Yes Neil there are examples where rational prescribing was practiced and audited for compliance even though the medicines were prescribed and dispensed at the same site. In 2004 in Cross River State and in 2008 in Bauchi State both in Nigeria our baseline situation analysis identified several challenges that faced the failing health systems, including the Out of Stock syndrome which means prescriptions issued to patients both inpatient and outpatient were not available in the facility. Patients go to poorly regulated retail drug stores in the town to get their medicines: in 2004 the rate of fake drugs in the country was estimated at 70%!!!. In addition poor storage of the drugs in the tropical heat meant that efficacy was not assured. Not to talk of high cost of medicines to patients in a system with over 65% out of pocket payment by patients / families for care.
We introduced the 12-Pillar clinical governance Programme for a whole health sector improvement, including setting up a ‘drug and commodity revolving scheme’ and produced an evidence informed state wide formulary (adapted from the National essential drug list). The result was quick is coming: out of stock eliminated; fake drugs eliminated; all stock at least two years shelf life; rational prescribing and dispensing achieved; and parallel sake of personal stock by clinicians eliminated!!
Joseph Ana.
HIFA Profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria, established by HRI Global (former HRIWA). He is a member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health, he led the introduction of the Homegrown Quality Tool, the 12-Pillar Clinical Governance Programme, in Nigeria (2004-2008). For sustainability, he established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria. His main interest is in whole health sector and system strengthening in Lower, Low and Middle Income Countries (LLMICs). He has written six books on the 12-Pillar Clinical Governance programme, suitable for LLMICs, including the TOOLS for Implementation. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Nigeria Medical Association’s Award of Excellence on three consecutive occasions for the innovation. He served as Chairman, Quality & Performance, of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He is member, National Tertiary Health Institutions Standards Committee of the Federal Ministry of Health. He is the pioneer Secretary General/Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers. (http://www.hifa.org/support/members/joseph-0 http://www.hifa.org/people/steering-group). Email: info AT hri-global.org and jneana AT yahoo.co.uk