I have first encountered irrational use of medicines when I was a junior pharmacist. I was dispensing a one-item prescription “Ibuprofen” to seemingly a rich lady. She insisted it won’t be possible that a reputable doctor could prescribe to her only one cheap medicine after she paid his expensive consultation fees. She irritably left the pharmacy to come back in few minutes with new prescription: Same medicine and another expensive multivitamin formula. My senior pharmacist pleaded me to say nothing, at the end we don’t want to lose customers! This eye-opening experience demonstrates some major suggested sources of irrational use of medicines: Prescribing, dispensing and patient.
Sudan’s health service delivery is pluralistic with significant domination by private for-profit providers. In private practices patients expect to receive the best therapeutic outcome for their high OOP expenditure. Best therapeutic outcome is often perceived by patients as poly-pharmacy prescribing.
On the other hand, doctors in public sector are overwhelmed by big number of patients and lack of resources. They eventually issue poly-pharmacy prescriptions to cover wide range of possible diseases in order to compensate the lack of proper diagnostics and short consultation time.
Meanwhile, the pharmacists are dominated by profit oriented business owners and they often do little in good dispensing practices. Hence, “prescription-only medicines” can easily be obtained as OTC from any pharmacy.
WHO estimates that 50% of all medicines are prescribed, dispensed, or sold inappropriately, while 50% of patients fail to take them correctly. The misuse of medicines results in wastage of scarce resources, emergence of antimicrobial resistance and eventual increased morbidity and mortality, stimulates unappropriated patient demand “a pill for every ill”, medicines stock-outs and loss of population confidence in the health delivery system(1). Hence, the service delivery and overall system’s outcomes and goals will be hampered.
WHO has set some recommendations for countries to promote rational use of medicines. Sudan is however lags behind in this regard. The Pharmacy, Poisons, Cosmetics and Medical Devices Act delegates the elaboration of regulations to National Medicines and poisons Board (NMPB), while the implementation is delegated to Federal Ministry of Health (FMoH).
The NMPB has set six targets to tackle the irrational use of medicines burning problem(2). Nevertheless, there is no mention to neither implementation strategy nor time-frame. FMoH monitors mainly four medicines aspects: safety, quality, efficacy and pricing(3). There is no attention given to rational use of medicines and there is no national program or committee involving government, civil society, and professional bodies to monitor and promote rational use of medicines(4).
NMPB should demonstrate leadership in elaborating clear strategy to promote and control rational use of medicines. This strategy should at least consider a national standard treatment guidelines creation, a national medicines information center establishment, a public awareness campaign, establishment of hospital’s drug committees and a rational prescribing training should be integrated in core medical training curriculum. FMoH should fulfill governance role, initiate dialogue among various concerned stakeholders and should finally ensure an adequate allocation of human resources to optimize health service delivery.
- World Health Organization (WHO). Promoting Rational Use of Medicines: Core Components – WHO Policy Perspectives on Medicines: Definition of rational use of medicines. 2002.
- Directorate General of Pharmacy S. Sudan Journal of Rational Use of Medicine. Sudan J Ration Use Med. 2012;1(1):1–18.
- Omer AM. Evaluation of national drug policy in Sudan : regulatory privatisation , social welfare services and its alternatives. 2015;2(6):271–83.
- FMOH S. Sudan Pharmaceutical country profile. Khartoum; 2010.