Всемирная организация здравоохранения (ВОЗ / WHO) · Technical Documents

WHO/SPEC Meeting on Technical Cooperation among South Pacific Countries/Areas in Pharmaceutical Supplies, Suva, Fiji, 4-8 December 1978 : report

31 декабря 1978 г. Всемирная организация здравоохранения

Полный текст размещён на сайте публикующей организации. lawenc.com индексирует метаданные и ведёт на официальный источник.

Полный текст

•

lep/DPM/OO2

ORIGINAL:

l!MGLISH

/SPEC MEETING ON TECHNICAL COOPERATION AMONG SOUTH PACIFIC COUNTRIES/AREAS IN PHARMACEUTICAL SUPPLIES

Sponsored by the

World Health Organization Regional Offioe for the Western Paoifio and the South Paoifio Bureau for Eoonomio Cooperation

Suva, Fiji

4-8 Deoember 1978

FINAL REPORT Rev.l

Not for sale Printed and distributed by the Regional Offioe for the Western Paoifio of the World Health Organization Manila, Philippines Deoember 1978 'i.f't:':!\_" ..

i\;l~llJ~'!. l~il;;~~~~':l'_';' '

'!/:-.- ;";',(', {_',

'i.i.'.

NOTE The views expressed in this report are those of the consultants and participants in the WHO/SPEC meeting on technical cooperation among South Pacific countries/areas in pharmaceutical supplies and do not necessarily reflect the policy of the World Health Organization nor the South Pacific Bureau for Economic Cooperation.

•

This report was prepared by the World Health Organization's Regional Office for the Western Pacific and the South Pacific Bureau for Economic Cooperation for Governments of their Member States and for participants in the meeting.

CONTENTS Page 1•

INTRODUCTION DRUGS

...... " ............ " " ...... " " . " .... " .. " ...... "--,, ........ " .... " " .. " ...... " .. " . " .... .

2. 3. 4. 5. 6. 7. 8..

REVIEW OF THE DRAFT COMBINED LIST OF ESSENTIAL ............ " .. " .... " .... " " " " " .. " " ...... " ........ " .. " .... " " .............. " " .................. " " .. 2

POSSIBLE PROGRAMME STRUCTURE FOR BULK PURCHASING OF PHARMACEUTICALS AND OTHER MEDICAL SUPPLIES ••••••••••••.•••••••• QUALITY ASSURANCE AND CONTROL OF DRUGS •••••••••••••••••••••••••

3 6 9

USE OF DRUGS IN ORGANIZED HEALTH CARE, ESPECIALLY IN PRIMARY HEALTH CARE AND SPECIFIC DISEASE CONTROL

........................

DEVELOPMENT OF REQUIRED MANPOWER IN THE AREA OF DRUG CONTROL AND MANAGEMENT ...••••..•.•••.•.•.....•••....•..••• REVIEW OF CURRENT DRUG LE'tlISLATION IN THE SOUTH PACIFIC REC~ATIONS

••••• •••

12 '2

.................................................... " . " .. " ................................ "

ANNEX 1 - ADDRESS BY THE HONOURABLE MINISTER FOR HEALTH, FIJI, MR EDWARD JAMES BEDDOES ••••••••••••••••••••••••• 13 ANNEX 2 - ADDRESS BY DR FRANCISCO J. DY, RE'tlIONAL DIRECTOR, WESTERN PACIFIC REGION, WHO ...•.•..••.•.••••.••••••.. ANNEX 3 - ADDRESS BY THE HONOURABLE MARE U. TUPOUNIUA, DIRECTOR, SOUTH PACIFIC BUREAU FOR ECONOMIC CooPBRATION (SPEC) " .......... " .......... " .......... "" .... " ...... " .. " .. "........ 21

ANNEX 4 - ADDRESS BY PROFESSOR M0RIZO ISHIDATE, CHAIRMAN, JAPANESE PHARMACEUTICAL ASSOCIATION AND CHAIRMAN, SCIENTIFIC COMMITTEE, SASAKAWA MEMORIAL HEALTH FOUNDATION, JAPAN •• • • • • • . • • . • • • . • • • • • • • •• • • • •• • • • •• . • 25/26 ANNEX 5 - AGENDA ...................... " ........................................ " ...... " " .............. " .. 27/28

ANNEX 6 - LIST OF PARTICIPANTS, TEMPORARY ADVISERS AND SECRETARIAT . • • • • • • • • • • . • • • • • • • • • . .. .. • • • • • • • • • • .. • • • 29

ANNEX 7 - LIST OF PARTICIPANTS IN GROUP DISCUSSIONS ANNEX 8 - TIMETABLE

•.••••••••••

35/36 37/38

• • . . • • • . • • .. . . • • .. . . .. .. • • • .. • • • • .. .. . • • .. .. .. • . • • .. • • •

ANNEX 9 - DRAFT FOR A COMBINED LIST OF ESSENTIAL DRUGS TO BE USED CURRENTLY IN FIVE SOUTH PACIFIC COUNTRIES (FIJI, PAPUA NEW GUINEA, SAMOA, SOLOMON ISLANDS AND TONGA) • • • • • • .. • .. .. • .. .. .. .. .. .. • • • .. .. .. .. • .. .. .. .. • .. .. .. .. • • • .. .. • .. 39

ANNEX 10 - COMBINED LIST OF ESSENTIAL DRUGS FOR SOUTH PACIFIC RmION - ANALYSIS OF DRUG CONSUMPTION FIGURES FROM FIJI, PAPUA NEW GUINEA, SAMOA, SOLOMON ISLANDS ARJ) TONGA .. • . . .. .. .. .. . . .. .. .. . .. .. .. . .. . . . .. . . .. . .. .. . . .. .. .. . . .. .. . .. .. . .. .. .. .... '19 ANNEX 11 - REPORTS ON A STUDY TOUR ON DRUG UTILIZATION IN RURAL HEALTH SERVICES IN PAPUA NEW GUINEA •• • • • • ••• •• 121 ANNEX 12 - COLLECTIVE PURCHASING OF DRUGS ARJ) MEDICAL SUPPLIES - DISCUSSION PAPER ON POSSIBILITIES FOR IMPLEMENTATION .................................................... ; .. .. .. .. .. .... 1:51 ANNEX 13 - WORLD HEALTH ASSEMBLY RESOLUTION WHA28. 65 ANNEX 14 - WORLD HEALTH ASSEJmLY RESOLUTION WHA28.66 ANNEX 15 - WORLD HEALTH ASSEMBLY RESOLUTION WHA31.32

................ ,. .... ......................

......................

ANNEX 16 - ECONOMIC AND SOCIAL COMMISSION FOR ASIA AND THE PACIFIC (ESCAP) RESOLUTION 173 •• • • ••• • ••• • •• 1.\7

INTRODUCTION

The WHO/SPEC meeting on technical cooperation among South Pacific countries/areas in pharmaceutical supplies was held in Suva, Fiji from 4 to 8 December 1978. The objectives of the meeting were: (a) review and approval of the draft combined list of essential drugs and report of the drug utilization study mission to Papua New Guinea; (b) evaluation of estimated quantity of each preparation procured by government currently for five countries in the South Pacific, viz. Fiji, Papua New Guinea, Samoa, Solomon Islands and Tonga; (c) establishment of alternative strategies for implementing TCDC in bulk purchase (procurement, storage, delivery) according to available physical facilities and manpower (situational analysis) and discussion of the possible programme structure and its relation with WHO, SPEC and other participating international organizations;

•

(d) technical recommendations for implementing the TCne programme in pharmaceutical supplies with suggested policy guideline; (e) review of the available manpower resources in each country/area in drug control, quality control analysis and drug management (procurement, storage and distribution) and evaluation of the needs for upgrading and new manpower development through fellowship and on-the-spot training; (f) consideration of the scope for cooperation in relation to other medical supplies such as vaccines, dressings, etc.; (g) review as far as feasible of current drug legislation in the South Pacific. The Honourable Edward Beddoes, the Minister for Health, Fiji, in his opening address emphasized the need for technical cooperation in bulk purchase of pharmaceuticals. He said that priority should be given to community needs, and underlined the importance of quality assurance of pharmaceuticals. Dr Francisco J. Dy, WHO Regional Director of the Western Pacific in a welcome address delivered by the WHO Programme Coordinator, Suva outlined WHO's Action Programme on Essential Drugs with particular reference to activities in the Western Pacific Region. Mr Mahe U. Tupouniua, the Director of SPEC, traced the background work of SPEC in the area of bulk procurement of drugs and urged the participants to explore every avenue to ensure that the objective of a practical, workable collective purchasing scheme is attained.

•

- 2 •

Professor Morizo Ishidate, President of the Federation of Asian Pharmaceutical Association and Vice-President of the Federation of International Pharmaceutical Association as well as chairman of the Board of Trustees of the Sasakawa Memorial Health Foundation, endorsed the efforts of WHO and SPEC in convening the meeting as a concrete step forward in technical cooperation in the pharmaceutical field. Dr Jona B. Sen ilagaka Ii , Permanent Secretary for Health, Fiji was elected chairman of the meeting. Mr Vladimir J. Holna, Chief of Pharmaceutical Services, Papua New Guinea and Dr Solia Tapeni Faai'uaso, Acting Director of Health, Samoa were elected as vice-chairmen. Mr Patrick A. Keefe, Principal PharmaCist, Fiji and Dr Policarpo A.S.C. Silva Rosa, Assistant Secretary (Medical Services), Papua New Guinea served as rapporteurs. .

REVIEW OF THE DRAFT COMBINED LIST OF ESSENTIAL DRUGS

The meeting reviewed the draft for a combined list of essential drugs1 prepared by a WHO mission which made a survey of drugs used in five South Pacific countries, viz. Fiji, Papua New Guinea, Samoa, Solomon Islands and Tonga in July - August this year. The object of the review was to identify the drugs which are essential for the delivery of health care, particularly in a primary health care system, and which could be used as a basic list for collective bulk purchasing. The meeting considered each drug and its dosage presentation in the combined list and on the basis of their therapeutic relevance, pharmacological justification, cost/effective ratio and suitability for collective bulk purchasing, selected for recommendation a revised list of essential drugs. In making its selection of drugs the meeting had the benefit of the most recent views of the WHO Expert Committee on the selection of essential drugs,2 as conveyed by the secretariat. Due consideration was given to local experience and practice. Among the essential drugs selected were those which would provide orders of sufficient size to be economically attractive to suppliers only if orders from individual countries were pooled. The relatively large turnover of other drugs on the list would enhance the collective bargaining position and therefore reduce drug costs.

, See Annex 9. 2 See WHO TRS 615.

- 3 -

Ad hoc committees were set up to standardize usage in situations where there-Were-unimportant variations in the preparations employed. The meeting brought together, for the first time, doctors and pharmacists who are involved with the procurement, distribution and use of drugs in the region. It also offered an opportunity for an exchange of information relating to sources of supply, sale prices, drug utilization, drug toxicity, and related pharmaceutical matters. Some of the drugs in the list may not be suitable for bulk purchasing, but are life-saving or essential for health care and as such should be made available. The criterion for inclusion on the list needs to be reviewed periodically. The revised list has been based on therapeutic need irrespective of patient numbers. It was understood that the drugs whioh are not on the list might well be used by individual Member countries according to their own special needs. It was also noted that the list needs to be reviewed periodically. The revised list of essential drugs' for combined bulk purchasing was then adopted and named "The South Pacific List of Essential Drugs". It was suggested that the list might be expanded at a later date to include other medical supplies.

POSSIBLE PROGRAMME STRUCTURE FOR BULK PURCHASING OF PHARMACEUTICAL AND OTHER MEDICAL SUPPLIES

After full discussion of this agenda item the partiCipants agreed that bulk purchasing in the South Pacific was justified with an overall aim to reduoe the price of medical supplies through a larger volume turnover and a planned ordering system and to ensure a supply of essential drugs at reasonable cost and established quality to all participating countries. The establishment of a common list of supplies made the realization of a joint system possible, overcoming some of the difficulties encountered by previous attampts in this domain. Political agreement regarding the establishment of a common system had already been expressed and three levels of ac~ion were now recognized. The functions of the Joint Management Board could be initially undertaken by the ministerial meeting convened by SPEC/WHO in '979. The Executive Committee would normally include senior health officers and chief pharmaCists from the Member countries.

1To be supplied separately.

- 4 • With regard to the operational level, ths establishment of a joint pharmaceutical service, with or without a oentral warehouse, was discussed. Two oountries offered to host the Joint faoilities stressing that such an operation would be completely independent from their government, aoting for the common good. The aotual looation would need to be decided on the basis of detailed analysis of requirements, transport possibilities, eto. The establishment of a central store, if found . appropriate, would not preclude flexibility in operations such as direct shipment from producers to individual countries. While it was foreseen that, at its initial stage, the programme would ooncentrate on the collective purchasing of essential drugs, oonsideration would need to be given to the problem of speoialized purohasing of other supply items required by the services. In considering viability·of the scheme attention should be paid to its cost/effectiveness taking also into account the almost oertain expansion of health services in view of growing demands for primary health care, expanded programme of immunization, malaria control aotivities, eto. The participants oonsidered that SPEC and WHO had a substantial role to play in launching the soheme, both in terms of technioal inputs and of mobilization of resouroes. Other organizations, for example, UNDP, UNICEF, might also have a oontribution to make. Referenoe was made to the possibility, in the immediate future, for governments to obtain oertain items (e.g. vaocines) through WHOIUNICEF supply servioes at favourable oonditions. An aotion plan should be developed by SPEC/WHO along the following lines: Based on the recommendations of the WHO/SPEC meeting of 4-8 December 1978 on a programme for the establishment of a joint pharmaoeutical servioe, prepare a suitable paper for consideration by the proposed Meeting of Ministers of Health in 1979. The paper is to inolude: (a) (b) (c) (d) (e) (f) (g) financial and other implications for the participating countries; programme management structure; membership conditions for participation in the programme; measures for financing the programme from national and international sources; the role, organization and location of a joint purchasing office; the role, organization and location of a quality control laboratory; the need for the establishment of regional warehouse arrangements, including the role, organization and location;

•

- 5 -

(h) (i) (j)

requirements for international technical cooperation; priorities for action and a time-frame for implementation; any other issues pertinent to the programme.

JOINT PHARMACEUTICAL SERVICE Suggested Programme Management Structure and Roles

Policy level

Joint Management Board

(JMB)

- is responsible for policy, direction and evaluation of programmes; - ensures its financing; - reaches agreements with other contributing parties; - recommends action to participating governments.

Implementation Exeoutive Committee •

- has responsibility for the supervision of implementation; - prepares documentation for policy deCisions by the' Joint Management Board; - deals with matters assigned to it by the JMB. Operations Joint Pharmaceutical Service - collects marketing information; - collects and disseminates information on drugs; issues tenders;

, ,

_ ensures quality of products; - manages stocks; - ensures distribution; - to

effect payments.

