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Saturday, 8 October 2011

Availability and rational use of drugs in the PHC facilities following National Drug Policy of 1982: Is Bangladesh on right track?

In Bangladesh, the National Drug Policy (NDP) of 1982 was instrumental in improving the supply of quality essential drugs at an affordable price, especially in the early years. However, over time, evidences exist about the deterioration of situation both in terms of availability of essential drugs as well as rational use of drugs. A recent study examined the current status in terms of availability, affordability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh. The study covered a random sample of  Upazila Health Complexes (UHC) in the rural areas (n=30) and a convenient sample of Urban Clinics (UC) in the Dhaka Metropolitan area (n=20). Observation, exit-interview and mini-market survey were done to collect data on WHO core drug use indicators in health facilities. 
Findings reveal the availability of essential drugs for common illnesses to be poor, varying from 6% in the UHCs to 15% in the UCs. Drugs dispensed out of total prescribed was higher in UHCs (76%) compared to UCs (44%). Dispensed drugs were not labeled properly, though 73% of the patients/care-givers reported to have understood the dosage schedule. Copy of an Essential Drugs List was available in 55% UCs and 47% UHCs with around 2/3rd drugs being prescribed from it. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of the encounters, more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection including pneumonia (10-20%). Prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of common people. Thus, the availability, affordability and the rational use of drugs have remained to be achieved in Bangladesh even 27 years after passing the much acclaimed NDP of 1982.

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