time can be kept to a minimum. Donor NGOs can help to ensure that money on pharmaceuticals is well spent by making sure that sufficient funds are allocated to management training activities.

Financing a sustainable drug supply

The cost of drugs and supplies can absorb between 20-40 percent of health budgets and this is a recurrent cost which may require access to foreign exchange. Deciding how to meet these costs is a high priority.

The first step should be to ensure that waste is reduced and that the best possible use is made of the money available. Good assessment, procurement and distribution systems will all reduce waste, as will education and training for prescribers and consumers and the use of treatment guidelines.

If it is necessary to charge fees to recover drug costs and maintain a regular supply of drugs, steps should be taken to ensure that access to care is not seriously inhibited. Often those who are least able to pay are exempted from charges. Many NGO health programmes have experience in administering revolving drug funds. Various options for user charges and other mechanisms for co-payment can be considered. Pre-payment insurance schemes can provide an alternative.

Controlling drug donations

It has become increasingly apparent during the past 10 years that donations of medicines can create more problems than they solve. While some donations are generous and appropriate, many are sent without knowledge of the needs of the recipients or an understanding of the conditions in which they will be used. In many cases, donated drugs are unusable and therefore have to be destroyed. Getting rid of unwanted drugs involves pharmacists or other personnel in dangerous, time-consuming incineration procedures as well as in unnecessary costs.

Donations are given in several ways. Some consist of unused drug samples and returned prescription medicines which are collected by pharmacies in many European countries for redistribution abroad as gifts. In addition, some national governments offer tax incentives to companies donating medicines. Often these medicines are approaching their expiry date when they are sent as donations.



The Consequences of Inappropriate Drug Donations: Two Country Examples

Eritrea 1989

During the war for independence, despite the careful wording of appeals, many inappropriate donations were received. Examples included seven truck-loads of expired aspirin tablets that took six months to burn and 30,000 half-litre bottles of expired amino-acid infusion that could not be disposed of anywhere near a settlement because of the terrible smell.

Former Yugoslavia 1994-1995

Of all the donations received by the WHO field office in Zagreb in 1994, 15 percent were completely unusable and 30 percent were not needed. By the end of 1995, 340 tons of expired drugs were stored in Mostar. Most of these were donated by different European nations.

-Guidelines for Drug Donations (WHO-DAP 96.2)



Unfortunately, inappropriate drug donations are common. NGOs such as the World Council of Churches and the International Committee of the Red Cross have led an international effort to improve the standard of donated drugs. Recently WHO published the Guidelines for Drug Donations that have been endorsed by many of the major humanitarian organisations active in emergency relief. These guidelines are built around four core principles:

* All donations should be based on an expressed need and unsolicited donations should be discouraged;

* A donation should be given with full respect for the wishes and authority of the recipient;

* There should be no double standards in quality. If the item is unacceptable in the donor country, it is also unacceptable as a donation;

* There should be effective communication between the donor and the recipient.

These guidelines have been developed to be useful for both donors and recipients. NGOs can promote their use and can incorporate the principles into their own drug policies.

The Guidelines can be obtained from WHO-DAP (see section 4).

Drugs for use in emergencies

In an emergency, clear policy guidelines are even more crucial. Supplying drugs in an emergency requires care and detailed planning. It is very important that the drugs supplied are the ones which are most needed. Inappropriate donations can cause confusion and hamper the efficiency of an emergency operation. The use of special pre-packaged emergency health kits may often be the most appropriate option for the period of the emergency. Details of emergency kits are given in The New Emergency Health Kit (see section 4).

Rational use of drugs

Making sure that the correct drugs are prescribed, dispensed and are used appropriately is of great importance. Efforts put into making sure that essential drugs are available can be wasted if the drugs are not properly used. The essential drugs list, formularies and therapeutic guidelines are important tools but they will have little impact unless they are developed with the involvement of those who will use them and are accompanied by training, supervision and evaluation. Recent studies have shown that the quality of dispensing is often very poor. In many countries, prescribing and dispensing time can be measured in seconds and often no time is taken to explain the drug and use with patients.

