Absence of guidelines poses challenges to medicine use— Prof. Ofori-Adjei
A former Rector of the Ghana College of Physicians and Surgeons, Prof. David Ofori-Adjei, has stated that the non-availability of treatment guidelines and related issues present key challenges in the way medicines are used in the country.
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He named some of the challenges as the number of medicines prescribed, exposure of patients to antibiotics and injections and prescription of medicines on the essential drugs list.
The Professor of Tropical Clinical Pharmacology and Medicine and Therapeutics at the University of Ghana School of Medicine and Dentistry was speaking at an inaugural lecture organised by the Ghana Academy of Arts and Sciences (GAAS) last Thursday, on the topic “Medicines and Health care in Ghana”.
The lecture also addressed the origin of drugs and medicines in Ghana, essential medicines, the supply-chain management of medicines, procurement and classes of medicines, among other such areas.
Prof. Ofori-Adjei said the lecture was premised on the fact that since the early 1980s the country had seen a series of interventions to address the issue of the rational use of medicines and access to the medicines that should be of good quality, efficacious, available at all times, affordable and within reach of those who needed them.
Concern
He said at the time the initiative started, the concerns included exposing patients to many medicines in one encounter, exposing patients to antibiotics unnecessarily, exposing patients to injections, the failure to prescribe by generic name and prescribing medicines without reference to approved guidelines.
“A survey we conducted in 20 health centres selected from across the country in the early 1990s showed that the second commonest diagnosis following malaria was ‘No Diagnosis Recorded’. This implied that those patients were receiving symptomatic treatment.
“The World Health Organisation (WHO) estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly.
“The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.
Use of Medicines - WHO definition
Quoting WHO’s definition of the right use of medicines, Prof. Ofori-Adjei said it was when “Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.”
He indicated that the importance of medicines was reflected in the Millennium Development Goals under MDG 8, and specifically Target 8.E which stated that in cooperation with pharmaceutical companies, access must be provided to affordable essential drugs in developing countries.
Medicines supply chain
Prof. Ofori-Adjei said the fragmented procurement of pharmaceuticals by the various service providers at the regional and district levels had also resulted in the loss of advantage in economies of scale from bulk procurement.
He, however, disclosed that a Supply Chain Master Plan had been drafted, which, when approved and implemented, should bring order to the supply-chain system.
According to Prof. Ofori-Adjei, as Ghana did not meet the criteria for global initiatives like the Global Alliance for Vaccine Initiative (GAVI), support for the supply of vaccines; and a process of graduating the country from such support had started and due to be completed by 2019.
“This has marked implications for government budget allocation for supply of medicines. The situation will get worse should the Global Fund (GF) also decrease or withdraw its funding for medicines for HIV/AIDS, Malaria and Tuberculosis.
“For the GAVI graduation the financial implications even during the transition period 2015-2019 will seriously affect the immunisation programme and the cost of the new vaccines, threatening the sustainability of this very important health intervention,” he warned.