A Study on Drug situation of Health Institutions of Sankhuwasabha, Nepal
By: Nawaraj Subba, MPH, MD (AM)

Summary: It was a cross-sectional study on the drug situation in health situation of Sankhuwasabha district. The study aimed at comparing the Drug scheme health institutions and Non-drug scheme health institutions for drug availability, prescribing practices, rational use of drugs, expiry of drugs in Sankhuwasabha district. Only 42 Samples was taken and HA, AHW, ANM, VHW, MCHW, Mukhia were respondents in the study. Questionnaire and forms were provided and FGD held during study. EPI-Info software was used for data processing in computer. Major findings were; the availability of drugs in Drug Scheme implemented health institutions was significantly higher than non-drug scheme health institutions (P=0.0002). Practice of prescribing drugs for buying from medical shops in drug scheme health institutions and non-drug scheme health institutions was different that is highly significant (P=.0.0001). More than 30 item drugs were expired due to over stocking in both health institutions mostly supplied through Regional Medical Store.

Study Design: It was a Cross-sectional Study of Sankhuwasabha district conducted in February 2002.

Rationale of Study: It is often reported that many drugs have been wasted because of short expiry date in one side whereas there are plenty of health institutions of having scarce of same drugs on the other in the district. Situation of availability of drugs is different in drug scheme health institutions and non-drug scheme health institutions. People from different VDCs are demanding drug scheme program year by year. And we have about 50% (17 health institutions) covered by drug scheme program in the district. In view of justifying the Drug Scheme program, it is right time to study by comparing the situation of drug position and prescribing practices in Drug Scheme and non-drug scheme health institutions.

Overall objective is to assess the drugs situation in both drug scheme health institutions and non-drug scheme health institutions of Sankhuwasabha district.

1. To assess drug availability in the health institutions.
2. To assess the practice of rational use of drugs.
3. To assess drug's store situation and date expired drugs.

Survey Organizations: Health Posts = 12, Sub Health Posts = 23

Samples: HA = 2, AHW = 27, VHW = 7, MCHW = 2, Mukhia = 4, Total Respondents = 42

Instruments: Questionnaire, Forms.

Data Processing: EPI-Info Computer Software.

 Major Findings

Drug Scheme health institutions had 83% of Essential drugs whereas Non-drug scheme had 46% of Essential drugs in the district. The availability of drugs was highly significantly different between drug scheme and non-drug scheme health institutions (P=0.000226).

In drug scheme health institutions 8% prescribers advised patients for buying drugs from medical shops. Whereas 30% prescribers in Non-drug scheme health institutions advised patients for buying drugs from medical shop. The practice of prescribing drugs for buying from medical shops was highly significantly difference between drug scheme health institutions and non-drug scheme health institutions in Sankhuwasabha district (P=0.0001536).

There is still a situation of taking incomplete courses of drugs due to inadequate money both in Drug Scheme health institutions (8%) and Non-drug scheme health institutions (10%).

The proportion of population that can not afford the cost of drugs still exists in both Drug scheme and Non-drug scheme health institutions (4.4%). 3% of health institutions attendants returned with empty hands due to lack of money from drug scheme health institutions whereas 5% attendants returned taking no drugs from Non-drug scheme health institutions.

Prescribers themselves realized that they are forced to prescribe unnecessary drugs due to over stock of drugs and bulk amount of near expiry drugs at store in their health institutions. However the situation is better in Drug Scheme health institutions (2%) than in Non-drug scheme health institutions (4%).

Health workers were experiencing following benefits from Drug Scheme intervention in their health institutions.

• Program has made available drugs through out year. It has also made prescribing easier.
• Prescribing practice has become more rationale. Prescriber ensures right patient, right drug for right time and period.
• Created trust upon health workers and drugs.
• Created a good environment of coordination between health workers and committee members.
• Facilitated for prompt consumption reporting as well as prompt demand and supply.
• Increased patient compliance.
• Preventing drug resistant.
• Drugs transportation has become easier.
• Program has made Health worker more active, creative and cooperative.
• Reduced unnecessary treatment due to charge for treatment.

Health workers are also experiencing following difficulties after drug scheme program intervention.