Monitoring how drugs are used can be easily assessed using methods described in the WHO manual How to investigate drug use in health facilities (see section 4).

Appropriate labelling

All drugs should be clearly labelled in easily read print using the generic name. Labels should be accompanied by clear and correct information for the prescriber, the storekeeper/dispenser and the patient. The label should always include the expiry date. Label information should be written in the local language or in another language understood in the region. Sometimes getting translations of labels takes additional time, but it will help ensure health workers know how to use the drugs correctly.



Labelling

Drugs procured for Georgia and Azerbadjan by Médecins Sans Frontières were relabelled in Russian by the International Dispensary Association (IDA) which supplied the drugs. This involved a delay of about one month but it helped to ensure that health workers knew how to use the drugs correctly.

-Information collected by Erik Schouten, Médecins Sans Frontières/Health Net International



Evaluating Funding Requests from NGOs

Some NGOs involved in drug supply provide funding to other NGOs. The questions below are designed to help donor NGOs apply an essential drugs framework in evaluating funding requests. These questions would be applicable and useful for any donor that funds drug supply programmes or projects.

1. What is being requested and for whom?

2. Has there been an assessment of needs?

3. Do the requests match national or local essential drugs lists?

4. Are generic drugs used wherever possible and are generic names used?

5. How does the donor or the recipient assure the quality of the drugs?

6. What level of expertise does the project's staff have?

7. Would additional training or technical support contribute to better management of drugs?

8. Are there adequate facilities for storage and distribution of drugs?

9. What will happen after this supply of drugs has been used?

10. How will the recipients dispose of/destroy any unwanted or unusable drugs?

11. How will the way the drugs are used be monitored?

12. Are there ways in which the project can be helped to become sustainable?

13. Is there a danger that the project might undermine the sustainability of other existing projects?



3. Where to Obtain Additional Information

A comprehensive list of the many organisations working in this field cannot be given, but the following organisations (which are listed in alphabetical order) are a good starting point for anyone working on essential drugs policies. Any of these contacts will provide support, suggestions and information for NGOs involved in drug policy or the provision of essential drugs.

Extra copies of this publication can be obtained from HAI-Europe.

CMC Churches' Action for Health/ World Council of Churches

The CMC works with church-related health institutions and NGOs involved in drug supply and the promotion of rational use of drugs. CMC has worked towards the rationalisation of drug donations and has developed guidelines for drug donations and equipment donations.

CMC Churches' Action for Health/World Council of Churches

P.O. Box 2100

CH-1211 Geneva 2

SWITZERLAND

tel: (+41-22) 791 6061/791 6111

fax: (+41-22) 791 0361

and

The Pharmaceutical Programme

CISS International (Community Initiatives Support Services)

P.O. Box 73860

Nairobi

KENYA

tel: (+254-2) 729 095

fax: (+254-2) 711 918



ECHO International Health Services

ECHO is a non-profit, non-commercial, self-financing medical supply agency committed to providing quality-assured, affordable medical supplies, essential drugs and new or reconditioned medical equipment for health care programmes in developing countries and for disaster relief.

ECHO International Health Services

Ullswater Crescent

Coulsdon

Surrey CR5 2HR

UNITED KINGDOM

tel: (+44-181) 660 2220

fax: (+44-181) 668 0751

e-mail: CS@ECHOHEALTH.ORG.UK



Essential Drugs Project

This organisation was set up by several UK NGOs to promote equitable access to essential drugs and the rational use of all drugs. It provides support and advice to health agencies and NGOs in the UK and collaborates with individuals, groups and networks internationally on a wide range of issues.

Essential Drugs Project

77 Lee Road

Blackheath, London SE3 9EN

UNITED KINGDOM

tel/fax: (+44-181) 318 1419

e-mail: EDP@GN.APC.ORG



Health Action International (HAI)

HAI is a global network of health, development, consumer and other public interest groups in more than 70 countries working for a more rational use of medicinal drugs. HAI represents the interests of consumers in drug policy and believes that all drugs marketed should be acceptably safe, effective, affordable and meet real medical needs.

