National Approach to the Rational Use of Medicines

1. National Approach to the Rational Use of Medicines Ph. BatoolJaffer Suleiman Director, Rational Use of Medicines MoH, Sultanate of Oman ICIUM Conference 2011, Antalya, Turkey 15 November 2011 The Omani Experience

3. Steps in Establishing DRUM Concern about misuse of medicines at all levels In 1996 a WHO Consultancy recommended that a team be established in MoH to monitor use of medicines. Minister of Health gave his full support A Ministerial Decree in April 2000 established an independent Directorate of Rational Drug Use (DRDU) reporting directly to the Under-Secretary of Health Affairs (in 2006 DRDU was renamed to DRUM)

4. Ministry of Health HE The Minister Undersecretary for Health Affairs Undersecretary for Administrative & Financial Affairs Undersecretary for Planning Affairs DRUM DGPA&DC DGMS Pharmaceutical Sector Partial organogram to show pharmaceutical sector of MOH including DRUM and the reporting relationships

5. 3 Core Functions of DRUM Training, Research & Publications. Examples • Induction courses & workshops for all cadres of health professional • Public Education Campaigns • Initial baseline studies • Intervention studies • Specific problem monitoring • Clinical audits • Oman National Formulary & Therapeutic Guidelines

6. Working Interrelationships

7. Prescribers (prior to 2000) • 81% were expatriates • Variety of backgrounds and training • No GPs were trained in RUM • No induction examination for GPs • Often face problems with local patients: LanguageAttitudes and beliefs • 4.5 average no. of drugs/prescription and 60% prescriptions contained an antibiotic

8. Pharmacists & Assistant Pharmacists • 72% & 49% were expatriates in 2000 • There were no clear job descriptions • Under-utilised resource • Weak on management skills • No clinical pharmacists before 2000 • Now 4 pharmacists/year are sent for training • Target was to have 1 CP / 50 beds by the end of health plan (2006 – 2010)

9. Public • Free medication, high demand & irrational use • Different levels of literacy • Strong traditional beliefs • No robust registration system at health facility level

10. Major Successes of National Approach on RUM • RUM now part of 5 year health plans • 34% of pharmacists & 37% of asst. pharmacists are expatriate (2010) • Reduction in average no. of drugs/prescription to 2.9-1.8 (2010) • 32% of public sector GPs trained in RUM (2010) • Prescriptions contained Antibiotic came down to 37%-15% (2010) • Publication of Oman National Formulary 2003 and 2009 • Publication of Oman Nurses Formulary (2008)

11. Major Successes cont’d • Handbook of pharmacotherapy guideline charts for common illnesses in PHC (2004: revised & reprinted 2011) • New guidelines issued for NSAIDs • Deletion of unsuitable medicines • Changes to the curriculum in pharmacy training • Specific job descriptions • Networking & collaborating with university, colleges, private sector, other institutions • Bi-annual newsletter “Pharmaco Logical” on Rational Use of Medicines

12. Major Successes cont’d • Now every new GP has to be examined at the time of recruitment on RUM (written & oral). • Financial analysis of PHC facilities • Gradually increasing awareness and acceptance of DRUM role • Establishing of an internet newsgroup for all RUM issues http://health.group.yahoo.com/group/rduoman

13. Lessons learnt • Political will and support • Mainstreaming RUM in health system: Dedicated department and national approach • Multiple interventions • To be seen as support rather than policing