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94 Andrea Gardellin, Abraham Gebre GiorgisComparison of affordability (both for adult and child) between the public and theprivate sectors (Figure 8) in Ethiopia shows that the treatment costs are moreaffordable Comparison in the public of affordability sector then (both the private for adult sector. and child) between the publicand the private sectors (Figure 8) in Ethiopia shows that the treatment costsThe same are more situation affordable is found in in the others public developing sector then countries. the private sector.The same situation is found in others developing countries.Figure 9. Affordability of pneumonia treatment for children and adultsFigure 9. Affordability of pneumonia treatment for children and adults5. Rational use of medicines5. Rational use of medicines5.1 Why 5.1 isWhy this important? is this important?Rational Rational use ofuse medicines of medicines means means that that “patients “patients receive receive medications appropriate appropriateto their clinical needs, in doses that meet their own individual require-totheir clinical needs, in doses that meet their own individual requirements, for anadequate period of time, and at the lowest cost to them and their community”.Overuse, ments, under for use an and adequate misuse period of medicines of time, and mayat lead the to lowest unnecessary cost to them suffering and anddeath, their and waste community”. of scarceOveruse, resources. under use and misuse of medicines may lead tounnecessary suffering and death, and waste of scarce resources.Many Many factors factors influence influence use use of medicines, of and and countries need to implementvar-ious strategies to improve rational use. Some policies, strategies and interven-variousstrategies to improve rational use. Some policies, strategies and interventions found tobe of value include: creating a mandated multidisciplinary national body to coordinatepolicies tions on found medicine to be of use; value standard include: treatment creating a mandated guidelines multidisciplinary (STGs) for common nationalusing body essential to coordinate medicines policies lists on medicine (EMLs) to use; guide standard procurement treatment and guide-training;conditions;establishing lines (STGs) drug and for common therapeutics conditions; committees using to essential coordinate medicines medicines lists (EMLs) management toin hospitals; guide procurement implementing and problem-based training; establishing pharmacotherapy drug and therapeutics training in undergraduatecommitteesto coordinate medicines management in hospitals; implementing prob-curricula; mandating continuing in-service medical education as a licensurerequirement; establishing effective supervision in health systems; using audit andfeedback lem-based to inform pharmacotherapy clinicians training and facilities in undergraduate about their curricula; practice; mandating developingindependent continuing sources in-service of information medical education about medicines as a licensure for requirement; providers and establishingeffective perversesupervision financial in incentives health systems; to overuse using audit medicines; and feedback establishing to inform andconsumers;avoidingclinicians and facilities about their practice; developing independent sources ofinformation about medicines for providers and consumers; avoiding perversefinancial incentives to overuse medicines; establishing and enforcing a soundregulatory framework; and guaranteeing sufficient government expenditure toensure availability of medicines and retain well-trained staff.
6. Using indicators to measure the pharmaceutical sector in Ethiopia 95Essential medicines lists, treatment guidelines, formularies5.2 Why is this important?The essential medicines concept is the basis for rational use of medicines.Ideally, countries develop and routinely update EMLs and drug formulariesthat meet the needs of their population according to a number of criteria, includingdisease patterns, patient characteristics, treatment recommendationsformulated in STGs, and level of care provided. Using an EML makes managementof medicines easier in all respects: procurement, storage and distributionare easier with fewer items, and prescribing and dispensing are morestraightforward for health professionals if they have to know about fewermedicines. A national EML should be based upon national STGs.Together an EML and STGs help to ensure rational drug use. STGs shouldbe developed for each level of care, based on prevalent clinical conditions andthe skills of prescribers practicing at that level. The STGs consist of systematicallydeveloped statements to help prescribers make decisions about appropriatetreatments for specific clinical conditions, providing a benchmark forsatisfactory diagnosis and treatment. Adherence to the recommendations inSTGs should be reinforced by prescription audit and feedback.A formulary can be an important source of evidence-based information aboutmedicines but it is important that it is consistent with STGs and the EML ifall three strategies are to achieve the maximum overall effect.5.3 What is the current situation?Figure 10. Countries withessential medicines lists(EMLs) updated within lastfive years
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