Thailand for example was systematically moving towards declaring itself a ‘Rational Drug Use’ country sometime in the near future. What that label meant was Thailand would, through various mechanisms, ensure pharma manufacturers, healthcare facilities, professionals and the general public followed World Health Organization guidelines.
Normally Sholmes would have been quite sceptical of such a claim, but in the case of Thailand – a middle-income country that had one of the best universal healthcare systems in Asia- he was willing to give it the benefit of doubt. Thailand had a very committed leadership when it came to public health, very dedicated health workers and a strong civil society movement, that enabled the public to have a say in both policy formulation and implementation.
In another part of the world, Cuba, renowned for its high investments in healthcare, was setting up a system of monitoring medicine prescriptions at every level and promoting rational use by involving both health professionals and the people.
Kazhakhstan had set up a National Medical Formulary to optimize the rational use of medicines and provide an educational resource for trainees and established practitioners. The role of pharmacists in implementing rational drug use, in particular, was being given a lot of emphasis.
Starting in the 1980s, thanks to activism by consumer groups, Australia had set up a robust system to ensure quality use of medicines, helped by the adoption of a National Medicines Policy in 2000. This had involved much hard work in preparing guidelines, lots of training work, involving consumers in decision-making, public education and regular monitoring with a process to learn from feedback. In the end it was all very worth it.
“It can’t be all that easy. I mean, you announce some good policies in your capital city and everyone around the country obeys like sheep, to give good outcomes?”, said Sholmes, a bit doubtful about how much could be achieved by working solely at the national level. The devil after all, (as the arch-villain Professor Moribund used to say), was in the details, which in turn are at the grassroots.
In Australia, for example, it turned out there were many challenges to translating their wonderful policies into practice. There was still a need to develop a culture of shared decision making in health care, improve individual and community health literacy, ensure information was provided to those from different ethnic backgrounds and provide health access to those without sufficient means.
As one speaker on the universal health care system in Indonesia explained, there was high political commitment to achieve universal health care, but at the provincial and local levels the system was plagued by many problems. Among these were inefficiency of health care facilities, underuse of generic drugs, substandard and falsified medicine and an orientation towards more costly hospital based treatment.
In Moldova, the country had a universal medical insurance system to help citizens get access to low-cost healthcare. However, the list of medicines eligible for reimbursement to patients has been riddled with problems, including lack of availability, unsafe drugs and lack of transparency in their selection.
In sub-Saharan Africa, where between 40 – 60% of health care is provided by the faith-based sector, the Ecumenical Pharmaceutical Network was doing stellar work providing pharmaceutical services. Motivated by justice and compassion EPN not only helped keep costs of drugs low but had an extensive program for ensuring their rational use, especially to prevent antimicrobial resistance. Operating since 1981, EPN provided quality-assured medicines to communities in rural, hard to reach areas where government institutions are often lacking.
“Communities? Why are we not hearing more about the role of ordinary folk in dealing with wrong use of medicines? Wasn’t that supposed to be one of the main themes?” said Whatsup suddenly.
“Next session, silly. Read the conference program carefully”, said Sholmes.
To be continued…