Assessment of impact of the rational drug use program implementation on drug use practices in public health facilities: the case of the Sekyere West District of Ghana.

Irrational drug use often leads to problems such as drug resistance and wastage of resources and overall decrease in the quality of care of patients in the population. After the implementation of the all important Rational drug use programme in June, 1999, there has been no evidence of a comprehensive assessment of impact on the RDU program on a larger scale in the sekyere west district of the Ashanti region as there were no statistics available on the subject matter at the District Health Administration (DHA.) This research work, (designed according to the World Health Organizations methods) seeks to assess the impact of the rational drug use program implementation in public health facilities in the Sekyere west district of the Ashanti region of Ghana. The study was carried out in five public health facilities out of ten in four sub districts within a period of one month (1st September to 1st Oc4ober, 2003). During the study, 300 patients records were reviewed retrospectively and a total of 150 patients were observed and interviewed prospectively to assess what was prescribed, dispensed and the information that was communicated to them. A total of 25 health workers were interviewed in the district to assess their knowledge level on rational drug use. Data were collected on prescribing, patient care and facility specific indicators such as number of drugs per encounter, percentage antibiotics, percentage injections and generic drugs prescribed, average consulting and dispensing time, percentage drugs appropriately labeled and knowledge of patients regarding drug use. Data were also collected on knowledge level of health staff and some of the motivating factors for irrational drug use in the district. The study revealed that, knowledge level of all the categories of health workers on rational drug use was good. The consulting and dispensing times were satisfactory and the poorest result was the percentage of drugs appropriately labeled yet knowledge of patients on their medications was excellent. Apart from the number of drugs per encounter which exceeded the Ashanti regional target, all the other prescribing indicators including antibiotics and injections use, fell below both the WHO and the Ashanti regional targets. Each health institution had copies of the EDL/NF and the STG but none of them had a BP or BNF for reference. There were no drug information center or library and drugs and therapeutics committee in place in all the institutions. The level of adherence to the standard treatment guidelines by prescribers was found to be excellent and the study revealed some motivating factors responsible for the irrational drug use practices in the Sekyere west district to include poor supervision, monitoring by authorities and irregular in service training among others. Generally, the intervention program on rational drug use implemented in public health facilities in June, 1999, improved drug use practice indicators for the better in the short term but has since worsened as evident in the results obtained from the study. Thus, the intervention program has not been able to make the needed positive impact on rational drug prescribing and dispensing practices in the long term. On the basis of the study prescribers and dispensers n the district must be retrained and educated on rational drug use, health staff must be provided with proper and current health information and each institution must be encouraged to form a drugs and therapeutics committee. There should also be proper and effective monitoring and supervision by authorities.

Source: KNUST