In Nigeria, irrational prescribing and use of medicines is fueled by lack of enforcement by the various layers of authority meant to do it - federal, state and local government. There are guidelines and formularies galore. There is the National Essential Medicines List (EML) now in its sixth edition (2016 edition). There is the National Standard Treatment Guideline first published in 2008, now in its 2nd edition (2016 edition). There is the Standing Orders for Community Health Practitioners who mostly man the primary health facilities, first published in 1995 the current edition has just gone into circulation (2015 edition). I think other LMICs may have similar publications / guidelines but lack enforcement too.
Rather than promote rational prescribing and use of medicines especialty antibiotics and opiates, the lack of enforcement of the separation between Over the Counter medicines (OTC) and Prescription Only Medicines (POM), is the tragic fact that access to any medicine in uncontrolled from open markets to patent medicine stores (that legally should on sell OTCs) and Pharmacies. In these outlets even sales persons consult, prescribe and dispense dangerous drugs jut to make more and more profit.
The lack of political will to enforce and control access to antimicrobial and other dangerous medicines is at the level of the ministries of health in the states and FCT (that inspect and license these facilities) and the Health Departments in the Local Government Councils. Health related associations and civil society organisations would have to increase awareness of the public to the harm that is caused by the present uncontrolled access to all sorts of medicines and also openly pressurise ministries and local governments to do their statutory role of enforcement!.
Africa Center for Clin Gov Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria
HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group
jneana AT yahoo.co.uk