HAI has three regional coordinating offices:

HAI-Europe

Jacob van Lennepkade 334-T

1053 NJ Amsterdam

THE NETHERLANDS

tel: (+31-20) 683 3684

fax: (+31-20) 685 5002

e-mail: info@haiweb.org



HAI Clearinghouse/Action for

Rational Drug Use in Asia (ARDA)

c/o Consumers International

P.O. Box 1045

10830 Penang

MALAYSIA

tel: (+60-4) 229 1396

fax: (+60-4) 228 6506

e-mail: CIROAP@PC.JARING.MY



HAI/AIS Latin America

Oficina de Coordinación AIS LAC

Aptdo. 41-128

Lima

PERU

tel/fax: (+51-1) 346 1502

e-mail: AIS@AMAUTA.RCP.NET.PE



International Dispensary Association (IDA)

IDA was set up to support health care initiatives in developing countries on a non-commercial basis by supplying high-quality medicines and medical supplies at the lowest possible price.

International Dispensary Association

Postbus 37098

1030 AB Amsterdam

THE NETHERLANDS

tel: (+31-20) 403 3051

fax: (+31-20) 403 1854

e-mail: IDA_SALE@EURONET.NL





International Network for the Rational Use of Drugs (INRUD)

INRUD works through research and training to promote rational drug use. It can provide particular help for those wishing to develop research or training programmes. INRUD does not supply drugs.

International Network for the Rational Use of Drugs

1655 North Fort Myer Drive, Suite 920

Arlington, VA 22209

UNITED STATES

tel: (+1-703) 524 6575

fax: (+1-703) 524 7898

e-mail: INRUD@MSH-DC.ORG



International Society of Drug Bulletins (ISDB)

ISDB encourages the development of high-quality, independent information about drugs and therapeutics and supports the work of independent drug bulletins all over the world. The organisation provides training, information exchange and support for organisations involved in information provision on drugs.

ISDB

P.O. Box 459

75527 Paris Cedex 11

FRANCE

tel: (+33-1) 4700 3320

fax: (+33-1) 4700 2864

e-mail: ISDB@COMPUSERVE.COM



Management Sciences for Health (MSH)

This non-profit organisation supports the development and application of management principles in primary health care and other medical fields. It works with government ministries, international agencies, private organisations and local agencies in more than 50 countries to find solutions to public health problems. MSH has created a 'Drug Management Program' which works with managers and policy makers in developing countries to develop new systems and maximize therapeutic benefits while minimizing costs. It provides technical assistance and training in the areas of procurement, logistics, rational use, finance and management information systems.

Management Sciences for Health

Drug Management Program

1655 North Fort Myer Drive, Suite 920

Arlington, VA 22209

UNITED STATES

tel: (+1-703) 524 6575

fax: (+1-703) 524 7898

e-mail: RPM@MSH-DC.ORG



Médecins Sans Frontières (MSF)

MSF focuses on relief in emergency areas. In addition, they produce several valuable publications.

Médecins Sans Frontières

Max Euweplein 40

1017 MB Amsterdam

THE NETHERLANDS

tel: (+31-20) 520 8700

fax: (+33-20) 620 5170



United Nations Children's Fund (UNICEF)

UNICEF has been active in providing support to governments regarding the acquisition, storage, distribution and rational use of essential drugs. The agency's supply division organises the purchasing of such drugs at low prices.

UNICEF Supply Division

UNICEF Plads-Freeport

DK-2100 Copenhagen

DENMARK

tel: (+45-3) 527 3527

fax: (+45-3) 526 9421

e-mail: SUPPLY@UNICEF.DK



World Health Organization (WHO)

Action Programme on Essential Drugs (DAP)

The Action Programme on Essential Drugs has played a major role in developing and promoting the essential drugs concept. It works to promote the development of national drug policies and to provide leadership and advocacy on drug issues. The programme's staff produces a wide range of materials.

World Health Organization

Action Programme on Essential Drugs

20 Avenue Appia

CH-1211 Geneva 27

SWITZERLAND

tel: (+41-22) 791 2111

fax: (+41-22) 788 0196

e-mail: DAPMAIL@WHO.CH



WHO Division of Drug Management and Policies (DMP)

This division is responsible for programmes in the areas of drug quality and information on safety and efficacy.

