[india-drug] Promotion of rational use of medicines

[CDMU Documentation Centre <cdmudocu@vsnl.com>]

Promotion of rational use of medicines
------------------------------------------

Community Development Medicinal Unit [CDMU] West Bengal, is a 
not-for-profit voluntary organisation, established with the objective
of improving access to essential medicines in the non-governmental
organisation (NGO) sector in India. It is located in the state of West
Bengal, with drug distribution outlets at Kolkata and Siliguri. For the
past two decades CDMU has been successfully running a project for
procurement and supply of essential drugs of good quality at affordable
price, thereby allowing disadvantaged  sections of different
communities access to essential medicines. A central selection team of
experts updates CDMU's list of essential drugs and list of suppliers
every year after reviewing tender quotations submitted by various drug
manufacturers. There are no unproven, hazardous, or irrational drugs in

the CDMU list. Suppliers are selected only if they meet certain 
pre-qualification norms. A section of the procured drugs are tested for
quality in approved laboratories. Drugs are purchased in bulk directly
from the manufacturers and can therefore be supplied to member
organisations or MOs (organisations to which CDMU supplies drugs on a
regular or periodic basis), even in remote areas, at prices
substantially lower (up to 250% lower) than open market prices. CDMU
membership has grown from 15 in 1985 to over 400 currently. Majority of
the MOs are voluntary organisations in and around West Bengal,
providing healthcare on a charitable basis.

It was a matter of grave concern to note that MOs, who procure drugs 
And medical supplies from CDMU, faced problems in using such items 
rationally. Many of them were not even equipped with trained doctors to
run their clinics, and depended on nurses, pharmacists or paramedical
staff, in their healthcare delivery programs. However, irrespective of
whether the health facilities were manned by doctors or non-doctor
healthcare providers, they often lacked an optimum idea of rational
prescribing and dispensing. There was a tendency to use popular branded
drugs without considering adequately their prices and justification.
There was a serious lack of unbiased information on available
drugs. Therapeutic guidelines either did not exist at all or, if they
did, were often impractical. Thus access to essential drugs in the most
appropriate manner with emphasis on their rational use was not being
ensured.

It was thus realised that unless the procurement-distribution of 
Essential drugs could be supplemented with appropriate educational
activities Upholding the cause of rational use of drugs, the very
philosophy behind CDMU's Mission would be defeated. This led to the
establishment of the CDMU Documentation Centre in the early 1990s,
dedicated to campaigning on rational therapeutics. The Documentation
Centre through its diverse activities like preparing
information-education-communication (IEC) materials, publishing drug
bulletins
and organising meetings / workshops / seminars with rational drug use
as the focus, aims at influencing doctors and paramedics towards
adopting a rational prescription habit and a rational attitude towards
drug use, appropriate to the needs of the community they serve. This
effort has now been systematised by a new project for promoting the
idea of rational use of drugs professionally.

Objectives of the project

Through this project conscious attempts would be made and would help 
The member organisation in following manner:

Promoting the concept of rational drug use
  a.. Providing unbiased and updated information on essential medicines

at the grassroots level
  b.. Raising the awareness of the concerned population in matters of 
drug use
  c.. Developing a closer liaison between CDMU drug distribution units 
and MOs
  d.. Helping to re-orient and upgrade the existing stores management 
systems of MOs
  e.. Increasing supply of essential medicines by CDMU

Methodology

CDMU has appointed a team, trained in marketing principles, to visit 
the NGOs working in the field of healthcare delivery in the state of
West Bengal. They are meeting the administrators, medics and paramedics
to discuss with them the need for rational use of medicines and the
benefits which the organisation, in its own sphere of activity, may
derived from implementing such a policy. The team utilises various IEC
materials prepared by CDMU, such as flash cards, posters, drug
information sheets, in English and in vernacular. Meetings / workshops
are arranged for the medics and paramedics in small groups, Where
resource persons and specialist speak about rational use of drugs 
(RUD), optimum management of diseases found in their localities,
organisation of medical stores, etc. Where feasible, meetings are also
be organised with common people of the locality, exposing them to the
various pros and cons of medicine use through posters and group
discussions. This in turn will help the MO in implementing RUD in the
locality.

CDMU expects to increase the circulation of its existing quarterly 
Bulletin Rational Drug Bulletin published in English. Another bulletin
in local vernacular is also published. Handouts on standard treatment
of diseases found in the community will also be occasionally published.

The project also entails various surveys. From the inputs available 
from MOs, local patterns of disease and therapeutic practices will be
analysed. A manual of standard treatment guideline is hoped to be
eventually developed. Surveys will also be conducted to find out the
access to essential drugs in Different localities and the constraints
towards implementation of a RUD policy.


Project evaluation

The project is sought to be evaluated after every six months for which
indicators have been prepared. New indicators may also be developed 
based on field work. An internal system monitoring team has been set up
with CDMU resource persons and administrative staff, to evaluate
progress every month. Two external evaluators and an external auditor
have been selected who will meet in six months to evaluate the project
impartially.

The project has been initially designed for three years. Successful
implementation will give CDMU the impetus to continue beyond the 
initial 3 years to further its social commitment in a systematic
manner. Further details are available at www.cdmubengal.org


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