Academic journal article Bulletin of the World Health Organization

A Baseline Survey on Use of Drugs at the Primary Health Care Level in Bangladesh

Academic journal article Bulletin of the World Health Organization

A Baseline Survey on Use of Drugs at the Primary Health Care Level in Bangladesh

Article excerpt


The International Conference on Primary Health Care at Alma-Ata in 1978 provided a guiding framework for public health initiatives (1). Its declaration included appropriate treatment of common diseases and injuries, and the provision of essential drugs as two vital components of the primary health care concept. The provision of drugs is the component of primary health care that patients most often demand and expect. Nevertheless, drugs continue to be in short supply, even when large portions of the health care budget are allocated for their procurement.

In June 1982 Bangladesh introduced a national drug policy (NDP) and a drugs ordinance (2), which follow WHO guidelines on the selection of essential drugs (3). Since the enactment of the drug policy, the production, quality, and availability of essential drugs have significantly improved (4). Although consultations with doctors most commonly result in drugs being prescribed, very little is known about the proper use of drugs. The quality of health care, particularly the rational use of drugs, depends on a wide range of activities, such as making the correct diagnosis, prescribing the appropriate drug(s), and dispensing them properly. When used rationally, drugs cure ailments; on the other hand, they may be dangerous and can threaten life when used irrationally (5).

The WHO Conference of Experts on the Rational Use of Drugs, held in Nairobi on 25-29 November 1985, was an important turning-point (6). The International Network for the Rational Use of Drugs (INRUD) was established in 1989 to promote the rational use of drugs in developing countries (7). The network generated indicators in three main drug use areas; prescribing, patient care, and drug systems; 20 randomly selected facilities and 36 encounters in each area were the minimum required to have representative data.(a) Eleven studies on the rational use of drugs have been undertaken since 1989. The first study using these indicators was conducted in Dhaka, Bangladesh, in 1991, in two rural health centres in the same district, and may not reflect the situation in the whole of the country (8). Therefore, we carried out a larger study representing Bangladesh in general.

The aim of the current survey was to assess drug use for six common diseases and to record the availability of essential drugs. The survey examined current treatment practices at outpatient clinics, including assessment of patient care in terms of history-taking, physical examination, and the time given to each patient; assessment of the dispensing process in terms of the time taken and whether drugs were dispensed according to prescription; patient's knowledge of how to take the drugs; the availability of twelve essential drugs on the survey date; and the availability of an essential drugs list in the facilities.


Medical colleges play a key role in improving the quality of diagnosis, drug use, and supervision and management capabilities of health professionals. The present survey was therefore implemented by one medical college's community medicine and pharmacology department in each of the four administrative divisions of Bangladesh. The survey was coordinated by the Improvement of Drug Management Project (IDM) at UNICEF/Dhaka, and by INRUD members in Bangladesh. The study was undertaken at the two lowest primary level facilities in the public sector: thana health complexes (THCs) staffed by five to eight doctors, who attend 200-300 outpatients per day; and union subcentres (USCs), staffed by a medical assistant who attends 50-100 outpatients per day.

A three-day workshop was organized in July 1992 to adapt the WHO/INRUD Indicators on Drug Use and to identify the six commonest diseases encountered in the outpatient clinics in rural Bangladesh. These were as follows: watery diarrhoea, dysentery with blood, helminthiasis, pneumonia, acute respiratory tract infections, and scabies. …

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