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Ofori-Adjei D, Gyansa-Lutterodt M, Asiama D, Dodoo A, Aboagye-Nyame F, Osafo E, Arhinful D

The Role of a Comprehensive Pharmaceutical Sector Development Programme in Improving Rational Use Of Drugs: The Ghana Example. Ofori-Adjei D, Gyansa-Lutterodt M, Asiama D, Dodoo A, Aboagye-Nyame F, Osafo E, Arhinful D

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Ofori-Adjei D, Gyansa-Lutterodt M, Asiama D, Dodoo A, Aboagye-Nyame F, Osafo E, Arhinful D

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  1. The Role of a Comprehensive Pharmaceutical Sector Development Programme in Improving Rational Use Of Drugs: The Ghana Example Ofori-Adjei D, Gyansa-Lutterodt M, Asiama D, Dodoo A, Aboagye-Nyame F, Osafo E, Arhinful D Noguchi Memorial Institute for Medical Research, University of Ghana, Accra Ghana National Drugs Programme, Ministry of Health of Ghana and INRUD-Ghana

  2. Abstract The Role of a Comprehensive Pharmaceutical Sector Development Programme in Improving Rational Use Of Drugs: The Ghana Example Ofori-Adjei D1,3, Gyansa-Lutterodt M2,3, Asiama D2,3, Dodoo A3, Aboagye-Nyame F2, Osafo E2, Arhinful D1,3 1Noguchi Memorial Institute for Medical Research, 2Ghana National Drugs Programme and 3INRUD-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 labeled, % 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 (45% to 90%). There was worsening in the labeling 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 labeling could be attributed to the lack of attention of the GNDP on dispensing and clear guidelines on labeling, and these must be corrected.

  3. Introduction Pharmaceuticals constitute a major component of health care. In developing countries access to medicines is a major problem especially for the poor in society. Ghana started a programme based on the WHO concept of Rational Use of Drugs and developed its first Essential Drugs List in 1986. In 1994, a comprehensive review of the pharma-ceutical sector was undertaken with a view of developing a master plan for the development of the sector. In the development of the first Medium Term Health Strategy (MTHS), from1997 to 2001, of the Ministry of Health, significant attention was paid to the pharmaceutical sector. The Ghana National Drugs Programme (GNDP) was established for the implementation of the pharmaceutical component of the MTHS based on the master plan in 1997. The GNDP was established as a project with funding from the Royal Netherlands Embassy and was to run for 5 years. Subsequently, the status of the project was changed to a programme. 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 medicines are used in a rational manner. Thus, a major focus of GNDP activity was the promotion of the rational use of medicines. Ghana Experience

  4. 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 Rational Use of Drugs (RUD) focal persons for each of the 10 regions in the country. They had the respon-sibility to effect cascade training based on the PRDU course of INRUD, monitor and feedback drug use indicators to their respective health facilities. In addition to promoting the rational use of drugs, GNDP as the Secretariat coordinated key activ-ities in the pharmaceutical sector through implem-enting partners responsible for regulation (Food & Drugs Board), pharmacy practice (Pharmacy Council), procurement (Procurement Unit) and also supported traditional medicine (Traditional & Alternate Medicine). A baseline survey of the pharmaceutical sector was one of the first activities carried out by the GNDP. Prior to that, in 1993, MSH conducted a comprehensive survey of the sector. In 2002, in collaboration with the World Health Organisation, another survey of the sector was done. The methods used were not dissimilar from that used by MSH in 1993.

  5. Objective This study was undertaken to analyse changes in drug use indicators in the public sector since the initiation of the GNDP. The presentation also looks at trends in regional performance with regard to some indicators based on monitoring and feedback and cascade training activities of the Focal Persons. Method The study was designed as a retrospective analysis comparing the drug use indicator studies carried with a similar methodology in 1993 by MSH, 1998 by GNDP as a baseline and WHO/GNDP study in 2002. Health facilities were randomly selected from the 10 regions in the country based on ecological representation. The sampling of prescription followed that described in the WHO manual on “How to study drug use at health facilities”. Data collection for the 1998 and 2002 surveys was done by regional RUD Focal Persons who have received training in the WHO methodology. Ghana Experience

  6. Methods (2) The reports of the three surveys were reviewed and the following indicators compared: • Average number of drugs/encounter • % prescription with an antibiotic • % prescription with an injection • % drugs prescribed on the Essential Drugs List (EDL) • % drugs prescribed actually dispensed • % drugs adequately labeled • % adequate knowledge about prescribed drugs and • % availability of treatment guidelines In addition, the annual monitoring data of the regional focal persons from 1999 to 2001 were compiled. Ghana Experience

  7. Results Data were collected from regional and district hospitals as well as health centres. The 1993, 1998 and 2002 surveys covered 20, 49 and 20 health facilities respectively. The 1998 study covered public, mission and private health faci-lities. Apart from the 2002 study that covered 4 regions the rest covered five regions. However, the regions selected represented the ecological zones of the country and were representative of the zones. The data collected covered drug use indicators, procurement, distribution, storage, dispensing and pricing. This report will focus on the drug use indicators in the public sector. This is because it is the aspect that is common to all the three surveys. Not all the drug use indicators were measured in all the surveys. The main indicators are shown in Table 1. Ghana Experience

  8. Results (2) Comparing 1993/1998 data with that of 2002 (Table 1) showed some improvement in the average number of drugs (4.3 to 3.5), % antibiotic (46.6% to 42.5%), % injection (55.7 to 33.5), % drugs prescribed that were dispensed (86% to 91.2%) and an increase in the availability of treatment guidelines (45% to 90%). There was worsening in the labeling of drugs (12% to 0.18%) and no change in prescribing according to the EDL (95% and 94.2%). Figures 1 and 2 are examples of the pattern of change in indicators following monitoring and feedback of indicators to health providers in the regions. Examination of the 1998 survey, the most comprehensive of the three studies, shows differences in the drug use indicators in public, mission and private health facilities. Figure 3 shows the differences noted. Injection use was highest in private (54%) than public (42%) and mission (28%) health facilities; while the use of antibiotics were highest in public facilities (56%) followed by mission (52%) and private facilities (48%) for outpatient encounters. Ghana Experience

  9. Table 1: Drug Use Indicators across surveys Ghana Experience

  10. Figure 1: Changes in Average Number of Drugs Prescribed by Region from 1999 to 2001 Ghana Experience

  11. Figure 2: Changes in % Injection Exposure by Region from 1999 to 2001 Ghana Experience

  12. Figure 3: Drug Use Indicators and Type of Facility Ghana Experience

  13. Conclusions The data suggest an improvement in the prescri-bing indicators between 1998 and 2002. The deterioration in labeling could be attributed to the lack of attention of the GNDP to dispensing prac-tices and clear guidelines on labeling. The deci-sion to invest in the training and re-training of the regional focal persons, providing funding for casc-ade training and monitoring appears to have cont-ributed to the observed improvements in some of the regions. Future activities would include the strengthening of Drugs and Therapeutics Committees to further improve on the rational use of medicines at both inpatient and outpatient levels. Acknowledgement These surveys were funded by MSH/RPM Project, The Royal Netherlands Embassy in Accra through the MoH/GNDP and the World Health Organisation. The surveys would not have been possible but for the immense contributions of members of INRUD-Ghana and the regional focal persons. Ghana Experience

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