- 6 -

QUALITY ASSURANCE AND CONTROL OF DRUGS

The general principles governing the quality assurance and control of drugs were discussed by the participants. The elements of a system applicable to the situation in South Pacific, when bulk purchasing of drugs is introduced, were examined. These include the following: (1) The utilization of the "Certification scheme on the quality of pharmaceutical products moving in international commerce" as recommended by the World Health Assembly in its resolution WHA28.65. 1

(2) The evaluation of data supplied by manufacturers relating to the quality and efficacy of their products. (3) The analysis by chemical and physico-chemical techniques and the microbiological testing of pharmaceutical products (including antibiotics) to establish pharmacopoeal specifications. (4) The examination of the adequacy of the packaging and confirmation of the stability of products periodically returned from storage at the end ~of the distribution channels. (5) The examination of products found in use to be of doubtful efficacy. (6) The provision of relevant information to the purchasing officer based on past experience. While all participants were convinced of the value of quality assurance, various options intended to achieve such ends were considered. These included no change to the present system, reliance on other countries for such assistance as they could provide, employment of commercial analysts to test products and the provision of a regional drug control laboratory. While some help would be forthCOming from other countries, it was considered that, in practice, they would not be able to provide the level of assistance necessary. The resources in such countries were not unlimited and they had their own problems and priorities. 4.1 Cost considerations

On cost considerations alone, the utilization of commercial analysts might be marginally cheaper, but this had a number of disadvantages as compared to the establishment of a drug control laboratory in the region. I

1 Annex 13.

•

- 7 -

There were hidden oosts attendant upon the present situation whereby the cheapest drugs were purohased. These oosts inoluded undeterminable defioienoies in the produots and oonsequent human suffering. Savings to a number of oountries would undoubtedly be made by a well-organized bulk purohasing system. It was not possible, at present, to determine whether these would exoeed the running oosts of a regional drug oontrol laboratory. The relative oosts of such a laboratory would deorease as the quantity of drugs purohased for the region inoreased. Quality assuranoe had oosts, but, if the oountries of the South Paoifio wished to provide their peoples with a higher standard of health care and make provision for the future, such oosts were inevitable. Other essentially unquantifiable oonsiderations were pertinent, and inoluded the following: (a) The mere existenoe of a quality oontrol faoi1ity would be a deterrant to the supply of a substandard drugs. (b) The development of a soientifio oapaoity and skills in the region would have implioations for other aotivities. (0) Sooia11y-rewarding employment would be provided for graduates of 100al eduoationa1 institutions. (d) The development of greater self-relianoe for the oountries involved would 01ear1y be advantageous. •

In view of all these oonsiderations, the partioipants reoommended the establishment of a quality oontro1 laboratory in the South Paoifio region • It was noted that the oost of establishing suoh a laboratory and of training the neoessary staff would be too great a burden unless international assistanoe were made available. Partioipants received a report relating to the development of basio tests for drugs whioh provide oonfirmation of identity and evidenoe of degradation. These will be of importanoe to oountries in the region whioh at present had to rely on labelling and visual oharaoteristios of drugs. ·The basio tests have been developed for a oonsiderab1e number of drugs and are being ourrent1y tested under field oonditions in several tropical oountries. The oost of equipment and reagents is very low. Partioipants agreed that these tests when fully developed should be used at the periphery of the distribution system. In determining the looation of the proposed laboratory, some teohnioal oonsiderations are pertinent. If the laboratory were established in the vioinity of an advanoed eduoational institution, it would faoi1itate soientifio oooperation and liaison between the staffs, and under suitable arrangements mutual use of library faoilities and perhaps oooperation in the servioing of equipment.

- 8 -

4.2

Regional drug control laboratory

4.2.1 Testing capacity. The range of produots which the laboratory should be able to test would initially comprise at least 200-300 of the drugs considered essential for the region. The laboratory should initially be able to perform approximately 500 analyses per year, this number gradually increasing to about 1000 or more. By an analysis is meant the oomplete set of tests and assays needed to arrive at a judgement concerning the quality of a given sample. 4.2.2 Premises and technical facilities. The laboratory should be located in premises of 300-400 sq m of total usable space, out of a total area of 400-600 sq m. Out of this 150-200 sq m should be equipped for proper laboratory purposes, the rest being allocated to supporting services, administration, library, stores, etc. The following technical facilities should be available: hot and cold water, drains, electricity (AC with voltage stabilizing equipment for physico-chemical rooms, if locally needed) and air-conditioning systems. 4.2.3 Personnel. The staff should comprise 15-20 persons. This will include the Director (preferably a person with a postgraduate degree in pharmaceutical analysis), 4-5 analysts (graduates in pharmacy, analytical chemistry, microbiology), 4-5 laboratory technicians, and 6-8 supporting staff (secretaries, maintenance workers, etc.). 4.2.4 EqUipment. The equipment of the laboratory would consist of special laboratory furniture, equipment for modern instrumental analysis and general laboratory equipment and implements. 4.3 ~.3.1

Costs and financing Initial costs Laboratory building, technical ) looal costs to be determined when facilities, general furniture ) site has been decided upon Special laboratory furniture (benches, chemical hoods, horizontal laminar flow hoods) $15 000 - $ 25 000 ) Equipment for modern instrumental analysis General laboratory equipment Reagents Books $60 000 - $100 000 ) $70 000 - $100 000 ) $163 000-$255 000 $10 000 - $ 20 000 ) $ 8 000 - $ 10 000 ) !

- 9 -

4.3.2

Estimated annual reourrent oosts Staffing ) Looal oost to be determined ) when site has been decided Utilities, maintenanoe and depreoiation ) upon $ 3 000 - $ $ 2 000 - $ $ 2~-

Supplies and equipment Glass and general equipment Books and per1od1cals Maintenanoe of instruments and equipment (10J

4 000) ) 3 000) )$27 000-$38 000 3 000)

) $ 5 000 - • 8 000)

Renewal of equipment of total original oost)

$15 000 - • 20 000)

External finanoial support would be needed for the initial oosts as well as for the annual reourrent oosts during a period of 3-4 years. Financial support is also needed to plan and to oost the laboratory as follows: 1

1 1

Pharmaceutical chemist with experienoe in laboratory organization and management Architect Engineer

3 months 3 months 3 months

USE OF DRUGS IN ORGANIZED HEALTH CARE, ESPECIALLY IN PRIMARY HEALTH CARE AND SPECIFIC DISEASE CONTROL

The report on the study on drug utilizat10n in Papua New Guinea was considered and the salient features were noted particularly the health oare delivery system at the peripheral units with standardized guidelines for management of common oonditions us1ng a drug list which had been formulated and is oontinually being reviewed by an advisory oommittee. Pharmaceuticals oonstitute a very important component of health care and essential drugs should be made available at all times at reasonable oost. Rational use of drugs should complement the bulk purohase scheme to improve pharmaceutical ooverage in terms of population to be covered as well as oonditions to be treated. There is a need to establish not only national lists of essential drugs based on the WHO model list and modified to suit local oonditions but also lists of essential drugs for various levels of the health care delivery system partioularly at primary health oare level.

- 10 -

Measures to achieve more rational drug use are recommended. These include dissemination of accurate and objective information on drug use tailored to the understanding of the prescriber and the patient, strengthening the component on drug use in the curriculum in the training education and continuing education of various grades of health workers and government or state interventions to influence the availability and supply of various drugs through judicious procurement based on lists of essential drugs and regulatory control of drug advertisement. Other possible measures to achieve a more rational drug use which were mentioned included import restrictions of certain pharmaceuticals, taxation and reimbursement schemes.

Extensive discussions were held on the concept and practice- of primary health care including the importance of community participation, self-reliance and intersectoral cooperation and reorganization of existing health care delivery systems to support primary health care. EmphasiS was put on ensuring the availability of the relevant essential drugs in appropriate dosage forms at all times at the primary health care level. The differences in drug utilization by different grades of prescribers, e.g. specialist physician, general practitioner, primary health care worker were brought out. Communication problems between various prescribers, national health planner or administrator and the political viewpoint reflecting the demands of the population could have impact on rational drug use. Experience and problems relating to self-care and self-medication and the use of traditional medicine were discussed. However, as future developments in these areas could not be clearly defined, the impact on drug utilization could not be accurately determined. The need for education of consumer in the proper use of drugs was emphasized. In this connexion, appropriate public education and information techniques to promote rational drug utilization shOUld be further explored. Based on foreseeable future development of the health services and of primary health care in most of the countries/areas in the South Pacific it is envisaged that future requirements of pharmaceuticals especially essential drugs will increase particularly in the amount and range of drugs required. Changing patterns in the provision of health services and in financing the provision of pharmaceuticals together with population growth and changing patterns of diseases would not only increase the future demands for drugs but also alter the proportion and range of various types of drugs in demand. Discussions were held as to whether cholera, typhoid and paratyphoid vaccines should be included in the list of essential drugs for the South Pacific. Although the effectiveness of cholera vaccine is questionable and WHO has recommended removing cholera vaccination as a requirement for international travellers, cholera vaccine has to remain on the list, because certain countries/areas in the world still require travellers to have a valid cholera vaccination certificate particularly if they come from cholera-infected areas.

- 11 -

It was decided to include cholera and typhoid and parathypoid vaccines in the list of essential drugs but with the caution that their effectiveness is questionable.

DEVELOPMENT OF THE REQUIRED MANPOWER IN THE AREA OF DRUG CONTROL AND MANAGEMENT

All countries of the region employ pharmacy assistants and with the exception of two countries utilize registered pharmacists with full university qualifioations. The number of pharmacists is small for the size of the population. There is no institution in the region which provides a full graduate oourse. Courses for pharmaoy assistants are available in Fiji and Papua New Guinea. The delivery of health care would be facilitated if the number of pharmacists were increased. A considerable improvement would result from expanding and upgrading the existing educational institutions. In order to increase the number of registered pharmacists, several countries had supported students at overseas universities. This had not proved entirely satisfactory since some had not graduated, or upon graduation had left the South Pacific. It was considered that better selection procedures and choice of training institutions would improve this situation. !

When a regional quality oontrol laboratory is established, there would be a need for graduates in the fields of pharmaceutical chemistry, analytical ohemistry and miorobiology. A pharmaceutical ohemist preferably with postgraduate experienoe in pharmaceutical analysis to supervise the drug centre laboratory would probably, in the beginning, have to be reoruited from outside the region, as would a microbiologist. Soience graduates of the UniverSities of Papua New Guinea and the South Paoific would, with some additional speoialized training, be capable of muoh of the analytioal work carried out in the proposed laboratory. Local oourses for general laboratory teohnicians are available. Graduates in pharmaoy teohnology oould also be a souroe for this type of work. Maintenance of laboratory equipment is a problem in the region and would be an essential need for proper operation of the quality oontrol laboratory. This type of training cannot be supplied in the region, but is available in New Zealand.

- 12 -

REVIEW OF CURRENT DRUG LEGISLATION IN THE SOUTH PACIFIC

Participants reviewed the legislation currently effective in the South Pacific region. In some countries, new legislation was being prepared or was to be subjected to review soon. In oth~rs, current legislation was to some extent outdated. In a few instances legislation was defective. Generally, enforcement was variable depending largely on resources and perceived needs. It did not appear that the deficiencies in legislative powers had led to situations which required urgent attention. Mostly the legislation was derived from that of previous administration. It was directed more towards the needs of metropolitan countries than those of the local communities. The value of drug control system based on registration was noted. It was considered that, at an appropriate time, the drug legislation in the various countries of the region should be reviewed with the intention of achieving harmonization because of developing regional cooperation on drugs. Such legislation should provide wide powers to the governments for the protection of the health of the community. Its basic principles should be simple and should be easy to elaborate when extension of its scope should become necessary. Implementation of the legislation should not be demanding of resources. Where necessary, the situation in relation to patented drugs should be reviewed and a policy determined. Provision should be made for the control of the sale of drugs either on prescription or over the counter. Consideration shoul~ also be given to such matters as official specifications for drugs, labelling, information leaflets, containers, licensing of manufacturers, wholesalers and retailers. Control over advertising would also be necessary.

RECOMMENDATIONS

The meeting recommended that WHO/SPEC take the following actions: to publish and disseminate the South Pacific List of Essential Drugs as adopted; to plan a programme for the establishment of the South Pacific joint pharmaceutical service as described in the report, in consultation with interested national administration; to propose a meeting of Ministers of Health of the South Pacific region in 1979 to consider implementation of the programme; to explore possible technical and financial support that might be required for the programme from bilateral and multilateral sources.

- 13 -

ANNEX 1

ADDRESS BY THE HONOURABLE MINISTER FOR .HEALTH, FIJI, MR EDWARD JAMES BEDDOES

I would like to thank the World Health Organization and the South Pacific Bureau for Economic Cooperation for the invitation to open this very important meeting on technical cooperation among South Pacifio countries in pharmaoeutical supplies. May I also take the opportunity of extending to you all my Government's warm weloome and sinoere wishes for a pleasant stay in Suva. The Government of Fiji attaohes great importance to this five-day meeting. I am pleased to note from the list of participants that other oountries in· the region also share our views on the need for the oollective purohasing of medioal supplies and are, therefore, represented here, on this auspicious ocoasion, at the highest level in both the medical and pharmaceutical fields. The presenoe here of oonsultants and advisers from WHO Headquarters in Geneva and from the Regional Offioe in Manila strongly refleots on the World Health Organization's ooncern and global target for better health for all by the year 2000. The oontinuing involvement of SPEC on the issue of bulk purohasing of drugs again reflects on the Bureau's oommitment for fuller technioal oooperation among not only its member oountries but also with those outside the region. It is, therefore, gratifying to note the presenoe of temporary advisers from Japan. Pharmaceutioal services are part and paroel of the health servioes of any oountry. The growth and development of this servioe should be in keeping with the overall sooioeoonomio development of any nation. This is espeoially important in developing oountries to which many of us belong. In most of the South Paoifio oountries health services are only one faotor oontributing to the overall health of the population. Beoause of the geographical situations involved, the oosts of drugs and medioal supplies to consumers are much greater than to those wbo are looated oloser to the souroes of supply. The problem is made much more acute because of limited material, human and financial resources to manufaoture our own drugs. We have no alternative but to rely on overseas supply, in terms of both quantity and quality, for our needs. This meeting will, I hope, lead to a muoh oloser oooperation in our region to oope with increasing costs and demand for drugs and medical supplies.

- 14 -

Annex 1 In formulating any national or regional drug policies priority should be given to community needs. In fairness to the consumer, quality control of pharmaceutical preparations is essential to ensure that those who receive such preparations get the best benefit out of them. I do hope that a system of drug quality control will be evolved to ensure that essential drugs reach consumers in the best usable form. I do not dispute the importance of pharmaceuticals in improving the quality of life of the population but any drug policy developed mainly for trade and industrial development is certainly not in the best interests of national health services and the community. We should recognize> the fact that pharmaceutical products cannot be considered as ordinary commodities floating in a free market situation but as essential items especially to the majority of the population in the region. In 1976, a resolution was passed down to the South Pacific Bureau for Economic Cooperation from the Pacific Forum, a meeting ground of prime ministers of the independent states of the South Pacific including Australia and New Zealand to investigate the feasibility of bulk purchaaing of drugs. Because SPEC had no medical or pharmaceutical competence in its secretariat, the World Health Organization agreed in March 1977, to provide the necessary technical assistance and cooperation for the scheme. A meeting of dootors and pharmacists in the South Pacific region was held in Fiji in April last year, under the auspices of the South Pacific Bureau for Economic Cooperation, with a view to the standardization of drug supplies and bulk purchasing. It did provide the first forum for exchange of views on pharmaceutical needs in this region. This was followed by visits to some South Pacific countries of a World Health Organization working group on regional aspects of drug policies and management. The group was headed by Dr Nakajima, Chief, Drug Policies and Management from WHO Headquarters in Geneva. This meeting is another step forward in the continuing work of investigating the feasibility of bulk purchasing of pharmaceuticals for the region. I know this is but one facet in the World Health Organization's programme of advancing drug policies and management: the goal of which is to provide the basic necessary medicines at reasonable cost to the whole population. While recognizing the importance of having an adequate supply of essential drugs and vaccines to meet the real health needs of the people, through the implementation of national programmes of health care, it is obvious that the availability of funds puts a considerable constraint on our ability to achieve this goal. Any scheme that will enable existing funds to be used more efficiently will be welcomed by all sections of the community.

- 15/16 -

Annex 1

It is in the areas ot bulk purohasing that WI will require the greatest degree ot oooperation &IIOng; regional governmentS it the soheme is to sucoeed and play an ettective role in reduoing the oosts ot essential drugs of assured quality to the public. This will need both political and technical cooperation. I assure this meeting ot my Government's fullest support and cooperation. I wish this meeting fruitful deliberation which I have the greatest pleasure to declare open.

