Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria
Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria
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DOI：
10.1093/heapol/17.4.378
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发表时间：
2002-12-01
影响因子：
3.2
通讯作者：
Akpala, CO
中科院分区：
文献类型：
--
作者：
Uzochukwu, BS;Onwujekwe, OE;Akpala, CO
目的：比较巴马科倡议药物循环基金方案已经运作的初级保健设施与尚未运作巴马科倡议药物循环基金方案的初级保健中心的药物供应和合理使用水平。该研究在尼日利亚埃努古州的21个拥有BI药物循环基金的初级保健中心和12个没有BI药物循环基金的初级保健中心进行。收集了有关设施储存的基本和非基本药物的数据。通过分析每个卫生中心的处方来确定药物使用情况。最后，消费者的比例，能够记住他们的给药schedues.Findings：平均35.4基本药物可在BI健康中心相比，15.3在非BI健康中心（p < 0.05）。BI保健中心的平均药物库存量足够维持6.3周，而非BI保健中心的平均药物库存量仅够维持1.1周（p < 0.05）。BI保健中心比非BI保健中心开更多的注射剂（64.7对25.6%）和抗生素（72.8对38%）（p < 0.05）。BI保健中心平均每张处方有5.3种药物，而非BI保健中心为2.1种。然而，通用名称和基本药物清单中的药物处方在BI保健中心（80%和93%）高于非BI保健中心（分别为15.5%和21%）（p < 0.05）。结论：据观察，BI设施在数量和平均库存方面都有更好的基本药物供应。然而，BI已经引起了更多的药物处方，这可能是不合理的。调查结果呼吁采取战略，确保更多的基本药物的供应，特别是在非BI初级保健中心，作为一项战略，以减少医疗费用和提高初级保健服务的质量，同时促进合理使用药物在所有初级保健中心。应进行更详细的研究（例如，通过焦点小组讨论或结构化访谈），以找出过度处方的原因，并制定未来的干预措施来纠正这种情况。
Objectives: To compare the level of availability and rational use of drugs in primary health care (PHC) facilities where the Bamako Initiative (BI) drug revolving fund programme has been operational, with PHC centres where the BI-type of drug revolving fund programme is not yet operational.Methods: The study was undertaken in 21 PHC centres with BI drug revolving funds and 12 PHC centres without BI drug revolving funds, all in Enugu State of Nigeria. Data were collected on the essential and non-essential drugs stocked by the facilities. Drug use was determined through analyses of prescriptions in each health centre. Finally, the proportion of consumers that were able to remember their dosing schedules was determined.Findings: An average of 35.4 essential drugs was available in the BI health centres compared with 15.3 in the non-BI health centres (p < 0.05). The average drug-stock was adequate for 6.3 weeks in the BI health centres, but for 1.1 weeks in non-BI health centres (p < 0.05). More injections (64.7 vs. 25.6%) and more antibiotics (72.8 vs. 38%) were prescribed in BI health centres than in the non-BI health centres (p < 0.05). The BI health centres had an average of 5.3 drugs per prescription against 2.1 in the non-BI health centres. However, the drugs prescribed by generic name and from the essential drug list were higher in the BI health centres (80 and 93%) than the non-BI health centres (15.5 and 21%, respectively) (p < 0.05).Conclusion: It was observed that the BI facilities had a better availability of essential drugs both in number and in average stock. However, the BI has given rise to more drug prescribing, which could be irrational. The findings call for strategies to ensure more availability of essential drugs especially in the non-BI PHC centres as a strategy to decrease medical costs and improve the quality of PHC services, while promoting rational drug use in all PHC centres. More detailed studies (for example, by focus group discussion or structured interviews) should be undertaken to find out reasons for the over-prescription and to develop future interventions to correct this.