World Health Organization

Division of Drug Management and Policies

20 Avenue Appia

CH-1211 Geneva 27

SWITZERLAND

tel: (+41-22) 791 2111

fax: (+41-22) 791 0746



4. Key Resources

The following publications all provide information on various aspects of rational drug use and essential drugs. Copies of the material should be requested directly from the publishers listed. Unless noted, these publications are available only in English. A price indication is given when possible.

General

Managing Drug Supply

Management Sciences for Health (1997)

Available from Kumarian Press, Inc. 14 Oakwood Avenue, West Hartford, CT 06119-2127, USA

This newly revised edition provides a complete overview as well as step-by-step approaches on how to manage pharmaceutical systems effectively.



National Drug Policy

Report of the WHO Expert Committee on National Drug Policies

Ref. no. WHO/DAP/95.9

WHO (1995)

English/French

Available from WHO-DAP

Free of charge

The guidelines cover the major components of drug policy and are intended to provide general principles and strategies that should be adapted to country needs.



Selection and Use

Estimating Drug Requirements. A Practical Manual

Ref. no. WHO/DAP/88.2

WHO (1988)

English/ French/Spanish

Available from WHO-DAP

Free of charge

The manual consists of eight training modules which explain the various steps necessary to estimate drug requirements.

The Use of Essential Drugs. Model List of Essential Drugs

(Ninth List, Seventh Report of the WHO Expert Committee)

Technical Report Series No. 867

WHO (1997)

English/ French (Russian and Spanish versions to be published shortly)

Available from WHO-DAP

Price: Sw. fr. 15-/US$13.50, in developing countries Sw. fr. 10.50

The Model List is intended to guide the selection of drugs in situations where the need is great and the resources are small. The list includes information on route of administration, dosage forms, and strengths for some 300 essential drugs.



British National Formulary

Jointly published by the British Medical Association and the Royal Pharmaceutical Society of Great Britain.

Available from the Pharmaceutical Press, P.O. Box 151, Wallingford, Oxon. OX10 8QU, UK or from booksellers. Low cost edition for developing countries available from TALC (Teaching Aids at Low Cost) P.O. Box 49, St Albans, Herts, AL1 5TX, UK.

Price: UK£5-/US$8.35 plus postage and packing.

This standard UK prescribing manual gives treatment guidelines and UK prescribing costs of generics and branded medicines. It is published twice a year.



Clinical Guidelines Diagnostic and Treatment Manual

Médecins Sans Frontières

English/ French/Spanish/Russian/Arabic/Portuguese

Available from MSF-The Netherlands (see section 3)

Price NLG 25-/US$12.50



Guidelines to Rational Drug Use

von Massow, Ndele, Korte

Macmillan (1997)

Available from TALC, P.O. Box 49, St Albans, Herts, ALI 5TX, UK or from booksellers

ISBN 0-333-69922-X

Price UK£6.95/US$11.61

Standard treatment guidelines and cost comparisons for essential drugs for developing country use.



Problem Drugs

A. Chetley

HAI/ZED Books (1995)

Available from Health Action International (see section 3)

English/Spanish (French and Russian versions to be published shortly)

Price: NLG 40-/US$20; reduced rates for groups in developing countries

Covers 10 categories of medicines which are commonly used inappropriately. It contains detailed information on the "problem drugs" currently being marketed together with recommendations for action.



How to investigate drug use in health facilities; selected drug use indicators

Order no. 1930049

WHO (1993)

English/French/Spanish

Available from WHO-DAP (see section 3)

The manual describes a simple standard methodology for gathering essential data on drug use patterns and prescribing behaviour in health facilities.



How to investigate drug use in communities

Ref. no. WHO/DAP/92.3

Hardon, Brudon-Jakobowicz, Reeler

WHO (1992)

English/French

Available from WHO-DAP (see section 3)

This guide provides simple research methods to identify problems in the provision and use of drugs at the community level.