ANNEX 2

ADDRESS BY DR FRANCISCO J. DY, REGIONAL DIRECTOR WESTERN PACIFIC REGION, WHO (Delivered by Dr C.J. Ross-Smith WHO Programme Coordinator, Suva) It is with great pleasure that I welcome all of you to this WHO/SPEC meeting on technical cooperation among South Pacific countries/areas in pharmaceutical supplies which was organized by the World Health Organization's Regional Office for the Western Pacific, in collaboration with the South Pacific Bureau for EconomiC Cooperation (SPEC). We are grateful to the Government of Fiji for hosting this important meeting. The Organization is intensifying its activities as described in the programmes on drug policies and management and pharmaceuticals. As you may be aware, following the World Health Assembly Resolution WHA 28.66,1 WHO convened an Expert Committee on the Selection of Essential Drugs. The Committee has produced a report which has generated a great deal of interest particularly among developing countries. When the report was presented to the WHO Executive Board at its 61st session in January this year, the subject was discussed extensively. At the World Health Assembly in Hay this year, the Assembly adopted Resolution WHA 31.32 2 wherein inter alia it "Urges Member States, particularly developing countries to: (1) establish adequate drug procurement, storage and distribution systems in order to make available drugs of adequate quality, at reasonable prices, to the population; (2) establish national drug lists or formularies by international non-proprietary names (generic names) including essential drugs selected on the basis of the health needs of the countries and taking into account the criteria of the WHO Expert Committee on the Selection of Essential Drugs (Technical Report Series No. 615); ••• " In the Western Pacific Region, I am pleased to say that we were the first region to convene in March this year a Working Group meeting on the regional aspects of drug policies and management in Hanila. The Working Group laid down the basiS for the formulation of the Regional Medium-Term Programme on Drug Policies and Management and Pharmaceuticals which provides the guidelines for our intercountry programme up to 1983. The Working Group proposed, among other things, a feasibility study on technical cooperation among developing countries/areas in the South Pacific in bulk pharmaceutical procurement and distribution.

1See Annex 14 2See Annex 15

- 18 -

Annex 2 As preparatory technical input, a preliminary survey of the situation of drug policies and management was carried out in a few selected South Pacific countries, namely, Fiji, Papua New Guinea, Samoa, the Solomon Islands and Tonga, in July-August this year. This was complemented by a survey on drug utilization at the different levels of the health service, especially in the rural health centre, in Papua New Guinea in August-September. We are particularly happy to collaborate with SPEC in the further implementation of this project by organizing the auspicious gathering here of expertise in pharmaceuticals as well as in health care from the South Pacific. We have in mind other related activities to the study of bulk purchase schemes of pharmaceutical in the South Pacific. These include a study of drug legislation in selected South Pacific countries/areas, a study on trade and transportation of pharmaceuticals and a preliminary feasibility study on the establishment of drug quality control in the South Pacific. We look forward to exploring with SPEC possible further collaboration in some of these as well as other activities such as those that may emerge from the recommendations of this meeting. We are grateful to the Japan Shipbuilding Industry Foundation (JSIF) for their generous financial support in the development of our regional intercountry programme on drug policies and management and pharmaceuticals. We are honoured by the presence at this meeting of Professor Morizo Ishidate, Chairman, Scientific Committee and Professor Kenzo Kiikuni, Managing Director of the Sasakawa Memorial Health Foundation. We deeply appreciate the technical advice from our colleagues from Headquarters, Dr Hiroshi Nakajima, Chief of Drug Policies and Management and Mr K.O. Wallen, formerly Chief of Pharmaceuticals. Both have played a key role from the beginning in assisting ns to develop the regional intercountry programme. We also appreciate the presence at this meeting of two other colleagues from Headquarters, Dr V. Fattorusso, Director, Division of Prophylactic, Diagnostic and Therapeutic Substances and Dr A. Mochi of the Division of Coordination. I must likewise thank our temporary advisers who have taken valuable time off from their bus)' schedules to assist us here, namely, Dr L.F. Dodson from the National Biological Standard Laboratory in Australia; Professor F.N. Fastier from the Department of Pharmacology, University of Otago in New Zealand; Dr Jack Onno, First Assistant Secretary (Health Care) in Papua New Guinea, and Mr Wong Yip Lung, Senior Pharmacist in the Ministry of Health in Singapore.

- 19/20 -

Annex 2

Among the national participants, and representatives and observers from the international and other agencies, we have gathered here notable expertise in the technical and administrative aspects not only of pharmaceutical service. management but also of general health care delivery. I have no doubt that ~his auspioious gathering will further reinforce and acoelerate our plan. in the South Pacific in the coming years in the field of drug policies and management and pharmaceuticals. I wish you all the best in what I know will be lively and meaningful deliberations in the next few days and I look forward to receiving your recommendations.

•

- 21 -

ANNEX 3

ADDRESS BY THE HONOURABLE MAHE U. TUPOUNIUA, DIRECTOR, SOUTH PACIFIC BUREAU FOR ECONOMIC COOPERATION I should like first of all to associate myself with the sentiments already expressed by the Minister in his words of welcome to you and at the same time also to extend a very warm welcome to SPEC Headquarters on my own behalf and on behalf of all of those who work here. This of course is not the first meeting held at SPEC Headquarters to which non-Forum member countries have been invited. Nor is it the first in the field of. health. However, apart from several meetings on the formation of a Regional Fisheries Organization this is the only other meeting at which all South Pacific island countries, irrespective of political status, are being represented. It is for this reason that I am doubly pleased to welcome you all to SPEC Headquarters particularly our fellow Pacific islanders from Guam, the New Hebrides and TTPI. You have come to this meeting from individual countries as well as from WHO and related agencies of the United Nations system, and from other international organizations. Such wide-ranging representation symbolizes the essential interface between the United Nations system and the countries it serves as well as among the member countries themselves. Although not a member of the United Nations system as suoh, we belong to the international community and thus we in SPEC look upon our involvement at this meeting as . an expression of South Paoifio Forum support of global efforts towards the betterment of human society through its secretariat. The purpose of this meeting has been clearly stated in the documents before you. The agenda oovers a wide range of items inoluding a programme structure for bulk purohasing, quality oontrol standards, the use of drugs in health care, and a review of drug legislation. Baoh one of these areaa is undoubtedly important. But above all I feel I should inform you that this meeting has arisen largely aa a result of a direotive from the politioal leaders of the Paoifio region who together oonatitute the South Paoifio Forum. In 1974 SPEC was asked by the Forum to study ways and means by which the proourement of goods used by the region could be made on a bulk or oolleotive basis. A oomprehensive study was carried out and finally two areas were selected as being worthy of further investigation. One of these was pharmaoeutical supplies. SPEC then oonvened a meeting of its ~embers to consider the programme. The meeting noted similar initiatives being made elsewhere. After disoussing the difficulties inherent in a colleotive purohasing scheme which oovers suoh a wide and conoentrated geographio region the meeting adopted a prooedure whioh permitted island oountries to benefit from the Papua New Guinea tender scheme. The generous offer by Papua New Guinea was reoognized as an interim measure only. Consequently, the meeting oonsidered the possibility of establishing a oentral buying offioe and recommended that SPEC approaoh WHO to oonduct a feasibility study on this proposal. This study has now been done and is the reason we ... ..-ttn8 this week.

- 22 -

•

Annex 3 The study confirmed what many people hoped - that the bulk purchasing of drugs was not only feasible but profitable and essential. In the course of your deliberations a number of key words and concepts familiar in development literature will keep coming up. They include political will, regional cooperation, complementarity, harmonization of policies, TCne, collaboration, action-oriented programmes and the like admirable concepts and euphonious words. But what profit would they be to this meeting or to the peoples of the South PaCific region if they remained merely rhetorical and void of practical application? The meeting comes at a critical point in the furtherance of this exercise. You are at a point where you can, if you wish, move beyond the . words and concepts and apply them to practice. We in SPEC would hope that this will be remembered as the success of this particular meeting. You have behind you that work that has already been put into the bulk purchasing of drugs and medical supplies in the form of studies, reports, meetings and recomendations already mentioned. In other words, I am suggesting that the point at which this meeting picks up the thread again is precisely where we left ott last time, and that we should try to avoid traversing ground already adequately covered. We see this meeting as essentially one in which the resources of the United Nations are applied to complement the meagre resources of the South Pacific region in the most advantageous manner. This would imply avoiding duplication, encouraging forward planning and follow-up of decisions already taken. You do not need to ask for political will; in broad terms it is there already. You do not need to argue the logic of the proposal; it has already been proved. Your essential task, I suggest, is to move on and make i t work. Further down the road we anticipate the involvement of the private sector. I hope you will take cognizance of the considerable role the private sector can play in an exercise of this kind, along with those of non-Government organizations. The "missionary" zeal and enthUsiasm inherent in NGO's particularly those of the church makes each dollar of development aid go furthar than is normally appreciated. But before all that, you have to be able to sell a detailed programe to governments. With financial stringencies all around the propositions you would be discussing should sell themselves. We appreciate that this task is not an easy one, but it nevertheless is a task well worth undertaking, and it is up to you to do it convincingly and effectively. Your deliberations will be closely followed not only by governments and the private sector but also by the public at large. Already the local press have featured this meeting in their columns and commented editorially. Hight I accordingly urge you to explore every avenue to ensure that the objective of a practical, workable collective purchasing scheme is attained.

•

- 23/24 -

Annex 3 The public has thrown you this challenge. And now in your hands is an opportunity to take it a step forward - a leap forward if you like - for regional cooperation for the health of the peoples of the South Pacific region. I do not think I can do more than quote from the Fiji Times Which said, nHopefully next month's meeting will come up with a solid plan of aotion n • I endorse fully this view and wish you well 1n your deliberations.

- 25/26 -

ANNEX II

ADDRESS BY PROFESSOR MeRIZO ISHIDATE, CHAIRMAN, JAPANESE PHARMACEUTICAL ASSOCIATION AND CHAIRMAN, SCIENTIFIC COMMITTEE, SASAKAWA MEMORIAL HEALTH FOUNDATION JAPAN

It is my great honour and privilege to be able to attend this important meeting as a temporary adviser, not as a representative of the Japanese Government. First of all, allow me to speak about myself. I am serving as President of the Federation of Asian Pharmaceutical Association as well as Vice-President of the Federation of International Pharmaceutical Association. In my home country, I am, besides President of Japan Pharmaceutioal Association, Chairman of the Board of Trustees of the Sasakawa Memorial Health Foundation which as you may know is cooperating in leprosy and parasitic oontrol work in Western Paoifio Region oountries in olose collaboration with WHO. I have great oonoern and interest both personally and as an offioer of international and national pharmaoeutical organizations. There is no doubt that great progress has been aChieved in the health and welfare of mankind, due to the tremendous development of pharmaceutical science and teohnology, but we also have to faoe a great ohallenge of how to seoure this progress for all people who are suffering because they do not share the benefits of this progress. I do endorse WHO's idea of health for all by year 2000. In September this year the General Assembly of the Federation of International Pharmaoeutioal Assooiations was held in Franoe. We adopted unanimously a resolution to give full support to drug polioy activities proposed by the WHO Direotor-General, Dr Mahler. Just ten days ago the Asian Pharmaceutical Congress was held in Manila, and I made a proposal as president to strengthen this important projeot of WHO. Let me oongratulate again all of you who are participating in this meeting in order to propose a practioal soheme in this region, which should provide a good example and pave the way for future progress. I would like to express my full support for the success of this meeting. Thank you.

- 27/28 -

ARHEX 5

AGENDA

,. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Opening Election of Chairman, Vice-Chairmen and Rapporteurs. Adoption of agenda. Review of the draft combined list of essential drugs. Possible programme structure for bulk purchasing of pharmaceuticals and other medical supplies. Quality assurance and control of drugs. Use of drugs in organized health care, especially in primary health care. Development of required manpower in the area of drug control and management. Review of current drug legislation in the South Paoifio oountries. Conclusions and recommendations.

- 29 -

ANNEX 6

LIST OF PARTICIPANTS, TEMPORARY ADVISERS AND SECRETARIAT

1. AMERICAN SAMOA

PARTICIPANTS

Mr Clifford T. MoCorkle Director, Pharmacy Services Government of American Samoa Department of Health Pago-Pago 96799 Mr Arthur Shields Assistant Director-General Pharmaceuticals Benefit Branch Department of Health P.O. Box 100 Woden, A.C.T. Dr Terepai Maoate Director Hospital and Clinical Servioes Ministry of Health Rarotonga Mr Matunga Tetauru Chief Pharmacist Rarotonga Hospital Rarotonga

AUSTRALIA

COOK ISLANDS

FIJI

Dr Jona B. Senilagakali Permanent Seoretary for Health Medical Department Government Buildings Suva Mr Patrick A. Keefe Principal Pharmacist Government Pharmacy P.O. Box 106 Suva

- 30 -

Annex 6

GILBERT ISLANDS

Dr Teimone B. Flood Secretary/Chief Medical Officer Ministry of Health & Community Affairs P.O. Box 268 Bikenibeu Tarawa Mr T.G. Davies Pharmacist Ministry of Health & r.ommunity Affairs P.O. Box 268 Bikenibeu Tarawa

GUAM

Mr James Gillan Administrator Office of Emergency Medical Servioes Department of Public Health & Social Services Agana Mr Werner Hoffman Executive Officer Department of Health Republic of Nauru Dr Frank B. Spooner Chief Medical Officer P.O. Box 55 Port Vila Mr Stuart Courtney PharmacistlMedical Supplies Officer P.O. Box 55 Port Vila

NAURU

NEW HEBRIDES

NEW ZEALAND

Dr A.G. Scott Director Division of Clinical Services Department of Health Wellington Dr Policarpo A.S.C. Silva Rosa Assistant Secretary (Medical Services) P.O. Box 6828 Boroko Hr Vladimir J. Holna Chief of Pharmaceutical Services Department of Health P.O. Box 2084 Konedobu

PAPUA NEW GUINEA

- 31 -

Annex 6

SAMOA

Dr Solia T. Faai'uaso Aoting Director of Health Health Department Apia Mr Samuelu Kaleopa Acting Chief Pharmaoist Pharmaceutical Division Health Department Apia

SOLOMON ISLANDS

Mr Leonard P. Maenu'u Permanent Secretary Ministry of Health & Medical Servioes P.O. Box 349 Honiara Mr Paul D. Benham Senior Pharmacist Ministry of Health &Medical Servioes P.O. Box 349 Honiara

TOKGA

Dr Laumeesi MaIolo Special Grade Medioal Offioer Health Education Division Ministry of Health Nuku'alofa Mr Samiu Latu Pharmacist-in-Charge Ministry of Health Nuku'alofa

TRUST TERRITORY OF THE PACIFIC ISLANDS

Dr E. Pretriok Ponape Distriot Hospital Kolonia Ponape E.C.I. 96941 Mr Edwin A. Gratonik Bureau of Health Services Office of the High Commissioner Seipan Mariana Islands 96950

TUVALU

Mr Kokea Malua Pharmacist Princess Margaret Hospital Funafuti

- 32 -

Annex 6

2. AUSTRALIA

TEMPORARY ADVISERS Dr L.F. Dodson Director Biological Standards Laboratory Department of Health Canberra Mr V.K. Garib Pharmacist Medical Department P.O. Box 106 Suva Professor M. Ishidate President Japanese Pharmaceutical Association Chairman Scientific Committee Sasakawa Memorial Health Foundation Sabokaikan Building 2-7-5 Hirakawa-cho Chlyoda-ku Tokyo 102 Professor K. K11kuni Managing Director Sasakawa Memorial Health Foundation clo Institute of Community Medicine The University of Tsukuba Niihari-gun Ibaraki-ken

FIJI

JAPAN

NEW ZEALAND

Professor F.N. Fastier Professor of Pharmacology Pharmacology Department Otago University Medical School P.O. Box 913 Dunedin Dr Jack Onno First Assistant Secretary (Health Care) Department of Health P.O. Box 30B4 Konedobu

PAPUA NEW GUINEA

- 33 -

Annex

.3.

