Promoting quality use of medicines in South-East Asia: reports from country situational analyses

Kathleen Anne Holloway,Sauwakon Ratanawijitrasin,David Henry,Budiono Santoso,Anita Kotwani,Gitanjali Batmanabane

doi:10.1186/s12913-018-3333-1

Abstract

BackgroundIrrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. The aim was to determine whether public-sector QUM is better in SEAR countries implementing essential medicines (EM) policies than in those not implementing them.MethodsData on six QUM indicators and 25 EM policies were extracted from situational analysis reports of 20 country (2-week) visits made during 2010–2015. The average difference (as percent) for the QUM indicators between countries implementing versus not implementing specific policies was calculated. Policies associated with better (> 1%) QUM were included in regression of a composite QUM score versus total number of policies implemented.ResultsTwenty-two policies were associated with better (> 1%) QUM. Twelve policies were associated with 3.6–9.5% significantly better use (p < 0.05), namely: standard treatment guidelines; formulary; a government unit to promote QUM; continuing health worker education on prescribing by government; limiting over-the-counter (OTC) availability of systemic antibiotics; disallowing public-sector prescriber revenue from medicines sales; not charging fees at the point of care; monitoring advertisements of OTC medicines; public education on QUM; and a good drug supply system. There was significant correlation between the number of policies implemented out of 22 and the composite QUM score (r = 0.71, r2 = 0.50, p < 0.05).ConclusionsCountry situational analyses allowed rapid data collection that showed EM policies are associated with better QUM. SEAR countries should implement all such policies.

Highlights

Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low
Data were extracted from 20 situational analysis reports covering all 11 countries of the World Health Organisation (WHO) South-east Asia region – two reports from eight countries in different years, two reports from India and one report each from two countries (Democratic Peoples’ Republic [DPR] of Democratic Peoples’ Republic of Korea (Korea) and Indonesia)
QUM data for all six indicators were extracted from 15 country-visit reports, with 1–2 QUM variables missing from four reports, and 5 out of six QUM indicators missing from one early report (Bangladesh 2010)

Summary

Introduction

Irrational use of medicines is widespread in the South-East Asia Region (SEAR), where policy implementation to encourage quality use of medicines (QUM) is often low. Since 2010 South-East Asian countries of the WHO have been undertaking 4-yearly rapid situational analyses of how medicines are used and managed with a view to developing a more integrated, coordinated health systems approach to promoting better QUM [21]. This process consists of rapid systematic data collection on medicines use and policy implementation by a multidisciplinary government team of four to eight people over 2 weeks using a predesigned workbook tool and ending with a national workshop to identify priorities for action [21]. The workbook tool (Additional file 2) builds on other tools [14, 23, 24] and was developed by WHO/SEARO during situational analyses done in 11 countries during 2010–13 and piloted for use by government staff in eight countries during 2014–15

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