Availability and rational use of drugs in some selected Government and Mission Hospitals in the Ashanti Region, Ghana

The performance of health services everywhere critically depends on the availability and use of pharmaceutical products. Indeed public confidence in health workers and satisfaction with health services depend upon the maintenance of a reliable and affordable supply of drugs. Many countries spend a large proportion of their health care budget on drugs, much of it wasted because of unsafe and inappropriate use of drug, and because bacterial resistance often renders drugs ineffective. It is in this vein that the Ministry of Health of Ghana through the sponsorship of the Royal Netherlands Government established the Ghana National Drug Program (GNDP) to promote the rational use of drugs in the country’s health institutions and among the general public as a whole. However, 5 years after the implementation of the program, the problem of irrational use of drugs continues to persist in health institutions within the Ashanti Region. There was therefore the need for a study to identify the underlying factors that promote the irrational use of drugs among health care providers in health institutions within the Region. There is a general belief in many countries that Mission hospitals offer better health care services than Government hospitals. No study has been done to find out whether this is true in terms of the availability and the rational use of essential drugs. The objectives of this study was to assess the level of availability of essential drugs and the degree of compliance to the rational drug use concept in some selected Government and Mission hospitals within the Ashanti Region and to identify the underlying motivating factors that promote the irrational use of drugs in health institutions within the Region. The study was an observational descriptive cross sectional survey that utilized both quantitative and qualitative methods. For the quantitative survey, a total of 700 prescription encounters, randomly sampled from four (4) Government and three (3) Mission hospitals in four (4) districts of the Ashanti Region between January 1 and August 31 2003 were reviewed retrospectively using the WHO standardized drug use indicators. Patient care and facility care drug use indicators were also prospectively surveyed on thirty (30) consecutive dispensing encounters. For the qualitative study, a structured questionnaire on the rational use of drugs and the motivating factors underlying the irrational use of drugs was administered to the main prescribers in the selected hospitals. The result of the study indicated a high percentage availability of key essential drugs in all the hospitals studied (86%-99%). The percentage of drugs prescribed actually dispensed at the facilities ranged from 76% to 95.5% and the percentage of drugs adequately labeled ranged from 85.9% to 93.5%. The results also indicated that the average number of drugs prescribed per encounter ranged from 3.0-5.0 with a mean of 3.65 for the government hospitals and 4.1 for the mission hospitals. The range obtained for the percentage of drugs prescribed by generic names was from 47.6%-69.7% and an average of 61.5% for the government hospitals and 57.0% for the mission hospitals. The percentage of drugs prescribed from the Essential Drugs List (EDL) was very encouraging with a range of 70.8% to 93.3% and an average of 80% for the government hospitals and 89.1% for the mission hospitals. Percentage antibiotics prescribed ranged from 28% to 51% with an average of 36.9% for the government hospitals and 36.2 percent for the mission hospitals. On the whole the results of the study indicated that the Mission hospitals performed better only in certain aspects of the rational use of drugs concept (injection use and generic drugs prescription) whiles the government hospitals performed better in other aspects (Average number of drugs per encounter, generic drugs prescription and antibiotic use). It can therefore be said that the mission hospitals in the Ashanti region are not more rational in their prescribing practices and the use of drugs than their government hospital counterparts. The compliance with the Standard Treatment Guidelines (STGs) study revealed a wide variability in the compliance to the STGs among health institutions within the Ashanti Region so far as treatment of malaria is concerned. The percentage use of Chloroquine as the first drug of choice for the treatment of uncomplicated malaria cases ranged from 15.5% in Komfo Anokye Teaching Hospital (KATH) to 76.4% at the Bekwai Government Hospital (BGH). The average cost of drugs per OPD encounter in the selected health institutions studied ranged from 020,600 in Offinso St Patrick’s Hospital (OSPH) to 038,360 in KATH. Vitamins and appetite stimulants accounted for between 2.6% in Kuntenase Hospital (KH) to 17.4% in KATH of the total cost of drugs purchased in the health institutions. Concerning the factors that underlie the irrational use of drugs in health institutions within the Ashanti Region, the study found out that the prescribers have adequate knowledge on the essential drug concept but knowledge, as we know, does not always translates into performance. The prescribing behavior is deeply ingrained and rooted in socio-economic and cultural conditions and according to the qualitative survey, is due to factors like patient demand, economic gains by prescribers, influence from medical representatives, lack of training, monitoring and supervision, lack of basic support services to aid in diagnosis, prevalence of infectious diseases and lack of regulatory enforcement of the use of the EDL and the STGs. From the results obtained from the study, it was recommended that the MOH should establish a framework for the enforcement of the EDL and the STGs and that the GNDP should assess the impact of their intervention activities of promoting the rational use of drugs in order to take remedial actions where there are deficiencies.

Source: KNUST