• It has increased more workload for health worker. Institutions where posts are partially fulfilled have remarkable workload experienced in terms of recording, reporting and financial updating.
• Sometime it takes more times to persuade someone to make them ready to pay money for drugs.
• Dispensing of drugs had to calculate in accordance to affordability of a patient that is not a norm of drug scheme program.
• Minor injury and ailments were discouraged to attend health institutions due to high cost.

People's reactions to drug scheme program as reported by health workers were as:

• In the beginning of the program people were found confused with the paying system in Government health institutions but it was gradually disappeared when they had got drugs 40% cheaper than market.
• Some people still blame that they have been forced to pay for free drugs supplied by the Government.

 9. Suggestions given by Health workers or respondents to strengthen Drug Scheme program.

• Long expiry drugs should be supplied.
• FEFO (First Expiry First Outing) should be followed strictly.
• Drug selection and Drug supply should be based on need and demand of health institutions.
• Drugs supply twice a year would be a better supply system.
• Vacant posts should be fulfilled in the health institutions.
• Regular supervision of Drug Scheme is needed.
• Financial auditing of drug scheme is needed in health institutions.
• Orientation is needed for VDC, School, mother's groups and FCHVs.
• Near expiry drugs should be reported and DHO should provide these drugs wherever needed.
• Purchasing of drugs from Health Institutions should be systematic and that requires monitoring from DHO.
• Review of this program should be regular and continuos.
• The value of Reward and Punishment should be enforced in the program.

Considerable amount of expired drugs every year is one of the major problems for drugs management in health institutions. Respondents have bitter experience of over stocking of certain drugs that they receive from Regional Medical Store despite they have stock of more than sufficient already in their store from previous year to year. The list below that expired last year in stores was came from different sources, mostly supplied through RMS.

1. Tab. Aminophyllin. 2.Tab.Aspirin. 3. Tab. Antillergin. 4. Tab. Ardiplex. 5. Tab. Co-trimoxazole. 6. Tab. Dimagel. 7. Tab. Digoxin. 8. Tab. Fersolate 9. Tab. Mebendazole. 10. Tab. Metronidazole. 11. Tab. Propanolol. 12. Cap. Ampicillin. 13. Inj. Atropine. 14. Inj. Dexamethasone. 15. Inj. Diazapam. 16. Inj. Dextrose Normal Saline. 17. Inj. 5% Dextrose Solution. 18. Inj. Lignocaine. 19. Inj. Normal Saline. 20. Inj. Ringer's Lactate. 21. Inj. Pheniramine Maleate. 22. P.P.F. 23.Inj. Pentazocine. 24. Inj. Distilled Water. 25. Powder Acriflavin. 26. Gentian Violet 27. Lotion Benzyl Benzoate. 28. Chloremphenicol Eye Cap. 29. Gentamycin Eye/Ear drops.

10.2. District Health Office: 1. Cap. Vitamin A. 2. Depoprovera.

10.3. DHO/BNMT/Drug Scheme Program: Inj. Adrenaline.

• Time constraints
• Budget constraints
• Recall bias
• Sampling Error
• Specific study for the health institutions such as Health Posts and Sub-Health Posts of Sankhuwasabha district.

Respondents have made recommendations to prevent drugs expired. They have given suggestions to strengthen the drug scheme in the district.

• The situation of drugs availability has been improved following the intervention of Drug Scheme program in the district so scheme should be implemented to all VDCs gradually.
• The practice of advising drugs to buy from outside has been significantly cut down after implementing the Drug scheme in health institutions. So, People and VDCs are welcoming to implement scheme in their VDCs year by year.
• To prevent drug expired in health institutions respondents have given suggestions as follows:
• Drugs with near expiry should not be send to this remote mountainous district from Regional Medical Store. Long expiry drugs should be send as per requisition of Health Institution from Regional Medical Store.
• LMIS should be properly used for assessing drugs stock and its need while making indent supply by concerned authorities.
• Near expired drugs from one health institution need to be given to another health institution within the district. District Health Office and Health Institution's incharge and Committee's chairman should take responsibility to manage near expiry drugs by mutual cooperation in district level.
• Supervision should be focussed for drugs and its expiry too. Reporting and feedback should be strengthen as well as prompt action at district level should be strengthen.

©2002. Nawaraj Subba, MPH.     Go to top of the page
Feeback: nrsubba@hotpop.com