SBCRBl'ARIAT

WHO

Dr V. Fattorusso Director Division of Prophylactio, Diagnostic and Therapeutic Substances WHO Headquarters Geneva Dr A. Mochi Chief Cooperative Programmes for Development WHO Headquarters Geneva Dr H. Nakajima (Secretary) Chief Drug Policies and Management WHO Headquarters Geneva Dr Y.H. Paik WHO Programme Coordinator Port Moresby Dr C.J. Ross-Smith WHO Programme Coordinator ~ Ms B. Saito Temporary Staff PharmaCist Drug Policies and Management Unit WHO Headquarters Geneva Mr K.O. Wallen Short-term Consultant WHO Headquarters Geneva Dr Wan Fook Kee Regional Adviser Health Services Department WHO Regional Office for the Western Pacific Manila

Mr Wong YiP Lung Temporary Adviser WHO Regional Office for the Western Pacific Manila

- 34 -

Annex 6

Mr E. Haywood Research Officer SPEC Headquarters Ratu Sukuna Road Suva

Mr R.N. Morgan Mr

Trade & Marketing Officer SPEC Headquarters Ratu Sukuna Road Suva Mahe U. Tupouniua Director South Pacific Bureau for Economic Cooperation SPEC Headquarters Ratu Sukuna Road Suva

- 35/36 -

ANNEX 7

LIST OF PARTICIPANTS, TEMPORARY ADVISERS AND SECRETARIAT MEMBERS IN GROUP DISCUSSIONS Participants Group A Kr Kr

Group B Kr

Clifford McCorkle (A. Samoa) Matunga Tetauru (Cook Islands)

Arthur Shields (Aust'ralia)

Dr Terepai Moate (Cook Islands) Dr Teimone B. Flood (Gilbert Islands)

Mr Patrick A. Keefe (Fiji) Mr T.G. Davies (Gilbert Islands) Mr Werner Hoffman (Nauru) Kr

Mr James Gillan (Guam) Dr Frank B. Spooner (New Hebrides) Dr A.G. Scott (New Zealand)

Stuart Courtney (New Hebrides)

Mr Vladimir Ho1na (PNG) Mr Samue1u Ka1eopa (Samoa) Mr Paul Benham (Solomon Islands) Mr Samiu Latu (Tonga) Mr Edwin A. Gratonik (TTPI) Kr

Dr Policarpo A.S.C. Silva Rosa (PNG)

Dr Solia Tapeni Faai'uaso (Samoa) Mr Leonard P. Maenu'u (Solomon Islands) Dr Laumeesi Ma1o10 (Tonga) Dr E. Pretriok (TTPI)

Kokea Ma1ua (Tuvalu) Temporary Advisers

Dr L. Dodson (Australia) Professor F.N. Fastier (New Zealand)

Dr Jaok Onno (PNG)

Secretariat Ms B. Saito (Geneva) •

Dr Y.H. Paik (PNG) Dr Wan Fool< Kee (Manila)

Mr O. Wallen (Geneva) Kr

Wong Yip Lung (Manila)

- 37/38 AN!l1!:X 8

TIMETABLE

DAY

MONDAY ~.12.78

--_.

TIME

TUESDAJ 5.12.78 Item _ continued

WEDNESDAY

6.12.78 Grou~ discussion Group A: Items 6&8 Group B: It. . 7

THURSDAY 7.12.78 Consideration of draft report on Items _ & 5

FRIDAY 8.12.78 Item 10

0830 - 1000

Opening ceremony (9.00 am)

1000 - 1030 1030 - 1230 Items 2, 3 and ~

COFFEE Item 5

Grou2 discussion continued LUNCH

As above

Item 10

1230 1~00

1~00

- 1530

Item ~ continued

Item 5 continued

Grou2 discussion continued

Consideration of draft reports on items 6,7, 8 & 9

1530 15~5

15~5

COFFEE Item ~ continued Item 5 continued

- 1700

Itea 9

As above

WORLD HEALTH ORGANIZATION

Geneva, 6 Octob er·197 8

DRAFT FOR A COMBINED LIST OF ESSENTIAL DRUGS I'

TO BE USED CURRENTLY IN FIVE SOUTH-PACIFIC COUNTRIES TONGA) (FUI. , PAPUA NEW GUINEA, SAMOA, SOLOMON ISLANDS AND

~ I'

(Survey based on WHO Missi on, July 1978)

INTRODUCTORY REMARKS 1. This Draft List will be discussed and finalized at the Meeting on Technical Cooperation among the South-Pacific Countries in Pharmaceutical Supplies, Suva, Fiji, December 1978. 2. All participants to the meeting are invited to check the List and to prepare proposals for the inclusion or exclusion of drugs, or for other modifications. 3. Participants from countries other than Fiji, Papua New Guinea, Solomon Islands, Tonga and Western Samoa are invited to add the code number for their country in column (c) of the List where applicable and, whenever possible, to provide information on the latest annual consumption figures (with year) and purchasing price corresponding to the dosage form( strength/presentation and/or package size used in their country. 4. The numbers in parentheses follOWing certain drug names are quoted from the WHO Technical Report Series No. 615, "The selection of essential drugs", as follows: (1) (2) (3) (4) (5) (6) (7) (8) Listed as an example of this therapeutic category: cheapest effective drug product acceptable; choose f

g ~

Specific expertise, diagnostic precision or special equipment required for proper use; Greater potency; Dosage adjustment necessary for renal insufficiency; To improve compliance; Best pharmacokinetic parameters for purpose; Adverse effects diminish benefit/risk ratio; Limited indications or narrow spectrum of activity;

- it -

(9) (10)

Fpr epidural anaesthesia; For disease or organisms resistant to the proposed drug(s).

5. In the attached Draft List, dotted lines in each therapeutic group separate the drugs included in the WHO model list of essential drugs (Technical Report Series No. 615) from drugs not included in that document and the numbers, as liste~ above unde~ point 4., have not been added to the drugs E£! included inithe WHO mod~l list. Participants are invited to consider and to propos~ if and When these numbers in parentheses, signifying the relevant cOmments as above under point 4., should be added. 6. Where columns (d) and (e) of the attached Draft List ~re concerned, the remarks and. suggestions for inclusio~exclusion and standardization have been prepared by the WHO Secretariat and are to be considered as tentative proposals. The participants are invited to review them .carefully and to make positive suggestions. 7. The WHO Secretariat feels that there are still too many products in the Draft List and a simplified version is recommended in view of the implementation of a bulk purchasing Jcheme in the South-Pacific countries. 8. The participants are al~o invited to ~dentify from the Draft List the drugs Which will be needed for primary health care in their country.

I[ ~

..... l ..... ... "'~." ","UlVt:,

£';110

DRAFT COHBIWID LIST OF ESSENTIAL DRUGS FOR SOOTH PACIFIC COUNTRIES (SPEC LIST 1911 AND WHO MISSION SURVEY 1978) Fiji, Papua New Guinea, Solomon Islands, Tonga, Samoa (a)

le1 ass if ication Dru~ narne (INN)

Dosage fOrmVStrength/Presentation -, and/or acka e size

(b) SPEC List WHO lRS + WHO July 1978 survey 615

(.)

(d)

(e) Suggestions

Remarks

for inchlsioo cr exclusion

count

code

1. ANAESTHETICS

1.1 General anaesthetics ether, ana.sthetic (2) inhalation inhalation inhalation injection

,.,., >o."~ , •• 250ml bottle Ye. ~linder

2,5,6,7,9 2,5,6,9 2. 9 2, 6, 9

halothane (2) nitrous oxide (2)

size eYe.

IShort acting; needs special equipment; may be replaced by ketam1ne

IExclusion ~

size thiopental sodium (2)

2.5 g \- :'al O.S g set 1 g ampoule

, ye., 2

~,6,7,9

4_w __ W ______________

ethyl chloride ketarnine hydrochloride

spray injection

100 rol

No No

2. 7, 9

Limited use

Exclusion

5~ 10 rol Vial lOD~ 10 rol vial 500 mg anpoule

5, 6, 9 2.6,7.9

methohexital sodium

injection

Alternative thiopental

Exc1us ion

(b)'tyES" or "NOli refer only to the drug (i.e. not dosase form, etc.) in the WHO model list. .I-

(c)

SPEC - South-Pacific Bureau for Economic CoopeT:tion Country code.: Cook "Is • 1 PNG 5 Fiji • 2 Solomon Is ... 6 Tonga 7 Gilbert 1 • • 3 '. Niue. 4 __ .9. Tuvalu 8 K

_w_

~A""n""

l.ot'l'¥

:'t:pL~1II0t:r

LY/O

DRAFT COMBINED LIST OF ESSENTIAL DRUGS FOR SOUTH PACIFIC COUNTRIES (SPEC LIST 1917 AND WHO M1SSIOII SORVEl' 1978) Fiji, Papua New Guinea, Solomon Islands, Tonga, Samoa (a)

Ir.l ass iflcation DrUB name (nor)

Dosage fQ~Strengtq/Presentatlon

(b) WHO TRS

(d) Remarks

(e) SuggestiCD8

for

and/or packa2e size 1.2 Local anaesthetics

615

survey (coun~]:)' codes)-

Inclusion/ 0(:1U510n

bupivacalne hydrochloride (2, 9)

injection in.lection (plain)

0.51 0.51

30 ml ampoule 20 ml vial

Ye. Yes

2 2, 6 6, 7 2, 5, 9 7

lidocaine ~drochloride

20 ml vial 50 ml vial 5 ml vial 50 ml vial 100 ml vial

5, 6, 9 9 6

gel

2t U

15 ml tube 30 ml tube 25 ml bottle

2, S, 9 2

topical solution lidocaine hrdrochloride + eplnephrine injection

It.!-1:100ooo 20111 vial NS 2t+1: 80000 NS +1 : 100000 50111 NS +1:200000 20111 NS

5 2 2 2

Standardization required

Exclusion

------------------anaesthetic, topical spray

Can

5, 7

Limited use

!Exclusion

(b)"YES Ii or "NO" refer only to the drug (i.e. not dosage form, etc.) in the WHO model list.

(C)SPEC _ South-Pacific Bureau for Economic Cooperacion • 1 Country codes: Cook· Is PNO • 5 • 2 Solomon II · 6 PiJi Gilbert 1• • 3 Ton.a • 7 Niue Tuvalu ·4 • 8 1;"",",,-

• Q

JJl-i.'J,!

:::.ept.emt)er

!~/O

DRAFT COMBIMED LIST OF ESSENTIAL DRUGS FOR SOUTH PACIFIC COUNTRIES (SPEC LIST 1977 AND WHO MISSION SURVEY 1978) Fiji, Papua New Guinea, Solomon Islands, Tonga, Samoa !classification Dru2 name (INN) (b) (c) WHO SPEC List Dosag~ fon~'- Strength/Presentation TRS + WHO July 1978 , and/or 615 survey (a) (d)

(e) Suggestions

Remarks

for inclusion ac exclusion

acka e size 1.2 (continued)

count

codes Dental supply (lidocaine + epinephrine preparation could be used for dental anaesthesia?)

prilocaine hydro-

injection

chloride + felypressin lidocaine + riephr1ne ep~·

3't+o.03 Units

2.2m! cart ..

ridge

injection injection

2t + U

1:80000 (plain)

2.2ml cartridge

2 2. 5

procaine hydrochloride

2ml ampoule

I I

Exclusion

~~ALGESICS.

DRUGS

~~D

ANTIPYRETICS. NOS S:",OIDAL ANTIINFLAMMATORY ANTI GOUT AGENrS tablet

acetylsalicylic acid

7581, 30Q0g 30Q0g l0Q0g

1000 1000 1000 1000 100 1000 100

Yes

7 2,5,6,7,9 5, 6, 7

I I High cost IExclusion

allopurinol (6) colchicine* (7) indometacin

table:, soluble tablet tablet

Yes Yea*

2, 5, 6, 7. 9

O.5mg 0.6., 25mg

7. 9 Yea 2, 5, 6, 7, 9

I • 1 • 4

Dosage standardization reqd_ red

I Exclusion

capsule

(b) ''YES'' or "NO" refer only to the drul

(C)SPEC _ South-Pacific Bureau for Economic Cooperation

(i.e. not dosage form, etc.) in the WHO model Ult.

Country codes:

Cook Is Niue

PNG Solomon Is Tonga

complementary drug

Fiji • 2 Gilbert 1. • 3

• 5 • 6 • 7

Tuvalu SM'Oa

• 8 • 9

L,t~L ~epL~~Der

l~/O

~RAFT COMBINED LIS! OF ESSENTIAL DRUGS FOR SOUTH PACIFIC COUNTRIES

(SPEC US! 1977 AND WHO MISSION SURY£!' 1978)

Fiji, Papua

Me~

Guinea, Solomon Islands, Tonga, Samoa (b) WHO

I leI ass i f1 ca t 10n I

(aJ Dosage foI"lD/'Strength/Presentation , and/or ~p~a£~a2e size

(d) Rem. irks

(eJ for inclusion cr exclusion

Drug name (INN)

r-__________________________________________ 2. (continued) ?araceta'nol elixir

IRS 6iS

+ WHO July 1978 survey (countrv codes)

12Oms/Sml 200m1 bettie ~es

6, 7 2, 5, 9

(powder) tablet 500.g 1000

2, 6, 7, 9

A.P. codeine c~ceine

tablet

NS NS

1000

No No No No No

Stanca~dizatlon

required stre~gth

compound + codeine

tablet tablet tablet tablet

1000 1000 1000 1000

Aspirin codeine tablet checked --J

to be

fa~acetamol

NS 100mg

p~enylbutazone

2,5,6,7,9 2, 5, 6 See also under point 7.2. page 15. Only -for association with penicilli

probenecid

;oOmg

topical: turpentine liniment linL~ent

4 litre tin INo

Limited use

Exclusion

(65X + camphor 5t)

(b)"y£S" or IINO" refer only to the crug (i.e. not dosage form, etc.) in the WHO model list.

(c)

SPEC· South-Pacific Bureau for Economic Cooperat1on Country codes: Cook Is - 1 PNG .5 Fiji ,.. • 2 $olOlllOtl I. • 6 Tonga • 7 Gilbert Is • 3 TuvalU • 8 Niue - 4 S8l!<t'a • 9

.&JUt' ::tepLemoer

J..~fD

DRAFT CCMIIDD LIST OF IISSEllTIAL DRUGS FOR SDUTII PACIFIC COOIITRIES (spl!C LIST 1977 AID lIIIO IIISSIOII SORYBr 1918> Fiji, Papua ..... Guinea, Sol...,.. Islands, To_, Suos (a) (b)

l!;:lasslflcation Dnla name (INN)

Dosag~ fora{Strenatiy"PresentatloD , aEK\lor oac.kaae .ize

WHO l'RS

(d)

(e)

Remarks

Su8sest ion. for

615

""rvey count

codesl

inclusion « exclusion

3. ANALGESICS, NARCCYrICS AND NARCOTIC AllTAGOIUSTS

morphine sulfate

injection

Io.s/mI

_oule x IofYeol2, 5, 7, 9

15. . .

""""",Ie "

2, 6, 7, 9

naloxone hydrochloride

injection injection tablet

2OWIIaof,4/- :a.l ~I Yeo I "Iml 400 "

I 2, S. 6, 9 2, 6, 7, 9

Safer than nalorphine

Inclusion a1 ternative

"". 0\.

pethidine hydro· chloride*(l)

5o.s1ml ampoule loo.clz.u _ule ~

Yel12' 5, 6, 7, 9

100

-------------------levallorphan tartr.te injectioo

x../81

lQoI vi.J.

I 110 I 7

I Duplication

Exclusion

nalorphine hydrochloride

iujectlon'~

SIll vial /110 / ~' 6, 9 ..,.1 In 1111 ___ poule 2, 5, 6 lo.s/.l hal. _ l e i (c) SPEC _ South-Pacific Bureau for Ecoaoodc Cooperation Count<y code.: Cook 1. - 1 PIIG ·5 Plji - 2 501_ 1& . 6 Gilbert Is - 3 Tonga • 7 lIiue - 4 'l'uvalu • 8 !I!. • e

""'.,1

(b),'rUU or ulIO tI refer oaly to the tlraa (i.e. not do.a.. form, otc.) io tbe lIIIO .odel Uot.

*•

complementary drul

J...tl'Jw.'

~eptemDer

l!;UO DRAF~

COMBINED hIST OF ESSENTIAh DRUGS FOR SOUTH PACIFIC COUNTRIES (SPEC hIST 1917 AND WHO MISSION SURVEY 1978) Fiji, Papua New Guinea, Solomon Islands, Tonga, Samoa (b) WHO TRS 615

(a)

lassification Drua name (INN)

Dosage f~n%\,istren8th/Presentation . and/or oackaR.e siz.e injecti':)!"'. inject:::"'.. tablets 2Cbg/ml

(0) SPEC List WO July 1978

(d)

(e)

Remarks

Suggestions for

survey (oountrv code.l

inclusion or exclusion

(continu,~d)

:-piur:'. alkaloids total phenoperidine droperidol 4 .•~~IIALLERGICS

Iml a:npcule No ampoule 50 packs No No

2, 5, 9 2, 9 2

NS 8111&

Limited. use

Antihistamines c~lot'phenarnine injecti~r:

lC\n&!'ml :O":1g

Yes 500

2,6 t 7,9 6, 7. 9

maleate (1) tablet

~ Powder

...... __ ._---_ .. _--ali~emazine

tartrate

syrup

3Om&!'Sml

125ml bottle No

~ Made in store

Limited use:

Exclusion

diphenhydramine hydrochloride mepyrarnine maleate pheniramine aminosalicylate

elixir

10m&!Sml

4/5000:11

5, 2

Powder

tablet tablet

sOmg lOmg

500

AlternatIve chlorpheniramine 100

(b) 'YES" or "NOli refer only to the drug (i.e. not dosage form, etc.) in tbe WHO model 11st.

