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Pillars of Responsible use of Medicines

MEDICINES

Pillars of Responsible use of Medicines

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Pillars of Responsible use of Medicines

Chaos in the regulation of supply and use of medicines imposes serious risks to the population.

Proper use of medicines can never be overstated. The risks posed by irresponsible use include antibiotic resistance, financial losses, and death due to side effects. Kenya’s culture of drug use contravenes all tenets of rational drug use. As described in A Nation on Drugs, the consequences of these are severe. It is important to strengthen our regulatory system in line with international standards of rational drug use.

There are twelve key interventions to promote ration drug use according to the World Health Organization (WHO)1. The culture of drug use in Kenya is clearly in contravention of each one of them. The existence of such a guiding list of interventions is a pointer to the risk of irrational drug use. It is a threat to individuals, to entire healthcare systems, to economies and the world at large. Adhering to these international standards of drug use should be considered seriously by every government. It is an obligation rather than a mere suggestion.

Sufficient government expenditure to ensure availability of medicines and staff

This is one of the twelve key points. Measured against it, the government performs terribly. There’s never enough stock in government hospital pharmacies. Patients seeking services have to carry their prescriptions to buy medicines in the chemists on the streets. For those admitted in the wards, their relatives have to buy what the doctor needs for their treatment. Even drugs required for surgery and ICU care are never available. The time needed for people to look for them or fundraise to get the money necessary to buy causes severe delays in treatment with consequent poor outcomes.

As hospitals struggle with medical stock, the agency established to supply them has been reported to destroy drugs worth hundreds of millions because they have expired. Several reports in our dailies regarding the Kenya Medical Supplies Authority (KEMSA) highlights inefficiency, incompetence, and unacceptable wastage. The problems include the purchase of expired medicines2 and a failed supply chain which causes the stock to expire before release to hospitals3. Whether you approach from an economic or medical perspective, the fact that such things would happen is utterly baffling. One expects that an authority that exists to perform a specific role is staffed with professionals who are highly qualified and motivated. They should understand the implications of poor procurement and delays in supplying the hospitals on time.

Avoidance of perverse financial incentives

The above failures open an avenue for enterprising individuals whose incentives are purely commercial. This is against one of the twelve key interventions of rational drug use. The result is the proliferation of chemists and the blurring of lines between the role of prescribing and dispensing. As described in A Nation on Drugsmany people flock to the chemists even without prescriptions. The chemists are all too eager to oblige because, hey, its the money! It is not just at the dispensing chemists that commercial motivations overrule the need for rational drug use. Some procure their stock through shady channels. This inundates the market with drugs whose quality is either questionable or which are outright fakes.

The uncovering of failure is often met with excuses and explanations. It is likely that KEMSA has reasons for its dismal performance. None of those reasons can assuage those who have suffered irreparable damage or families who have lost loved ones due to the chaos in the drug system. KEMSA is not alone in this mess. The supply and regulation of medicines is a complex system in which it is a single player.

Use of appropriate and enforced regulation

Another important player in this wide system is the Pharmacy and Poison’s Board. It is responsible for the licensing and registration of professionals and enterprises dealing with pharmaceutical products. Since regulation is the backbone of maintaining standards in the broad medical system, the role of this board is crucial. It is not enough to have rules and regulations on paper. What is more important is how they are enforced.

Chemists are important because they fill a gap left by the failure of the established authority. If chemists didn’t exist, there would be unimaginable suffering. We know all too well that public institutions and agencies are terribly unreliable. They will fail us as they always have. Embracing private enterprise is for our own good. This must be balanced by strong regulation. Only this will ensure the profit motive does not override safety and quality regulation.

Strong regulation at all levels of the drug supply chain is crucial. We must ensure that there are no loopholes in the importation, storage and distribution and dispensing of medicines. All these levels of handling medicines need to abide by high standards to ensure quality is maintained. For this to happen, the board needs to ensure that the entire system is only staffed with professionals who are properly qualified and licensed. It is necessary to conduct frequent impromptu inspections to ensure that all the rules and regulations are adhered to. Serious penalties must be imposed on those who break these rules.

Public education about medicines

Another tenet of rational drug use, according to WHO, is the promotion of public awareness regarding medicines. Public education is important because even where all the above pillars fail, as they have, an educated public becomes the last line of defense against the dangers of irrational drug use.

There many avenues for public education. These include mass media, schools, and hospitals. Health education should be an important part of the school curriculum from the earliest stages of the school system. People need to know from an early age that not all ailments require medicines and that self-medication is dangerous. The doctors should also use their consultations with the patient to educate them.

These are just a few of the pillars of rational drug use. Measured against these standards, our culture of medicine use is irrational and a dismal failure. By failing to follow them, we are exposing ourselves to serious health and economic consequences. We need to align our medical system with established rules to reverse this trend.

Bibliography

  1. World Health Organization. The Pursuit of Responsible Use of Medicines: Sharing and Learning from Country Experiences. https://www.who.int/medicines/areas/rational_use/en/
  2. Edwin Mutai. Audit queries Kemsa’s purchase of Sh352 million expired drugs. Business Daily, March 27, 2018.
  3. Nasibo Kabale. No medicine? Sh1.2bn KEMSA drugs near expiry. Business Daily, February 28, 2019 .

 

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