Transcript Setting the Scene

Promoting Rational Drug Use
in the Community
Setting the Scene
The Essential Drugs Concept
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 :
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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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Decline in TB (UK)
Nuffield Provincial hospitals trust
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death rate per 1000
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children death per million
Deaths of children under 15 attributed to scarlet fever,diphtheria,
whooping cough, measles in England and Wales
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Early Landmarks in Drug Development
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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
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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
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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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Objectives of the South African
National Drug Policy
 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
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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
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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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Current Trends and Challenges
 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 consumers
Massive 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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Current Trends and Challenges
 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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Current Trends and Challenges
 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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Antiretroviral therapy coverage for adults,
end 2003
400,000 people on treatment: 7% coverage
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Africa
Asia
Latin
America and
the Caribbean
Eastern
Europe and
Central Asia
North
Africa and
Middle East
Source: UNAIDS/WHO, 2004
Setting the scene
2004 Report on the Global AIDS Epidemic (Fig 33)
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Prices (US$/year) of a first-line
antiretroviral regimen in Uganda: 1998−2003
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Price US$
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Jun Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
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Price US$
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98 98 98 98
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Source: UNAIDS/WHO, 2004
Setting the scene
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
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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
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