Dear HIFA colleagues,
In my original message I pointed out that lack of availability of reliable information is a factor in the problem of overuse of medicines in low- and middle-income countries, acknowledging that there are other factors including perverse financial incentives.
Several members have picked up on the latter:
Massimo Serventi (Tanzania): "Whatever is the reason behind over-prescription of drugs in low-middle income countries the system of delivering drugs in the same setting where they have been prescribed is wrong."
Najeeb Al-Shorbaji (Jordan): "The fact that any prescription is a “purchase order” written by the physician is not well-known. That purchase order, like any other purchase order entails a commission. Pharmacies have become shops like any other shop for trading rather than health and medical purposes."
Zakiuddin Ahmed (Pakistan): "Conflict of interest which potentially resides within the Physicians’ conventional practice should always be kept in mind and mitigated through patient centric policies & regulations."
Farooq Azam Rathore (Pakistan): "We need to look into the possible reasons that encourage this kind of behavior. One reason that I have identified is poor regulations and control by the institute and the other is lack of support for academics and research. Research and academic require money and if the organization is not willing to invest in their physicians many of them get detracted by the offers by the Pharmaceutical company. However there is a large number of physicians from all ranks and speciality who actually collaborate with the Pharmaceutical companies for undue favors"
If I may play the devil's advocate, there are advantages as well as disadvantages to selling medicines on the same premises as the health centre. Any profits generated by the sale of medicines can provide a vital contribution towards the costs (including the salary costs) of running the centre. So, rather than enforcing separation of clinic and pharmacy, are there other ways to promote good financial management and rational prescribing? One approach might be to increase self-auditing of prescription patterns, so that excessive use is made transparent, and perhaps include measures of use of specific antibiotics that should be used only in exceptional circumstances? Any approach should be multifaceted and should include availability of information to support rational prescribing.
Does anyone know any case studies where prescribing has been improved as a result of such measures, even where medicines are sold on the same premises as the clinic?
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