(0)

Country codes:

SPEC ~ South~Pacific Bureau for Economic Cooperation Cook Is • 5 PNG - 1 $01_ Is - 6 Fiji - 3 2 a 7 Tonga Gilbert I. a 8 Niue Tuvalu -4 -.- .. -'.

S"!!9,~

9 ------------a

-- -

urlV ~ept .... or

!~I~

DRAFT COMIIIIIBD LIST or ISSIIITUL DIOOS POll SOUTH PACIfIC COUlltllIlS CSPIC LIST 1m AID IIRO MISSIOII SUI. . ItT8) '1j1. Papua _ _ • Sol.-.. I.lud., ToI\p. s.-

fla •• lfle.tioD n_ eM) DrUB

Ca> Do.ap fo~Strenat~Present.tlon

Cb)

WHO 1lIS

• S. ANTIDOTES. CHELATING AGENTS. etc.

and/or _J).ck~"C!! .1&.

615

(d)

Ce)

Remarks

Suggestions

~cJ!U!I~t!y_c~e.)

for inclusion at ex.c.lusion

atropine sulfate

Strength O.6m& to belexcluded Strength 1.2m& to be excluded Sugsest O.S aDd 1 . . calcium disodhaD edetate (2)

charcoal. activated

can be used for this purpose

lncluaiOD

dimercaprol (2) pralidoxime iodide

~ ,

-------------------'"

deferox.. lne mesilate

injection

SOOag

vial

\10 I 2. 5, 6

6. AIITlEPILEPTICS

carbamazep1ne (10)* . diazep_ lDJec~lon

tablet injection

200ag

200.,

100 200

i'les*1

2, 7, 9 6

lo.s/2ml 2ml amPoule ~.s

2, 5. 6, 7. 9

l(b)"YIS" or tlNO" refer only to the drug (l.e. not dose.. form. etc.) in the lIIIO 1O>IIe1 U.t.

(c) SPEC • South-Pacific Bureau for Econaaic Cooperation Country code.: Cook Ia - 1 Fili - 2 Gilbert 18 - 3 l'IIG - S $oloaoa. 1. - 6 Tonp - 7 T\lV'alu . - 8

*•

compleaentary drug

(.....

111_·4

!I:...,...

- ,

""MI September

197~

DR1I'T COIIBIJIm LIST or ESSEIITIALDRUGS FOB SOOTH PACIFIC COUNTRIES (SPEC LIST 1971 AIIO Il/1O MISSIOII SURYBr 1918) Fiji. Papua lew Guinea. ,Soloraon Islanda. Tonsa. s ...oa (a)

iclassif1cation Dru" Ilam~ (INN)

Dosa&~ fo~Sttengt~Presentation . and/or . packaRe size

(b) WHO

(c)

TRS 615

SPEC List WHO July 1978

(d) Remarks

I (country 2

survey codes)

<e) Sugge s t: ions for inclusion CJ[' exclusion

(I,

(continued) ethos~xiUllde

capsule elixir

25Qng ISmw'5ml 15m&/5ml 200m';?

200 NS lOOmI

IYes

phenobarbital

res I ~ 5. 6 2, 7, 9

, 1 Made in store

phenobarbital sodium

ir.jection

NS box of 10 1000 1000

tPSYCbotrOPIC substances convention s:hedule 4

phenobarbi tal

tablet

15mg 3Qng EQng 3Qng

2, 6, 7 2, 5, 6, 7, 9 2, 6. 9

Strength to be standardized

phenytoin sodium

capsule injection

200

1$1

I I

phenytoin sodium

250n&!5ml vial 500ml 1000 1000

2. 5, 6 7. 9 5. 6 2,5,6,7,';)

suspension 30n&!5ml tablet 3cma 10C1D8

--------------------. paraldehyde primidone injection tablet 25Qng

Sml ampoule 1000

No INo

2, S, 6

Toxicity

Exclusion Exclusion

2,5.7,9

Precursor of phenobarbital

(b)

"YES" or UNO" 1:efer only tc. the eh-us (i.e~ not dosage form, etc.) lu the II!\O ..odel lis t.

(c)

SPEC - South-Pacific Bureau fOT Economic Cooperation Countxy codes: Cook Is • 1 PNG .5 Piji . • 2 $olomon I. s 6 Gilbert Is • 3 • 7 Tonga Niue .4 Tuvalu 8 SamOA 9

pale 9 Ut~

;:,epLem oer

.L~IO

CODIITRIES DIIari COMBI1IBD LIST or ESSEIIT llL DRUGS FOil SOUTH PACIFIC 1978) SURnJ MISSION IIHO (SPI!C LIST 1977 &JID

"iji, Papua Raw Guinea , Solomon Island s, TObg1I, _

(a) r.l •• sific.t ion Drull n .... .cI1ll1) Dosage (o~Stren8th/Presentatlou and/or packaa e size ,

(b) WII0 TIIS

(d) Remark s

615

Uoount.ty codea)_ ,,-

(e> Sugges tion. for inclus ion ex exclus ion

7. AI<'TlINFECTlVE DIlUGS

granul es tablet tablet elixir

7.1 Anthel minthi c drus" bephenium hydrox ynaphth oato (8)* mebend azole pipera zine adipat e piperazin~

5& eq to 2.5& base 100 mg

sachet

Yes' 6, 9 Yes Safer than tiabend azole 2, 5, 6, 7

Inclus ion

3000&

1000

Yes

citrate

eq.to 15Qag bydrate /ml Z.Z5/11<re 3001al

5 9 6 1

Made in store Made in store

, ~ ,

tetra~hlorethYlene*

capsul e tablet

lml 5000&

100

Yes* 2, 5, 6

tiabend azole

Yes 100 pack.

6 2, 7, 9

Exclus ion ?

(b) ''lIS'' or I'NO" refer only to' the drug (i.e. not do ••ge form, etc.) in the IiIID aodel 11•••

*•

complementary dru8 ----- -

---"

---

(c)SPEC - South- Pacific 8ureau for Bconoudc COoperation PRG - 5 Country codes: COok Is - 1 1. - 6 $01_ Piji 10 - 2 TOOlP - 7 Gilber t la - 3 -4 Tuvalu - 8 Biue ,-' ___ . _. ____ ~~W. ~

---'-- ___ __

Ut'N{ ::ieptember l!:.1/d

DRAFT COMBINED LIST OF ESSENTIAL D~UGS PO~ SOOTH PACIFIC COUNTRIES (SPEC LIST 1977 AND WHO MISSION SURVEY 1918) Fiji, Papua New Guinea, SOlomon Islands, Tonga t ~!.ficst~on Drug "ame (INN)) (a) (b) WIlD

samoa

Dosage

tOt1!\'1Strength/present a t ion and/or packalite size

TRS

(d) Remarks

615

survey (countrv codeS)

(e) Suggestions .tor inclusion or exclusion

7.2 Antibacterial drugs

ampicillin (1) eq. to anhydrous

capsule

2SQng

sOOmg

1000 1000

Yes

2,5,6,7,9 9 2, 5. 6. 7, 9

12Smg/Sml 10Qnl bottle elixir (= Sl.:.S~. syrup, mixture)

ampicillin sodium

injection

2SQng SQQng

vial vial

2, 5, 6, 1, 9 2, 5, 6 Yes 9 2, 7

benzathine benzylpenicillin (5)

injection

300.000 1.. , L5ml Units/.I 600.000 1-, l.Sml Untts/mi

IV> ,

, ,

t t-'

benzy~penicillin

injection

potassium

1 meg. vial 1000 (1.000.000 Units) (600 mg)

Yes

2,5,7,9

injec:i.::m

5 mega

vial (5.000.000 Units) (38)

procaine penicillin 3g/for aqueous suspension injec~

. (b)'tyESIf "NO" refer only to 'tnl': _~ug (i.e. not dosage form. etc.) h the WIlD model Uat. Dr

(e)

SPEC • Sout~-Faclfic Bureau for Economic Cooperation ~ 5 Country cod~s: Cook Is PNG • 1 Fiji Solomon Is · 6 • 2 Gilbert I • • 3 Touga • 7 Tu'\. dIu Niue ·8 • 4 - -------

•

jJ~MI

::teptemoer

J.!1/0

DRAFT COMBINED LIST or ESSENTIAL DRUGS FOR SOUTH PACIFIC COUITRIES (SPEC LIST 1977 AND VIIO·IIlSSIOIi SURVEY 1918) Fiji, Papua Rew Guinea, Solaon Islands, Tonga, Samoa (a)

pase 11

(b) WHO TRS

~lasslficatioD Drua name (INN)

Dosage fo~Strength/Present.tion , and/or Dackaa.e size •

(d) Remarks

(e) Suggestions

61S

for inclusion or: exclusion

(country codes) -

7.2 (continued) chloramphenicol (7) capsule

2So.g

1000

Yes

2,5,6,7,9

chloramphenicol sodium succinate

injection

vial

Yes Yes Yes

2,5,6,7,9

chloramphenicol palmitate suspension 125m~1 (mixture)

100n1 1000

2,5.6,7,9

cloxacillin (sodium) (penicillinase resistant, 1) cloxacillin sodium

capsule

2SOng

2,5,7.9

,I ~ ! II\)

inject~on

2So.g (base) sOOng

vial

Yes

2. 5. 9

vial.·

6 2, 9 Ye.Easy administration Inclusion Inclusion

l25m&l'Sml 100n1 el 'Jr (d" f syrup) eapaule doxycycline hydrochloride* (6, S) el ixlr

100ng lo.&l'ml 60.1

(b)''YES Ii or "NO't refer only to .the drug

(i.e. not dOBase form, etc.) in the WHO model Ult.

*•

complementary drug - - - - - - - ----

{c)SPEC • South-Pacific Bureau for Economic Cooperation • I Country codes: Cook Is PIIG • S • 2 Fiji 10 solomon Is • 6 Gilbert Is • 3 Tonp ·7 (- ,.. lIiue -4 Tuvalu • 8 W. 8""""'---- __ • _9

DR,,'T COHBIHED ~IST OF ESSERTIA~ DRUGS FOR SOUTH PACIFIC COUNTRIES

(SPEC

LIS~ N~w

'0', AND WHO MISSION SURVEY 1978) (b)

Fiji, Papua (a)

Guinea, Solomon Islands, Tonga, Samoa , • ------~------------r---(-e)~-(e) (d)

1(1 as s ifi CB ticn I DT\ig name (INN)

Do sage, fcrITV' Strength/Present a t ion and10r packsJi!;e size

WHO TRS 615

SPEC List + WHO July 1978 survey (country codes)

Remarks

Sugge s t ions

for inclusion or exclusion

7.2 (continued) eryth.romycin

capsule elixir (oral susp.)

2SQog

100

125..&/5ml lOcml 250mg 1Omg/al 4am&1ml 1000 2ml \"1a1

erythromycin stearate tablet gentamicin sulfate (4) injection

2ml Vial

phenoxymethylpenicillin potassium

mixture oral susp.

125..g/5ml 80ml

(dry syrup) 12S.g/5ml 100m! tablet

12Smg 25(bg 300.000 Unit.;.. l (3tnog)

Not stated

1000

procaine benzylpenic111in* (7)

injection (oily)

injection

3,000.000 vial Unit';.. l

(3g) procaine benzylpenicillin with benzylpenicillin injection

400.000 Units/l0m1

(b) ''YES'' or "NO" refer only

the drug

(i.e. not dosage form, etc.) in the WHO model Ust.

(C)SP!C • South-Pacific Bureau for Economic CQoperation Country codes: Cook Is • 1 PNG • 5 Fiji,' • 2 Solomon Is • 6 Gilbert Is • 3 Niue ·4 Tonga Tuvalu Samoa • 7 • 8 • 9

* .,.

complementary drug

J./u·",

~~~I.~WU~"

.1:1,0

DftAFT COMBINED LIST OF ESSENTIAL DRUGS FOft SOUTH P1CIPIC COUNTHIIS (SPEC LIST 1971 AND WHO MISSION SUR'IEt 1918) Fiji. Papua Mew Quinea, Solomon Islands, Tonga, Samoa

Ca) flat.flic.tion Drug name (INN)

(b)

Dosage'£o~Strengt~Present8tion .. and/or packaae size injection

WIIO

snc

(d) R.emarks

TRS + WHO July 1978 615 survey (country codas)

(e) SUSIe s t ion.

for inclusion cr ex.clusion

7.2 (continued) procaine benzylNo 15, 6 Remark. aa above

penicillia comb. Triplopen(R) = benethamine benzylpenicillin + procaine benzylpenicillin + benzylpenicillin sodium salazo5ulfapyridine (2)

Exclusion·

tablet

SOOng

1000

Yes I 2, 5, 9

For ulcerative colItis

sulfadiazine. (7, 8) sulfadimidine (1)

injectiQn .1xture injection

vial x 10 RS

sO!JoD&! Sml lr/3ml SOOng

10Qal ampoule

"T '.' Yea Yes I 2. 7. 9

sulfadimidine sodium

6 2. 7, 9 6

(Powder:

2. 9) stand.rdl~

Dosage and strength to be sulfadimidine

tablet

1000

2, 5, 6, 7. 9

sulfamethoxazole + trlmethoprim

mixture

Not stated l00ml

(syrup) tablet

400mg +

1000

2,5,6,7,9

80mg

(b)"rBS" or ''NOli refer only to the druS (i.e. not dosage form, etc.) in'the WHO model Ust.

*•

complementary drug

(e)SPEC • South-Pacific Bureau for Economic Cooperation Country codes: Cook Is • 1 PNG • 5 Fiji • Z 'olOlllOD. Is • 6 Gilbert la • 3 'l'cap • 7 Biue· 4 (:.., TUvalu', - 8 Bmoa ~. ~""-----

Uho¥ bCPLCIlIOC.L

l.~/O

DIIAFT _ I . I S T 0' IISSI'BU&I. Mlues POll SOIl'l'll P1ClnCCOIlHTIIIES (SPEC I.IST 1911 AID WHO IIISSIa. SUllYIY 1918) PiJi, P.pua II"" Gui""., 501_ Islanda, to,.&, _ (a)

lasslfication DrUB n ..... (INN) .

Doaage,f°rmVStreuath{Presentation • and/or packaae size

(b) WHO TIIS

(d)

(e> Suggestions for

Remarks

615

survey (country codes)

inclusion orexclusion

1.2 (continued)

- ".

tetracycline hydrochloride (1, 4)

capsule injection

2SCIog 10Q0g 2SQog

1000

Yea

2, 6. 7. 9

vial Vial 10Qn1

6, 7 2, 6, 9 2, 6, 9

mixture (oral susp.)

125"';s..1

------------------amoxicilHn clind~cin

ca.psule hydro-

2SCIog

No 100 pack. No 2

High blood concentration Alternative erythromycin

Includon Exclusion

capsule

15Qoc 2SQoc SOCIog

chloride kan~cin

sulfate

injection

vial

, lincomycin hydro-

IS capsule injection ne~cln

vial vial 100 packs vial lOO 1000 pack. 1000 (c) No No No

5 2 5

SOQas

6 5, 6 2. 7, 9

chloride

6OQoc 50C10g 5C1og

sulfate

tablet

nitrofurantoin

tablet

1090&

6 2

(b) "YES" or "NO" refer only to· the drug (1.e. not dosage form, etc.) in the WilO model Ust.

SPEC· South-Pacific lureau for Economic Cooperation • 1 Country cod •• : Cook Is PNG • 5 • 2 Fij1 " •• $olOlllOB Ie . 6 Gilbert Ie • 3 'tonga • 7 .4 Iliue Tuvalu 88Il10.

• 8 • 9

UH¥ i)~~H.. t:.I1IU~L

1., I

DUPT COIIBUID LIST r:Jl BSSIITIAI. DBIlGS POI SOUTII PACIFIC COUIITIIIES (SPIC LIST 1m AID lIIIO MISSI~ SllRft! 1978)

Fljl, Papua Rev Gulnea, 501..- Illande, TOlISa, Suoa

b ... 1Hcatlon DruS name (INN)

(a)

Lbt Dosase (o~S~renat~Pre.entatioQ DS + WHO July 1978 61S survey and/or .. Dackatle· size (country codea) ..

(b) WHO

snc

(e)

(d) Remarks

(e) SUSIe a tiona for lncludon III exclulion

7.2 (continued) oxytetracycline hydrochloride capsules 2500g (tablet a) injection 10<J00a (lM)

To be standardized with other te tracy clines

1000 vial vial

S, 6 S S 5

injectlon 25Qag (IV)

au~s!nn 12S...,&llOOd oral phtalylsulfathlazole probenecid sulfmoethbole tablet tablet tablet SO<Jooa SO<Jooa 10<J00a 1000 1000 ·1000 No No No

6. 7. 9

Doubtful effectiveness See aloo under point 2., pase 45 Oaly fOT association with penicillia

Bxclualon

~ •

2, 6, 7, 9 2, 7,9

7.3 Antifllarial druss diethylcarbamazine 7.4 Antileerotic dr~s

tablet

SQo&

100 1000

Yes

2, 7 5, 6, 9

(9 • free supply)

clofazimine* (10)

capsule

lOOag

100

Yeo- 2, S, 6; 9 .

(b)"YES" or "NO" refer only to· the druC (l.e. not do .... form, etc.) in tho WHO _.1 Uot.

*•

ccaplemeotary dru&

SPEC - South-Pacific Bureau for lconoalc COoperation • .1 Countl'J cod.s: Cook 10 l'IIG ·5 Fiji 1a 801_ 10 .6 ·2 Gilbert 10 • 3 'l'onrIa -7 (lib Blue -4 -8 ~u ,B _ _ t ..

DPl'\ September 1978

DRAFT COHBIIID LIST O~ ESSENTIAL DRUGS FOR SOUTH PACIFIC COUHTRIES (SPBe LIST 1977 AND WHO MISSION SURVEY 1978) Fij1, Papua New Gui~aa,

Solomon Islands, Tonga, Samoa (c)

fl Drug assification name (INN) 7.4 (cc'Jntinued)

(a)

I(b) WHO

Dosage ..jorrn/Strengch/Presentation

•

and/or D8cka2e size

IRS 615

SPEC List WHO July 1978 survey

(d) Remarks

(e)

Suggestions for inclusion or

(country codes)

exclusion

dapsone rifampicin

lYe.

(10)

ca?sule

15""& 300mg

100 100 100.1

i lye. ~o

2, 5, 6, 9

2, 9 2,5,6,9

See also under point 16.3. page 8,

monoe thano 1 amine oleate

injection

Limited use;

sclerosing agent for

Exclusion

varicose veins

;;;

(b)

"YES" 01' "NO" Tefer only to the drug

(i.e. not dosage form. etc.) in the WHO model U •• ,

Fiji

• 2

Solomon Is Tonga

• 6 • 7

Gilbert 10 • 3 _________________

Niue

tuvalU' ~___

Samoa

• 8 • 9 _ ______'______ .__________ _

- 11'COMBlJIlD LI.,. or ......1... DIUGS I'0Il _'ACIPI' 1111101 (IPIIC: US!' 1971 AIID Il11O "U_IOII _IIY 1971'

CUI'I!C! til THERlPlUTlC CATIOOR1II

~L"5

__ 519 10.85'

'1 365 2.03'

1 "'

,.89S l.nO 0 ....

9 151

'.19' 252

2191 2.2" 10 199

111 1i1l6 ]

....

In.l••aica. antl,,~lc •• nonateraidal antl_inn ••atory drug_ and anU ..iOUt drul;a and narootic an~l"

11 155

52 936

19 691 '0.• 00'

3. ''''1&41.108. ftArQotlc.

2.86' _ 0]1 I.DI'

2.111

" 650 1.66. O.llS

8.30. 0.1" 1 900

109 231

3.101 16 10S

0.'"

9311

33 0.008,

ITT 0.011 5 OG:I

.0 0.011'1 o.os. 32•• 105

0.51' l8!> 0.1)' 6 101

'592 0.83'

0.26'

0.23' 1021

...

'.51'

0.2"

, ,,6 0.3]' 7. anU-lnteatlve drue;8

20_

1.65' .. 216 ]2.63'

0.50' I.. 992 50.89.

O.TI' • , .. 706

'02 951

03'108'

25.05'

52.96' 91 0.00"

o.oss 818 0.'5'

'T.'"

0.011

3550 0.86.

310

I] 112

0.30' 0.091

11. 1,_ - -"""'ft~"· . : !! t 12. Cardlo"•• oular dr~

.•'-"""-

0.'0' 15 269 3.121 15 125

020

0.001' "

'5'

I 190

0.911

, .,5 0.09S . 3.]lS 111 1111

o.os.

3.65.

310

1 502

3.81' 8 601 '.31' 5266

0.'" 166 0.00'

896

659 0.50' • 08. 3.32' 1 It09 1.151

"'"

12 201

3.83' 9 98.

0.62' 10 169 3.60S 11 123

.....

2.03' • 636

131SO 1.'91

2.61' • 356 0.69'

100 111

3.51' 22 682

551' 2.8'JJ

• IS. Dh.... U.o.

1.13.

0.511 • 190 O.ll'

33 0.0]'

0.19' IS ...

1 515

0.86,

o 0.6

2.~S

.n o.n.

23" 1.M.

0.5]'

'ne••

- 110 \0

(DIBINm UST OF ESSENTUL 0ItUGS POI SOUTH.. '&eIPIC • • 1011

(SPBC LIST Iq11 AND WIIO MISSION SUR.a 191')

CU.RINCY US DOLLARS THERAPEUTIC CUIIiORIIS

Totals by oountry, by therapeutlo eat••ory and 'aroenta,e or total "p!ndltures FIJi Papua New s..oa 5ola.on TOftAa bland. Guinea I.lands 9 798 2.181 5 965 1 227

leMlonal total by The~.peutle e.te«0ry and percent.A_ or tatal expend1ture 3' 259 1.191

3.011 11 131 O.HAJ

0.6OJ

• ]20 J.~I'

31 90] 7.76J 36 7'9

1.61' 8 970

., '''2 , 0';,

II.'.»', 550 0.291 • 615 2.111'

S S05

61 67i1

2.1.'

13111 162 6.90'

,10 .... 6.2IJ

8.9_' 11131 1.00'

•• 56J 82 O.OU

19.

.....~ole ,..launts (perlphe.... ll,. aqUna) and

21 2911

ant ..on1ata

0.53J

1 21.

~1II

l729 •• 891 8 189

1.83J Ox,tocloa Perl~l

o.l8J

.,.

0.7" 37 621 1. ]11

9 .63 2.]OJ d1al,.1. $Glutlon q q86 1.091

0.'2J , 79' O.09J

Tl3 0.37J

21 911

0.7"

22.

7 75' 1.89J 0.95J

'5 002 0.77J

• 590

.66 0.09J 6 59]

2.3lJ II

• 830 '.09J

29 319 I ...'

3 89'

,sa )2'

8. I',

517

, 79S ,6 9S7 69

2.]OJ

3.'5' 11 198

'."J

'75 130

6.OH

2!1. 26.

SoluU. . cor.... U ... " r , .leatrol,t.e. Md OIe1e1..ba.. dl.turbanOU '

53 680 13.06J 1 022

211 ]89

11.13J 1~

8.99' 2 509

13."" 0.06'

131 115 11.5"

'ltaa1M.wI

_..n.1a

191

-. Ear,

....

nose, ,th$8lt lDr')

, , ,

0.25'

0.78,

1.3'J 700 0.371

0.0.1 ~

1 1"

) DruI ) WIG

elasalfloallona

;>()

) ItOt lnol~ed 1,.

. ,-) , , , , , ,

!!-~tcal

) Serl•• No. 615

,.port.

D.OQ'), , 116 0.06' It} 999 152

0.002'

O.OS' • 119 2.20' 236 O.l2J.

3.89"

86 O.OO'J

, .80 1.1IOJ

0 •• 61 11" 008

...

.. S-.

0.""

0.0111

, ,"

Tot.al "

......t .., and Nll.... 1 total

952 sal 100,

'9& 828 100s

191 276

100' .......... \t, oount.., ot t.IWI NCl_1 total

100'

,n19' 'OOJ

2 87' 589 l00J l00J

67.92J

6.80;,

6.65'

'.2S,

- 121 ANNEX 11

REPORT

OF A STUDY ON DRUG UTILIZATION IN RURAL HEALTH SERVICES IN PAPUA NEW GUINEA ZT Aquat - 2 Sept8lllber 1978 by

Dr So~ Tapenl Fa'.luaso' Dr SupUeo Follak1 2 Dr P.A~S.C. Sllva R08.3 1ftB) Taporary Adviser.

, Acting Dlrector of Health, Samoa. 2Dlrector of Health, Tonga. 3Assistant Secretary, Department of Health, Papua New Guinea.

- 122 -

Annex 11

INTRODUCTION

A study an drug utilization in rural health servioes in Papua New Guinea was carried out by Dr Solia Tapeni Fa'aiuaso, Acting Director of . Health, Samoa; Dr Supeleo Foliaki, Director of Health, Tonga and Dr P.A.S.C. Silva Rosa, Assistant Secretary, Department of Health, Papua New Guinea from 27 August to 2 September 1978.

TERMS OF REFERENCE

The terms of referenoe were: (a) to investigate drug utilization patterns in the different levels of the provinoial and rural health servioes and to discuss ita significant linkage to health servioe development planning and review logistios, information provision and education and training, disease pattern, patient oomplianoe, eto.; (b) specifio discussions on the use of drugs for important disease oontrol such as malaria and other parasitio diseases, skin diseases, leprosy, tuberculosis, respiratory diseases and asthma, diarrhoea, intestinal parasite infections, anaemia and malnutrition, hypertension, diabetes, and canoer will be oonsidered; (c) to study limited drug use and its quality and quantity for each level of health servioes taking into oonsideration the health conditions, socio-cultural fao·tors and the level of training of health workers; (d) to disouss eost/effeotiveness of drug use for primary health oare and speoific disease oontrol.

BACKGROUND INFORMATION

Papua New Guinea is a country in the South Paoific zone of approximately 476 500 sq km made up of· the eastern half of the island of New Guinea and several offshore islands. The central part of the islands consists of complex mountain ranges while its ooastal areas tend to be swampy with some large rivers in the bigger islands. The population nearing 3 000 000 is classified as Melanesians with the exception of about 50 000 Caucasians and people of mixed raoe. Their cultural and linguistic diversity makes them extremely heterogenous. However, during the last 100 years the introduction of English, Pidgin and IIctu languages has oontributed to better integration. ,

- 123 -

• Annex 11

The population density is estimated at 4.21 persons per square kilometre. Generally the mountain provinces (Highlands) are densely populated, while the swampy lowlands have the lowest density. It is estimated that about 80J of the population lives in the rural areas. The first contact with the Western world probably started some four centuries ago with Portuguese and Spanish navigators. After being explored, colonized and administered by the Germans, British and Australians, the country attained self-government in 1973 and full independence in September 1975. Since independence, in line with the policy of decentralization of power and devolution of responsibilities to the provinces, provincial gc'()rnments have been established in most of the 20 provinces. In 1978 some of the functions of various government departments were either transferred or delegated to the provinces. Among those that remained in the hands of the central government Department of Health are the medical supplies for all institutions, whether run by central government or prcvincial government.

ACTIVITIES AND FINDINGS

•

The health services. The development of health service in Papua New Guinea was rapid in the years following the Second World War, when disease patterns were recognized and the main morbidity and mortality identified. The central administration began taking more interest in health services which up to then had been pioneered and run largely by the churches. At the same time training of indigenous health workers was initiated. Since then expansion of services and training of health workers of all categories gradually gained momentum. Currently, health services in Papua New Guinea are delivered through a pyramid of skills based on: (1) aid posts, (2) health subcentres and centres, and (3) hospitals. Aid posts. These are the smallest health care units and they serve a population of between 500 and 3000. There are about 1800 such posts and more are being established. This is a combined effort by the community and the provincial health service, and in some cases between the community, the mission and the provincial health service. An aid post is manned by an aid post orderly (APO) who usually has had six years of primary education plus two years' training in health care. He has sufficient knowledge, training and experience to carry out his duties, namely: (1) provide curative treatment for common diseases; (2) recognize complications and refer difficult cases to a health centre or hospital; (3) provide domicilliary treatment of tuberculosis and leprosy patients; (4) patrol regularly to create awareness of the health problems in the villages; (5) assist in the disease control programmes such as immunization; and (6) assist the MCH sisters in their work, etc.

- 124 Annex 11

•

Health suboentres are aid posts with MCH servioes being added. For these additional servioes trained nurses are posted to health suboentres. Aid posts and health suboentres are supervised and oontrolled from health oentres, whioh are the next higher institutions in the pyramid. Health oentres. A health oentre area oovers a population of between 5000 and 20 000 with inpatient faoilitaties for about 30 beds. Some large health oentres are oomparable to hospitals in staffing pattern, equipment and aotivities. However, a typioal health oentre is run by a health extension offioer (HEO) and assisted by MC.H sisters, aid post supervisor, hospital orderlies, nurse aides and in some oases by a dental therapist, medioal laboratory assistant and health inspeotor. Eaoh health oentre is also provided with suitable road or water transport. Health oentres p'. ride oomprehensive, preventive health servioes suoh as family health (maternal and child health, immunizations, nutrition surveillanoe and rehabilitation, sohool health, family planning), environmental hygiene and sanitatio~, health eduoation, epidemiological surveillanoe, eto. Hospitals, both provinoial and regional, make up the top of the pyramid and are staffed by dootors and speoialists and provide oo~rehensive nursing oare and anoillary services. In addition to intram~ral patient care, hospitals also partioipate in the training of all oategories of health workers and provide valuable support to rural health services through regular visits to health oentres and even aid posts by medioal offioers. Disease pattern. The disease pattern varies between the highlands and the coastal areas. The authors were told that hypertension, cardiac failure and diabetes were uncommon in the highlands. For the whole oountry, the following health problems are rated in order of priority: (1) (2) (3)

Respiratory diseases Malaria Gastro-intestinal diseases Malnutrition Tuberculosis Accidents and injuries Pregnancy and its oompl1 cations

(8) (9) (10) (11) (12) (13)

Leprosy Skin diseases Sexually transmitted diseases Psychosocial disorders Dental diseases Neoplastic and degenerative diseases

(4) (5) (6) (7)

- 125 Annex 11

The rating of health problems is based on the National Health Plan whioh lays down the faotors considered important in suoh rating, viz.: Susceptibility to treatment Preventability COIIIIIunicabili ty Distribution Pain and suffering Residual disability Expectation for health aotion Cost of treatment Mortality Morbidity Social disruption Economic costs Demands for treatment Social and cultUral importance

Many of these health problems can be reduced to a large extent through effective preventive measures and low level but effective technology. It is through the realization of this fact and the firm adherence to the National Health Plan's principle of: "No person should be engaged to perform a task if a lesser trained, lesser paid worker can be employed to carry Ol''; the task adequately" which have led to the development of appropriate technology and provision of appropriate supplies. To develop these technologies, workshops were held and speCialists in various aisciplines urged to prepare standard management procedures of common diseases for the use of APOs, nurse aides, health extension officers, nurses and even doctors. The basic principle adopted in these management procedures is to use the simplest level of technology in diagnosis, management and treatment with the least expensive and most effective drugs available. An outstanding example of such efforts is the booklet on "Standard Treatment for Common Illnesses of Children in Papua New Guinea" first complied in 1974 and updated from time to time by the PNG Paediatric Society. Other publications now available are "Dosage Book for HEO's"; "Standard Management of Common Medical Problems of Adults 1n PNG"; "Management of Tuberculosis and Leprosy Patients"; "Control Measures for STD"; "Drug Referenoe for Nurses"; etc. Training and retraining of health workers is then hased on the standardized prooedures which spell out in great detail the diagnostic approach, treatment, complications, referral and follow up. Health workers at all levels are continuously urged to use the recommendations as much as possible in their work. Drug utilization. The "bible" of drug utilization by different levels of provincial and rural health services in Papua New Guinea is the "Medical Stores Catalogue". This is a publication prepared by the Pharmaceutical Services Division of the Department of Health and it contains all the drugs that can be utilized by health services in the country. It also incorporates the recommendations of the Pharmaceutical Advisory Committee which consists of senior specialists, a pharmacologist, the chief of the ~harmaceutical services and two assistant secretaries at health headquarters. This committee may delete an item, change the category of a drug, or introduce a new preparation upon representations from field workers or on their own initiative. Such decisions are based on effectiveness as well as cost of the drug.

- 126 Annex 11

Drugs utilized at different levels of the health service, and hence by the different levels of health workers, are clearly categorized in the Medical Stores Catalogue. Health workers are allowed only to order or prescribe drugs or items listed in the category of their qualifications. Those categories are as follows: Category A

Persons allowed to order Medical officers, health extension officers and nurses Maternal and child health nurses Medical officers Specialist medical officers only Medical officers needing these restricted items held at medical stores Pharmacists only

B C

There is also a list of supplies, including drugs, which an aid post must have. Findings. The whole system appears to be working satisfactorily. However, comments heard, during the visit, indicate that problems still occur, especially with regards to the distribution and local availability of drugs, rather than the range of drugs allowed. As an example, concern was expressed that drugs which are considered essential and should always be held in sufficient stocks, such as penicillin and chloramphenicol for pneumonia and meningitis, chloroquin and amodiaquin for malaria and oral rehydration fluids for severe diarrhoea tend to run short at times. Inexperience on the part of health workers, lack of funds to create basic stocks and erratic shipments from overseas are some of the causes leading to local storages. The rural health workers - the health extension officers, nurses and aid post orderlies - are well accepted by the community. This acceptance speaks well for the work that they have done and are continuing to do. However, the authors were told that those who live closer to the big towns are starting to bypass the aid posts and health centres and go straight to the hospitals. Commoner still is the bypassing of aid posts for the health centres. The range of drugs in category A for use by nurses and health extension officers is quite wide. Perhaps this is justified by the wide range of medical conditions that they have to deal with as well as the large number of population per health service feasibility. The aut.hors were rather surprised by the widespread availability of penicillin throughout all health facilities. Apparently allergic reactions to penicillin are rare in Papua New Guinea.

•

- 127 Annex 11

DISTRIBUTION SYSTEM

Procurement of medical supplies represents the major responsibility of the Chief of Pharmaceutical Services who prepares a functional budget. This budget is based on current departmental policy, current and anticipated trends in medicine, planned expansion of medical services and current and anticipated trends in world prices of major items. The actual purchasing, including payments, is handled by the Papua New Guinea office in Sydney which acts as a general purchasing agent for the Government. Due to the large amount of work, a special medical purchasing section has been established within the Sydney office. Purchase is done on world markets at competitive prices which enable the Department to stretch its modest financial allocation. Deliveries from overseas countries are usually on a elF Papua New Guinea ports baSiS, and from Australian manufacturers on a FOB Sydney or Melbourne basis. Quality control is attempted through spot checks carried out in Sydney by the materials inspection officer. Similarly, major overseas conSignments are examined at the country of origin by independent organizations before shipment. All supplies by a new company are tested for quality by the National Biological Standards Laboratory in Canberra. Similarly, storage tests under tropical conditions are carried out on samples provided by manufacturers against tenders. There are six medical stores in the country which provide for the distribution of all medical and allied supplies. Each store caters for a group of provinces with the exception of the Madang store which serves only Madang. The other stores are at Port Moresby, Lae, Goroka, Rabaul and Arawa. A pharmacist is in charge of each store. He is assisted by storemen and clerical staff. Church institutions such as health centres, subcentres and aid posts are integrated with government health services and subsidized through grant-in-aid system. They receive medical supplies from medical stores on the same basis as government institutions. Some of the large health centres, with one or more doctors, supplement their needs through gift parcels of drugs and their own joint procurement agencies based abroad. From Base medical stores drugs are distributed directly to hospitals and health centres using appropriate requisition forms which are normally submitted every two months. Health centres issue supplies to aid posts under this jurisdiction. In the case of health centres and aid posts an "imprest" system is devised to prevent overstocking and to reduce the times health workers would spend making calculations. Each health centre and aid post has an estimate of stock of various drugs which are to last for a period of two months.

- 128 •

Annex 11

There is no drug manufaoturing industry in Papua New Guinea, either in the publio or private seotor, and there are no plans to establish any at present as suoh a venture is oonsidered uneoonomioal without possibilities for export. However, a feasibility study on small looal tableting and paokaging plants would be in order. The budget allocation for medioal supplies for 1977/1978 was K2 350 000 whioh represented about 8% of the total budget of the Department of Health. No attempt is made in this report to disouss the cost/effeotiveness of drugs use for primarY health care and speoifio disease oontrol as the authors were unable to obtain reliable data to allow a meaningful disoussion to be made.

CONCLUSIONS

Papua New Guinea's health oare delivery system based on a pyramid of health institutions and a referral system from the simplest skills to the more sophisticated faoilities and expertise has been well established and acoepted by the people. Guidelines on management of common medical problems have been developed over the years and all health workers are adequately trained in the use of these standardized teohnologies. Standard management prooedures whioh apply to the most common illnesses are based on the least oost and most effective approach. Limitation in the range of drugs used is aohieved through standard management procedures, thus oontrolling demand, and the Medioal Stores catalogue thus regulating supply. Drug polioy is based on oost as well as effeotiveness and is administered by an advisory committee of speoialists in their respective fields of medicine, pharmacology and health administration. Availability of drugs at oonsumer points is not so reliable. This problem oould be mitigated by better training and supervision of health workers, oreation of larger baok-up stooks and making proper allowances for delays in shipments from overseas suppliers when oonsidering tenders. There is no drug manufacturing industry in the country, but a feasibility study on a small tableting and paokaging plant would be a worthwhile undertaking.

- 129 Annex 11

ACKNOWLEDGEMENT

The authors wish to express their thanks to the World Health Organization in making this study visit possible. Their thanks also to Dr Alan Tarutia, Secretary for Health, Department of Health, Papua New Guinea and his staff for preparing and arranging their programme and to all provincial health staff who helped them by providing information and showing them around the various health institutions visited.

- 130 -

Annex 11

LIST OF PLACES VISITED Places visited 1. 2. WHO Office, Port Moresby Department of Health, Konedobu Discussions held with Dr Y. H. Paik, PrograJlllle Coordinator Dr A. Tarutia, Secretary for Health Hr V. Holna, Chief of Pharmaceutical Services Dr Peter Palmer, Hospital Superintendent Mr D. Benyon, Hospital Pharmacist Dr J. Taylor, Hospital Superintendent Hr T. Moses, HEO Training Officer Hr K. Pedigaga, REO Training Officer Hr K. Tai, HEO Training Officer Mr Joel Banam, Dean of the College

3. 4.

Goroka Base Hospital Kainantu COJllllunity Health Practice Centre (this is a health centre where HEOs are trained during their second year) College of Allied Health Science, Madang Catholic Health Centre, Alexischaffen Siar Aid Post Base Medical Store, Rabaul Nonga Base Hospital Vunapope Hospital, Catholic Keravat Health Centre

5. 6. 7. 8. 9. 10. 11.

Hr A. Salieu, OIC of the Residency PrograJlllle for HEOs Dr G. Winyard, Provincial Health Officer, Madang

Hr R. Monson, Pharmacist Dr J. Kaven, Provincial Health Officer Sr Helmtrude, S. Boorne Hr John Galele, HEO IIC

•

- 131 -

ANNEX 12

COLLECTIVE PURCHASING OF MEDICAL DRUGS AND SUPPLIES POSSIBILITIES FOR IMPLEMENTATION DISCUSSION PAPER

Introduction Bulk purchasing has been a subject discussed in the Pacific for a number of years. The South Pacific Bureau for Economic Cooperation (SPEC) was requested by the South Pacific Forum to look into its feasibility. Accordingly, an examination was undertaken and a report publishe4 as document SPEC (76)8. This report named medical drugs and supplies as a commodity group for which collective purchasing might prove feasible. SPEC was thus requested by member governments to pursue the investigation further with the objective of the possible introduction of collective purchasing for this commodity group. A.

Summary 1. This disoussion paper has been discussions at tha proposed meeting member island countries,who at the the purchasing officers for medical prepared as a guideline for the of govornment pharmaoists of SPEC same t1me are also assumed to be drugs and supplies.

2. The first and primary task of the meeting is to study the possibility of arriving at a common list of medical drugs, acceptable to the participating countries (standardization). A combined list of the items and their quantities purchased by the various countries has been prepared and is distributed together with this discussion paper. Chapter B (Standardization) describes how the common list has been prepared and states the criteria that could be adopted to arrive at a list of reduced length. 3. Chapter C (Sources of supply) discusses the present sources of supply of the countries as far as they are known to SPEC. SPEC proposes to approach these known suppliers and other suppliers that may possibly be mentioned at the meeting in order to obtain comparative information on prices, oonditions of delivery, quality inspection, etc.

Annex 12

4. Various methods of distribution oan be envisaged. These are discussed in chapter D. Partial deliveries (spread over the year), split up deliveries (already addressed to the final destination) and a possible central depot with its funotions are the points discussed in some detail. Eight alternatives are recognized, which are schematically displayed on page 138. 5. Chapter E deals with the methods of administration, which differ with the methods of distribution and the problems to be faoed. 6. At this stage it is still too early to make cost oalculations and thus to say anything about the possible savings and, therefore, about the attractiveness of the proposal to the various countries. The tentative conclusion is drawn however that the most simple way is that of collective ordering with direct deliveries to the country of destination, while the central depot alternative appears to present considerable difficulties as to responsibility, invoicing and payment. 7. It is suggested that prior study of this discussion paper and the other documents could further the discussions and the progress of the meeting. Suggestions by delegates will of course be very much appreciated. B. Standardization 1. The idea behind collective purchasing is that, when combining the requirements of various countries, bigger quantities can be offered to the international suppliers and thus lower prices may be obtained or possibly some savings in freight might be made where minimum freight rates apply on small quantities. It follows from this that the more homogenous the package to buy, the better the chance that suppliers might be interested and willing to quote a lower price. 2. The first effort has therefore been to obtain an idea of what the various SPEC island member countries are buying, both in drug specifications and in quantities. A questionnaire was sent out to this end in September 1976 and by the end of that year answers had been obtained from all members except Niue, with Nauru not interested in participating. 3. As SPEC does not have the required expertise to review the various answers, the assistance of the principal pharmacist of the Fiji Medical Department was sought and obtained. He catalogued the various drugs as to use and combined all answers onto one list.

.; l};;. -

Annex 12

~. The primary conclusion is that there are many possibilities for reducing the total number of items on the collective list.

It is therefore appropriate for a meeting of government pharmacists to scrutinize the collective list systematioally and to discuss the possibilities towards reducing this list and to agree in principle to adopt that reduced list for ordering their own requirements. As some countries added more groups into their list than others, the latter might grasp the opportunity to enter their requirements for items not originally stated. 5. As criteria for reduoing the list the following may be used: (a) Is there any appreciable difference in the effects of some of the drugs from the same group. (b) Can an unbranded drug be used to replaoe a drug marketed by a special manufacturer under its own name (the latter generally is more expensive)? (c) The suitability of a drug to withstand storage under tropical conditions and the shelf life under those conditions. (d) The price of the speoifio medioament (when there is no appreciable difference in the effects of various similar drugs, the cheapest one should be preferred). C. Sources of supply 1. SPEC island member countries use purchasing agents for their medical supplies, who in turn buy from a variety of manufacturers. These purchasing agents are: (a) Crown Agents, U.K. tendering and buying from various sources, mainly European; Crown Agents operate a quality inspection system before goods are sent to their Pacific destinations and it is understood that all supplies physically pass this inspection department. Crown Agents are used by Fiji, Solomon Islands and Tuvalu (formerly also by the Gilbert Islands). (b) New Zealand Hospital Board, which combines island countries' requirements with the New Zealand hospitals' own requirements and tender for the total; it is understood that supplies for the island countries physically come via New Zealand and that quality inspection is done in New Zealand. Used by Cook Islands, Niue and Samoa; probably (but not specifically known) also by Tonga.

- l}\ •

Annex 12

(c) Papua New Guinea Purchasing Office in Sydney, tendering and purchasing with many international manufacturers. Prior quality tests on major overseas consignments are carried out by independent organizations 1n the oountry of origin before shipping and deliveries are on a CIF basis to Papua New Guinea ports; supplies from Australia are inspected in Sydney by the medical section of the PNG Purchasing Office used by Papua New Guinea. (d) Australian sources, used by Nauru; no details available.

(e) Messrs Keep Brothers of Birmingham, used by Gilbert Islands, no further details available. 2. It is not considered wise to set up each own purchasing agency for medical supplies for SPEC countries; using the knowledge of the trade and the experience in tendering from existing organizations would be far less expensive and could avoid costly mistakes likely to occur in learning the business. 3. SPEC therefore proposes to approach the purchasing agents mentioned under a, b, c, and e above with the reduced list and the individual and the combined quantities to ask for price quotations, conditions of delivery, system of quality inspection and the charges for the combined requirement for various methods of distribution (see chapter D). Getting price quotations may present some difficulties as we understand that the purchasing agents tender with manufacturers, but their latest obtained prices may give SUfficient indication as to the price levels for comparison purposes. D. Methods of distribution 1. It is understood that purchasing agent~, although tendering for annual requirements, negotiate the purchases in such a way that partial deliveries, spread over the year, are shipped to the reoeiving countries, calculating their fee over the total amount of the annual requirement. For many medical supplies with a limited shelf life partial deliveries are a necessity.

It is however not known whether such partial deliveries influence the prices of the manufacturer. If they do, as may reasonably be suspected and as partial deliveries will undoubtedly lead to higher total shipping cost, investigations should be made to determine Whether for items where the shelf life is unlimited (e.g. dressings) the additional cost for part deliveries is balancing the saving in interest brought about by payments spread over the year.

- 135 Annex 12

2. It is, moreover, understood that there are examples where a supplier is willing to split up a oonsignment as to the final recipients. If this also would apply to medical supplies (either supplied directly by the manufaoturers or via the purchasing agenoy), the supplies could be shipped directly to the reCipient countries, but most probably this would involve higher shipping cost than in the case of shipping a larger quantity to a central place, although the secondary shipping cost to the final destination might ohange the picture. 3. Shipping to a central point leaves the choice between either immediate transhipment to the country of destination or storage in a central depot. This will hardly mean a difference in shipping oost from the central receiving point to the country of destination, provided the same means of transport is being used. A central depot will add to total cost (storage, labour, supervision by probably a pharmacist, stock-keeping and maybe quality inspection). However it will give the advantages of a lower total stook as statistically it can be proved that a central safety stock for emergencies amounts to a lower stock level than when the individual national safety stocks are added up. Moreover it leads to shorter lead times for the individual oountries in getting new supplies and in emergency cases air transport can be utilized as one generally is dealing with low volume and high cost items. 4. In the case of a central receiving point and a central depot, the main criterion for choosing such a place is transport connections to the various countries. It seems rather straight forward that Fiji then is in the best position. Papua New Guinea, being the biggest consumer, would be a logical location from that point of View, but west-east connections, both by ship and by airline are not particularly good. This may lead to the conclusion that suppliee for PHG have to be shipped directly to that country with Fiji becoming a central place for the rest of the countries. In the case of Fiji, the Nadi area would be the best from the point of view of air connections. Locating a central depot in Lautoka might open the possibility of requesting the Fiji Government to entrust the supervision as a part-time job to the government pharmacist of the Lautoka Hospital, thus saving on overhead expenses of employing a separate pharmaCist. 5. The various eXisting alternatives discussed above have been graphically displayed in the annex together with their various consequences. It is clear that the cost consequences have to be calculated, but this can only be tried after more is known about items and quantities. It may even show from the discussions that some of the alternatives oan be left out as being impractioal or not wanted.

- 136 Annex 12 E. Methods of administration 1. A collective purchasing scheme will need some kind of administration the extent of which largely depends on the method of distribution that will finally be adopted (see Chapter D). In every system it will have to start at the national level in the participating countries, where the annual required quantity per item of the agreed common list of medical supplies has to be established. A standard list will have to be used, listing all the items of the agreed list and every country indicating which annual quantities of which drugs and other supplies are required. In the case where there is no central depot the number of batches in which the annual requirement has to be supplied has to be indicated; it would be advisable when all participating countries would use the same scheme, e.g. supplies to be received in the course of the first month of every quarter. 2. These lists have to be sent as follows:

•

(a) In the case of a central depot (alternatives 1 and 8, but also 2 and 7 from Annex) the lists have to go to that central depot, where one total list has to be prepared for further despatch to the purchasing agent. (b) In the other cases (split up deliveries, alternatives 3, 4, 5, and 6) directly to the purchasing agent, to be received there around the same time for combined processing; this would be facilitated by routing the lists via a central Pacific address. 3. In the alternatives 4 and 5 the supplies will reach the country of final destination without any intermediary; invoices to be sent directly to the receiving country. In the alternatives 3 and 6 sorting out the already addressed packages from the combined shipment and their transhipment to the country of final destination can be left to an appointed reliable stevedoring company or shipping agent; here too, invoices can go directly to the countries of final destination. 4. Alternatives 1, 2, 7 and B require the involvement of a depot with an adequate administrative system. In alternatives 2 and 7 the individual items from the consignment have to be put temporarily in storage racks, each with proper identification. Immediately after that order picking has to start according to the (e.g. quarterly) requirements as stated on the annual requirement lists of the participating countries. As there are only a limited number of customers (i.e. participating countries), the picking operation, followed by packing, is of a limited character but requires trained operators, thoroughly acquainted with medical supplies; moreover supervision by a pharmaceutical assistant (a qualified pharmacist is probably not required) is needed. All this is not a continuous operation and it may thus be difficult to keep the staff. The best solution would be for this work to be performed by an existing government pharmacy against an arranged fee.

- 137 -

Annex 12

In alternatives 1 and 8 a system of stockkeeping is required with a strict first in first out system to be maintained; periodic quality inspection will almost be unavoidable and a qualified pharmaoist should be in oharge of a thoroughly trained team of operators. Partioipating countries can order supplies on short notice and frequently, if so wished. Storage is of a more permanent character with refrigerated oells for certain products, picking is a more frequent operation and permanent staff may be employed. 5. With alternatives 1, 2, 7 and 8 shipments from the purchasing agent would be invoiced to the central depot and thus a system of prioing (including the cost of the depot, e.g. on a percentage basis) and invoicing to the recipient country will have to be set up. This oould well take away many of the advantages of lower total inventory and short lead time. A difficult problem to solve will also be how the depot will have sufficient funds to pay the purchasing agent and who is going to be responsible oppOSite the purchasing agent. F. Tentative conclusions 1. Without having made any cost calculations, covering the total chain for the eight alternatives, taking into account that SPEC's role is only of a promotional character and at the maximum could be only that of a mailbox (according to Chapter E, paragraph 2b) and, morever, taking into account the various difficulties to be overcome, the tentative preference is for alternative 4. This would reduce the collective purchasing to a mere collective ordering. 2. The least preferred alternative seema to be alternatives 1 and 8, mainly due to the administrative consequences, although there may be considerable advantages for the participating countries.

'cu::.TR.I@->U"IoN

A """"I!.I'IAr1'l£s

FoR

M£.""CAI.

5upp\..,iE.S

; C.&PaT' ,,~QltIlCil&

~ 0.

_ _ _ PR.~~.. AT'..

'tIri= w"..,V'&I(,.

II I ~~. 2. , ~; .. CI.. , Z'

! . ....

I-

.j{.PA~I"G i,,, ,~~,,,

f ....' .. _

.... - ., °1 c. '" z C.

:h~ -Q J

<Ii

-.~'

\"'U",,.,oN

..!

~ 0 :> Ii

:. ~~ i~TtJ 0, .. 0,:.. ._

-l.

u· a

\J :JI , j,

"'- c.{ ~ 1:':>

f> ..,

I:>

/>...

.)i'

c.&""WM. , _ ~ ;: ..... Pot" - - - , ......... S.-:... .,.M""T~ ~

lc.fD' ', c./ <> ')

B/c'1 ..ic. . , ; ;;fc":.

C ~,IIt6.C

-----------H, - « l

A-

D i:>

t{o; Ali> ."

l .... .)-.....)

....

~D"'" .... ,... '4\ po

.../ .,101."'-" f· ...

~ .... ,

1 A.. ~ I

Q '

(N""'.)

,.,/c.' r.,c:. .

..:&."',..Ai. .... ... ~T ---~~ W ....".."p..,. --~~"Ir-M~ ------~

t':> C

,..

'" D

"I,; ., 'Ala")

I' 0\

. 1 . . ~

l ,..

~ ..... "

'i''''' C;1Oi:~ 6'".k tpAc~."" ~p,,, 'i>'TOI:,..c... ::: '. r ~,....,. .. l ,. c.'d~

...

[L Q ~' 7 i "

" ~ P

c. D

sic:. '.

. _" .. i...,A..A1'.o .... - - - - 6 ;~ Di..A.o .. lA,U

iC-

,A/".)

z .. ~ ~ 2 ; T

.... ~ ..

:s ,,, .. .... '" vi

~: Le ... £,>, Ott MOS" c.."'~1 : M'C. ... €.$T oR: "OU :,).F~IW .." ? ; NE.C..,.. ,~ ,.-.vi-'S..tG.A.TlaN

-I

C\j ....

.. w 'Z

~ '" • ..

~\~"'uo

! d~ -. ~

/I t_ .. a

Q.4. vA .. ~ r • l ':) 'oil ~ V _

0'4

all

2", A

.., =~t ..

rUZ'1 Q -':-4.Ql i. .. " oJ ~

"'r.tco.,

i~..t ~

- 139/140 ANNEX 13

TWENTY-EIGHTH WORLD HEALTH ASSEMBLY PROPHYLACTIC AND THERAPEUTIC SUBSTANCES

WHA 28.65 29 May 1975

Good practices in the manufacture and quality control of drugs and certification scheme on the quality of pharmaceutical products moving in international commerce The Twenty-eighth World Health Assembly, Recalling resolutions WHA22.50, WHA23.45 and WHA25.61, Having noted resolution EB55.R21, Having examined the report of the Director-General on Prophylactic and Therapeutic Substances, 1 ADOPTS the revised texts of the good practices in the manufacture and 1. quality control of drugs and the certification scheme on the quality of pharmaceutical products moving in international commeroe, as appended to the report; 2. RECOMMENDS ~hst

Member States:

(a) Apply the revised requirements for "Good Practices in the Manufacture and Quality Control of Drugs" as formulated in the report of the Director-General; (b) Participate in the revised "Certification Scheme on the Quality of Pharmaceutical Products moving in International Commerce" as formulated in the report of the Director-General; 3. REQUESTS the Director-General to report to a future World Health Assembly on the implementation of the above recommendations.

Thirteenth plenary meeting, 29 May 1975 A28/VR/13

•

1Document A28/12 ••

- 141 -

ANNEX 14

TWENTY-EIGHTH WORLD HEALTH ASSEMBLY

WHA 28.66

29 May 1975

PROPHYLACTIC AND THERAPEUTIC SUBSTANCES The Twenty-eighth World Health Assembly, Having considered the report of the Director-General on Prophylactic and Therapeutic Substances;1 Recognizing the importance of further development of international standards and requirements for prophylactic and therapeutic substances, Convinoed of the necessity of developing drug policies linking drug research, production and distribution with the real health needs. 1. THANKS the Director-General for his comprehensive report;

2. URGES governments and professional bodies to ensure that the health personnel and the public are adequately educated and kept informed as to the proper use of prophylactic and therapeutic substances, and

REQUESTS the Director-General: (i) to continue to develop activities related to the establishment and revision of international standards, requirements and guidelines for prophylactic and therapeutic substances in consultation, as appropriate, with relevant governmental and nongovernmental organizations in official relations with WHO; (ii) to develop means by which the Organization can be of greater direct assistance to Member States in: (a) the implementation of national programmes in research, regulatory control, management and monitoring of drugs and, in so doing, also in the formulation of national drug policies; (b) advising on the selection and proourement, at reasonable cost, of essential drugs of established quality corresponding to their national health needs; (c) the education and training of scientific and teChnical manpower for research, production, evaluation, control and management of prophylactic and therapeutic substances •

• 1Document A28/11.

- 142 -

Annex 14

(iii) to study ways and means of optimizing inputs and outputs of the international system for drug monitoring so that it will be useful for both developed and developing countries; (iv) to disseminate to Member States evaluated information on drugs, and

(v) to report on the above matters to the Executive Board and a future World Health Assembly. Thirteenth plenary meeting, 29 Hay 1975 A28/VR/13

- 143 • ANNEX 15

THIRTY-FIRST WORLD HEALTH lSSl!MBLY

WHA31.32 23 May 1978

ACTI<li PROGRAMME ON ESSBNTIAL DRUGS The Thirty-first World Health Assembly, Recalling resolutions WHA28.66 and EB61.R17; Having oonsidered the progress report by the Direotor-Genera1 1 on Drug Polioies and Management; Realizing that large segments of the world's population do not have aooess to the most essential drugs and vaooines that are indispensable to ensure effective health care; Recognizing the importanoe of an adequate supply of essential drugs and vaccines to meet the real health needs of the people, through the implementation of national programmes of health care; Deeply oonoerned by the high proportion of health budgets spent on pharmaoeuticals by governments, partioularly of developing oountries, thereby limiting the remaining funds available for the provision of adequate health care to the whole population; Stressing the need to provide essential drugs of adequate quality, in suffioient quantity at reasonable oosts to meet the health needs of these oountries; Considering that local production of essential drugs and vaooines is a legitimate aspiration which developing countries have expressed on many ocoasions, and that considerable progress has been aohieved in some oountries; Considering that the establishment of a pharmaoeutica1 industry in countries where it does not exist requires transfer of appropriate technology and investment and that most developing oountries cannot afford thiB without international oooperation; Recognizing the importanoe of objective information about pharmaoeutioals and the risk of unoontrol1ed promotional aotivity by manufaoturers, particularly in developing countries;

• 1Dooument A31/12.

- 144 -

Annex 15

Convinoed that oolleotive purohases of large quanttties of pharmaoeutioals would substantially reduoe their oosts; Convinoed that urgent internatIonal aotion is required to alleviate this situation through the establishment of an aotion programme of technioal oooperation on essential drugs aimed at strengthening the national capabilities of developing oountries in the field of seleotion and proper use of essential drugs to meet their real needs, and in local production and quality oontrol, wherever feaSible, of suoh drugs; Highly appreoiating the steps already taken by the Direotor-General to make available essential drugs and vaooines neoessary for the extension of the health care ooverage of the population; 1. 2. ENDORSES resolution EB61.R17. URGES Member States, partioularly developing oountries to: (1) establish adequate drug proourement, storage and distribution systems in order to make available drugs of adequate quality, at reasonable prices, to the population; (2) establish national drug lists or formularies bv internaUonal nonproprietary names (generio names) inoluding essential drugs seleoted on the basis of the health needs of the oountries and taking into . aooount the oriteria of the WHO Expert Committee on the Seleotion of Essential Drugs (Teohnioal Report Series No. 615); (3) enaot legislation as appropriate covering drug registration, use or presoription by generio names, oontrol of drug information, inoluding therapeutic indications and mentton of s1.<1e-effects, price regulation and definition of the type of drugs authorf.zed for uae or presoription by different levels of health workers; (4) oollaborate in the exchange of information on drug polioies and management through bilateral or multilateral programmes and WHO. 3. REQUESTS the Direotor-General: (1) to continue to identify the <1rugs and vaooines which, in the light of scientifio knowledge, are indispensable for primary health care and control of diseases prevalent in the vast majority of the population, and to update periodioally this aspect of the report of the Expert Committee on Easential Drugs; (2) to oooperate with Member States in formulating drug polioies and management programmes that are relevant to the health needs of populations, aimed at ensuring aooess of the whole population to essential drugs at a oost the oountry oan afford;

Annex 15

(3) to improve existing WHO supPly servioes for drugs, inoluding vaccines, and medical equipment throush oloser collaboration with UNICEF, and to ensure that developing oountries take full advantage of such services;

(4) to ensure oollaboration with UNDP, the World Bank and regional Development Banks and Funds, UNICEF and UNIDO with a view to ensuring that technical expertise and financing are made available to interesterl countries to establish local production, wherever feasible, corresponding to their health needs, it being understood that financing should be independent of the source of technology; (5) to develop further the dialogue with pharmaceutical industries in order to assure their collaboration in meeting the health needs of large underserved segments of the world's population; (6) to study how prices of pharmaceutical products are determined and poss.ible strategies for reducing suoh prioes including the development of a code of marketing practioes, with special emphasis on pharmaceutical products essential for the populat.ions of developing countries; (7) to take appropr.iate steps to cooperate with Member States in develOPing quality control systems for drugs, either imported or locally produced, and to establish regional quality oontrol networks; (8) to foster exchange of information among Member States on drug policies and management and on technical aspects of pharmaceutical products; (9) to submit to the sixty-third session of the Executive Board a comprehensive aotion programme as outl.ined above aiming at fostering teohnical cooperation among developing countries and to stimulate bilateral and multilateral cooperation in this programme; (10) to invite governments directly interested in the implementation of this aotion programme in their own countries, governments willing to provide support, relevant United Nations agencies and other appropriate oooperating parties to participate; (11 ) to submit a report on the progress achieved in the implementation of this aotion programme to subsequent sessions of the Exeoutive Board and World Health Assembly • •

Twelfth plenary meeting, 23 May 1978 A31/VR/12

- 147 -

• ANNEX 16

ESCAP RESOLUTION 173 (XXXIII)

Inoreased participation by the develo~i~ island countries of the Pacifio in the aotivities ot t economic and SOcial Commission for Asia and the Paoific

•

The Economic and Sooial Commission for Asia and the Pacifio, Recalling its resolution 141 (XXX) and the subsequent change of name of the Economio Commission for Asia and the Far East to "Economic and Social Commission for Asia and the Paoific" in recognition of the geographical scope of the Commission, Noting the desire expressed by the developing island countries of the PacifiC to playa more active role in the affairs of the CommiSSion and the development of the region as a whole, Recalling General Assembly resolutions 3202 (8-VI) oontaining the Programme of Aotion on the Establishment of a New International Eoonomio Order and 3362 (S-VII) on development and international eoonomic co-operation, in which the Assembly, inter alia, called upon the international community to assist in the structural transformation of the eoonomies of the developing countries while devoting partioular attention to the least developed, land-locked and island developing oountries,

•

Reoalling further General Assembly resolution 3338 (XXIX), in which the Assembly, inter alia, invited the heads of organizations oonoerned wl.thtn the United~on;-system to intenSify their efforts with respeot to developing island countries within their fields of competenoe, Recalling also resolution 98 (IV) adopted by the United Nations Confence on Trade and Development on the least developed among the developing oountries, developing island oountries and developing land-looked oountries, in which the Conferenoe,.inter alia, urged international ~rganization to pursue and intensify studies and technical assistance efforts t~ assist small islands in overooming the peculiar problems of their geographical situation and characteristios, Further recalling General Assembly resolution 31/156 on an aotion programme in favour of developing island oountries, Reaffirming its resolution 169 (XXXII) on special measures in favour of the least developed, land-locked and island countries,

•

- 14& -

Annex 16

1. Requests the Executive Secretary (a) to consult with the developing island countries of the Pacific which are members or associate members of the Commission with a view to seeking their views on how the developing island countries of the PaCific can be assisted in playing a more active role in the affairs of the Commission and the development of the region as a whole, (b) to consult fully with other multilateral bodies such as the South Pacific Commission and the South Pacific Bureau for Economic Cooperation as well as the United Nations agencies working in the Pacific region, so as to ensure the fullest coordination between them and (c) to report to the Commission at its thirty-first session on the progress made in implementing this resolution; 2. Requests the United Nations Development Programme and interested members of the Commission to assist in the implementation of this resolution to the greatest extent possible. 520th meeting, 29 April 1977

• •

•

Основные сведения

Организация Всемирная организация здравоохранения (ВОЗ / WHO)

Тип документа Technical Documents

Дата принятия 31 декабря 1978 г.

Источник Всемирная организация здравоохранения