Supply and Marketing

MSH International Drug Price Indicator Guide

Produced annually by Management Sciences For Health (see section 3)

Single copies available free of charge

A regularly updated list which provides an indication of the current generic prices from non-profit suppliers on the international market.



The New Emergency Health Kit

Order no. 1930018

WHO (1990)

English/Spanish/French

Available from WHO-DAP (see section 3)

Price: Sw.fr.8-/US$2.86, in developing countries Sw.fr. 5.60

This booklet provides information on the development of the kit, now adopted by many organisations as a reliable, inexpensive, appropriate and quickly available source on the essential drugs and equipment urgently needed in a disaster situation. It provides a description of the kit's contents, treatment guidelines and some useful checklists for suppliers and users.



Guidelines for Drug Donations

Interagency Guidelines

Ref. no. WHO/DAP/96.2

WHO (1996)

English/ French/Russian/Spanish

Available from WHO-DAP (see section 3)

Free of charge

WHO has developed these Guidelines in collaboration with the major relief organisations. They can help both donors and recipients to maximise the potential benefits of drug donations.





Guidelines on Equipment Donations

CMC Churches' Action for Health/World Council of Churches.

Available from CMC (see section 3)

English/French/Spanish/Portuguese

Developed to help donors and recipients maximise the potential benefits of donations of medical equipment.



Ethical Criteria for Medicinal Drug Promotion

WHO (1988)

Arabic/Chinese/English/French/Russian/Spanish

Available from WHO-DAP (see section 3)

Price: Sw.fr.. 8-/US$2.86, in developing countries Sw.fr. 5.60

The criteria give manufacturers, prescribers and NGOs a framework to ensure that promotional practices are in keeping with acceptable ethical standards.



E-Drug electronic conference

Today approximately 700 health professionals have subscribed to this electronic network that focuses on essential drugs and related topics. No costs are involved and interested individuals can sign up by sending an e-mail message to: MAJORDOMO@USA.HEALTHNET.ORG

with the following text in the body of the message:

subscribe e-drug <your e-mail address>

The subject heading should be left blank.



Newsletters

Contact

This bi-monthly publication highlights various activities on rational drug use and often contains full reprints of new guidelines and other material. Subscription information available from: CMC/Churches' Action for Health/World Council of Churches (see section 3).

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The Essential Drugs Monitor

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5. Acknowledgements

Members of the International NGO Working Group (1995-7)

* Carolyn Green, ECHO International Health Services Ltd., United Kingdom

* Ellen 't Hoen and Catherine Hodgkin, Health Action International (HAI)-Europe

* Eva Ombaka, the Pharmaceutical Programme CISS International (World Council of Churches), Kenya

* Philippa Saunders, Essential Drugs Project, United Kingdom

* Erik Schouten, Médecins Sans Frontières/HealthNet International, The Netherlands



HAI-Europe would like to thank the following people for providing comments on various drafts of this publication:

Christel Albert-Misereor E.v., Germany

K. Balasubramaniam-CI/ARDA/HAI-Asia, Malaysia

Wilbert Bannenberg-Consultants for Health and Development, The Netherlands

Pascale Brudon-Jacobowicz-WHO-DAP, Switzerland

Carinne Bruneton-PIMED, France

Sr. Joan Devane-MEDS, Kenya

Andrew Herxheimer-Cochrane Collaboration/ISDB, United Kingdom

Hans Heuvelmans-Médecins Sans Frontières, The Netherlands

Lis Jorgensen-IBIS Health Group, Denmark

Richard Laing-Center for International Health/Boston University, United States

Leo Locher-Medico International, Germany

Roberto Lopez Linares-AIS, Peru

Kurt Markwalder-Swiss Red Cross, Switzerland

Albert Petersen-DIFAM, Germany

Eric Ram-World Vision International, Switzerland

Diana Smith-CMC/World Council of Churches, Switzerland

Mark Weber-Swiss Red Cross, Switzerland

Karin Wiedenmayer-Swiss Tropical Institute, Switzerland



This document was produced with support from the European Commission, DG-VIII.



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