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PSM - Use of medicines and other health products

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Use of medicines entails the concept of “rational use”, pharmacovigilance, and waste management. Similarly, the appropriate use of diagnostics and laboratory devices is linked to the respect of the international guidance on condition of use, and other aspects such as installation, calibration, training and maintenance plans for more complex diagnostics.

“The rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” WHO definition, 1985

Dispension of ARV medicines in Zambia

WHO advocates 12 key interventions to promote more rational use:

  • Establishment of a multidisciplinary national body to coordinate policies on medicine use
  • Use of clinical guidelines
  • Availability of timely and accurate inventory data for decision-making
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  • Development and use of national essential medicines list
  • Establishment of drug and therapeutics committees in districts and hospitals
  • Inclusion of problem-based pharmacotherapy training in undergraduate curricula
  • Continuing in-service medical education as a licensure requirement
  • Supervision, audit and feedback
  • Use of independent information on medicines
  • Public education about medicines
  • Avoidance of perverse financial incentives
  • Use of appropriate and enforced regulation
  • Sufficient government expenditure to ensure availability of medicines and staff.
  • Source: Promoting Rational Use of Medicines: Core Components - WHO Policy Perspectives on Medicines, No. 005, 2002.

UNDP's support

For Global Fund supported countries, rational use of medicines has been ensured by the adoption of WHO evidence-based guidelines for treatment. The WHO guidelines are conceived to recommend the use of the most appropriate medicines, including the indication of formulation, dosage, administration route and treatment duration.
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Patient adherence to treatment is normally assessed routinely within health programmes and in external national programme reviews led by WHO. Similarly, for diagnostics and other health products, correct use is ensured by adopting WHO guidance and recommendations for use at different levels of the health system. For complex diagnostics, UNDP has supported countries to install, calibrate, train staff and set up a maintenance plan.

Programme management support in Global Fund countries includes medicines prescription, dispensation, patient adherence measures, and resistance surveillance. Notification of adverse drug reactions is promoted within national pharmacovigilance systems. In Zimbabwe, UNDP provides technical assistance to the National Regulatory Agency to upgrade the national pharmacovigilance system from paper-based to electronic-based system for reporting adverse drug reaction.

UNDP’s approach to the use of health products includes also upfront reduction of waste by engaging with manufacturers to optimize packaging, as well as working on waste management including pharmaceutical waste, and for specific categories of drugs such as cytotoxic drugs.

UNDP's offer

WHO is the agency mandated for technical assistance in the area of rational drug use and pharmacovigilance.
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Service level agreements between UNDP and countries to strengthen pharmaceutical management can include aspects related to rational drug use and pharmacovigilance.

As part of national strategic laboratory plans, UNDP has developed expertise in contracting for installation, calibration and maintenance services of complex diagnostics for tuberculosis and HIV.

Guidance

Rational use

WHO has defined core components for the rational use of medicines, which shall be applied across all medicine categories.

WHO resource material on rational drug use can be accessed at the WHO webpage:

For additional information on irrational use, its adverse impact and underlying factors as well as strategies to improve rational use, the following resource is proposed:

Pharmacovigilance

WHO has developed key resource documents on the importance of pharmacovigilance, on minimal requirements for a functional pharmacovigilance system and for its assessment:

WHO resource material on pharmacovigilance (including specific publications for HIV, TB and Malaria) can be accessed at the WHO webpage: