World Health Day 2011: Combating Drug Resistance with Strong Health Systems

World Health Day 2011: Combating Drug Resistance with Strong Health Systems

Drug Therapeutic Committee training course in Kampala, Uganda.

As we celebrate World Health Day on April 7, 2011, the global health community is focusing on an increasingly dangerous health challenge---drug resistance. Antimicrobial resistance (AMR)---defined by the World Health Organization (WHO) as the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive---is a global public health threat that is rapidly wiping out the effectiveness of many first-line treatments. It undermines major public health achievements in treating infectious diseases such as HIV & AIDS, tuberculosis, malaria, and sexually transmitted infections. Not only is AMR a complex, cross-cutting problem affecting a wide variety of sectors, but it has crossed all national, geographical, and ethnic boundaries and is spreading globally.

One common problem  leading to AMR in both developed and developing countries around the world is the irrational use of medicines. When health care providers prescribe inappropriate medicines or patients take their medicines incorrectly or buy poor quality medicines from unlicensed sellers, there is a risk of increased morbidity, mortality, and costs for patients. With effective prescription, dispensing practices, and correct use of antimicrobials, infections can be properly treated before they become increasingly difficult to combat.

For over 10 years, the Rational Pharmaceutical Management (RPM) Plus Program and its follow-on program, Strengthening Pharmaceutical Systems (SPS)---both funded by the United States Agency for International Development (USAID) and implemented by MSH---have worked to improve rational medicines use, mainly through technical assistance to drug and therapeutics committees (DTCs) in developing countries. These committees manage the selection of medicines for the formulary; they evaluate the medicines use and then implement strategies to improve their use throughout the health care system.

Such activities lead to the procurement of safe and cost-effective medicines and improved use of medicines that enhance health outcomes and AMR containment. Many hospitals and health facilities in resource-limited settings, however, either lack DTCs or do not manage them efficiently.

Through SPS, assistance has been provided in two ways: training initiatives and follow-up support. Comprehensive training programs teach health care professionals about how DTCs function in hospitals and primary health clinics and create advocates for rational medicine use at all levels of the health system.

By promoting and supporting  drug therapeutics committees in various countries, participants who were trained and supported, by RPM Plus and currently SPS, have a wide range of accomplishments. For example, in Kenya outpatients receiving antibiotics for each visit decreased from 90 to 60 percent, while in Malaysia a system that monitors prescribing patterns for certain high-use antibiotics has been established.

SPS continues to build capacity within resource-limited countries to effectively manage pharmaceutical systems, successfully implement USAID priority services, and ultimately save lives and protect the public's health by improving access to and the use of medicines of assured quality. SPS is dedicated to helping countries strengthen their existing pharmaceutical systems by customizing and implementing proven tools and approaches to achieve better medicines management and use.

Mohan Joshi is the Senior Technical Manager for AMR on the SPS Program at MSH.


LIana Haddad
Dear Mr. Mohan josh I am a pharmacist and i have MPH /health management, my master thesis was about assessment of drug use /public primary health clinic /Bethlehem district/Palestine, using the WHO indicators and forms. Antibiotics use was relatively high and especially for children under 5 years old . Now I am trying to continue this study, but firstly I cant make a decision about which subject I have to choose ,such as antibiotics resistance or using the scientific name of drugs. secondly I cant find the write agency to work with or to supervised such research or study. Thank you
The commitment of all caregivers in collaboration with patients they serve will improve the outcomes and reduce MDR-TB spreading.
Dr Quinto Okello
I am in charge of health services in one of the Districts in Uganda, and irrational drug use is an every day thing which i grapple with. This is a known factor contributing to AMR. Shortage of Human Resources for Health in health facilities means that often low cadre staff such as Nurses or nursing assistant make diagnosis and prescribe treatments setting the stage for irrational drug use and ultimately AMR. Addressing shortage and quality of prescribers is one important, albeit not the only solution to AMR
omalla samuel
Medicines therapeutics committees can go along way to improve on medicines management. This committee should even be scaled down to the lowest level of service delivery. They should be enabled to function effectively. The use of unwanted antimicrobial is increasing and something must be done to reverse this status quo

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