Regional Meeting on the Role of Education in Rational Use of Medicines, Address, 12-14 December 2007. Bangkok, Thailand

Address By Dr Samlee Plianbangchang Regional Director, WHO South-East Asia At Regional Meeting on Role of Education in Rational Use of Medicines Bangkok, Thailand 12-14 December 2007 Regional Meeting on Role of Education in Rational Use of Medicines 12-14 December 2007 Bangkok, Thailand Address by DR SAMLEE PLIANBANGCHANG REGIONAL DIRECTOR, WHO SOUTH-EAST ASIA Your Excellency, Dr Mongkol Na Songkhla, Minister of Public Health, Royal Thai Government; Professor Charas Suwanwela, Honourable Chairman of the University Council of Chulalongkorn University; Dr Charuaypon Torranin, Honourable Permanent Secretary, Ministry of Education, Royal Thai Government; Dr Surasak Taneepanichskul, Honourable Dean, College of Public Health Sciences, Chulalongkorn University; Distinguished participants; Honourable guests; Ladies and gentlemen; I warmly welcome you all to the South-East Asia Regional Meeting on the Role of Education in Rational Use of Medicines. At the outset, I would like to thank the College of Public Health Sciences, Chulalongkorn University, for hosting this important meeting. I thank Dr Mongkol Na Songkhla, Minister of Public Health, the Royal Thai Government, for agreeing to inaugurate the meeting. I thank Professor Charas Suwanwela and Dr Charuaypon Torrani, Permanent Secretary, Ministry of Education, Royal Thai Government, for agreeing to address the meeting. The presence of these and other high-level dignitaries signifies their keen interest in the role of education in rational use of medicines. I thank all participants for sparing their valuable time to attend the meeting. All of us agree that medicines are really important for our life. At the same time, we agree that irrational use of medicines is very prevalent and posing a serious public health problem. Medicines are used by many people inappropriately; either 2 as overuse, underuse or unnecessary use, when not indicated. The problem has led to an enormous loss. In economic terms, the global estimate of this loss is about US$ 120 billion annually. This is a really unacceptable situation. It is easy to go around and ask people to use medicines rationally or appropriately. However, it is very difficult for people to decide on such rationality or appropriateness. Certainly, when people get sick, there is somebody to help take the decision on how to get well, and, in many cases, offer advice on the use of medicines. They are usually the health-care providers. Often, people can get help from their own peers in making such a decision. Health-care providers actually play a key role in influencing the ways people use medicines. Attempts have been made in the past to promote this role of health- care providers to ensure that medicines are properly used. However, it is evident that only this approach is not adequate to help people get the right medicines in the right doses that are used for the correct length of time. To be able to make an appropriate decision on the use of medicines, the people themselves need to be equipped with the relevant knowledge and know-how. If we have to get better results from our efforts in promoting the rational use of medicines in community; then the people themselves must be empowered to look after their own health more effectively. Therefore, educating people and consumers extensively on a large scale becomes imperative. This education should be extended from the community to the general population, and to the public at large and not only to the current clients of health-care facilities. And such education should start at an early age, and should be integrated into the educational system from the primary to the college level. The rational use of medicines needs full awareness and strong advocacy at policy- and decision-making level in countries. In order to succeed in this formidable task, it is necessary to gain a complete political understanding, strong political will 3 and unwavering political commitment. Issues relating to irrational use of medicines are very complex and complicated indeed. These involve a wide range of behavioural, psychosocial and economic parameters, which have to be taken into serious consideration when such education is planned. This is why we have invited to this meeting participants with widely differing backgrounds – but people who can make a difference. In fact, these are the people, without whose participation it will not be possible to implement this important initiative successfully. These people are teachers, women’s representatives, NGOs, consumer groups; they are in addition to doctors, other medical personnel and government representatives. The ethical dimension, which is extremely important, must be integrated into and inculcated in this educational process. Among other things it should be made clear to all that to prescribe a more expensive medicine, when an equally effective and cheaper one is available, may be considered unethical. While accepting that medicines are important for people’s health, the people must be made to understand at the same time that medicines form only one component of a range of interventions needed to stay healthy. In order to remain in good health, people must be educated and encouraged to do other things than taking medicines. This can be achieved particularly through the regular and adequate practices for health promotion and disease prevention; practices that generally do not require medicines. To stay healthy means, among other things, to have less need for medicines for curative purposes. This situation can lead to the making of better and more informed decisions on the use of medicines. Not less important, the people must be made to clearly understand the undesired side-effects of taking certain medicines, either in short- or long-term use. And they must always be told and convinced not to take any medicines 4 unnecessarily. They must be told that, if they take many medicines without appropriate advice, one drug may interact with another to induce undesirable side- effects; or even decrease or increase the effect of one medicine to the detriment of the patient. This type education of the people, similar to public education in general, is really a difficult task. Many factors influence the level of success in promoting the rational use of medicines. These include, the level of education of people; strategy and approach to ensure effective educational process; body of knowledge and know-how to be imparted to people; and policy commitment and support at the national level. As far as the level of education of people is concerned, our efforts should be directed towards functional literacy; whereby, people are empowered to take care of their own health, even though they may not be able to read or write. Taking care of one’s own health also includes the ability to make appropriate decisions on the use of medicines. We have to choose the right strategy and approach to ensure an efficient and effective process of the education. We need to have resource centres for pooling bodies of knowledge and know-how for use as the content of educational message. Certainly, we have to work closely with policy-makers at national level to gain adequate political will, commitment and back-up support. Rational use of medicines is a long-standing issue. Advancement in pharmaceutical sciences has enormously contributed to the positive impact on health. At the same time, it also leads directly or indirectly to an inappropriate use of medicines, and to the unnecessary use of more expensive medicines. This situation usually comes along with the undesirable aspects of promotion of the pharmaceutical products. We should try in every possible way to control and prevent the unwanted impact of this technological advancement. We understand that there are several population groups in our efforts to promote the rational use of medicines. In this exercise, we should pay our special 5 attention to the education of all people; people who may or may not be clients of health-care facilities. We believe that people themselves, if properly informed, can help in a big way in improving the rational use of medicines. It is really a daunting task, but is very challenging indeed. Being responsible for the health of the public, which is a fundamental human right of everyone; we have to work closely together to ensure that consumers are adequately informed on all aspects of this issue. In pushing forward this important educational strategy to improve the appropriate use of medicines, we have to work with all stakeholders; the public and private sectors; governmental and nongovernmental organizations; civil society; and the communities themselves. To fulfil the purpose of this task, actions of several sectors and disciplines need to be extensively mobilized. This formidable challenge really requires unstinted determination and commitment of all concerned. WHO is ready to provide support, as much as it can, to help ensure efficient coordination and cooperation among all stakeholders. With these words, let me wish you all, all success and all the best in your deliberations. And I wish this meeting every success in bringing together the people who are moving forward towards the same objective. That objective is to improve the rational use of medicines through educating people of all walks of life. Thank you.