Review of USAID"s rational pharmaceutical management project [: executive summary]

The component is implemented by Management Sciences for Health (MSH) and U.S. Pharmacopeial Convention (USP). Interim evaluation covers the period 9/92-12/97. MSH has assisted country programs, especially that of Russia, in drug selection and formulary development, and has provided TA in drug procurement/supply management to Ecuador, Mozambique, Nepal, Russia, and Zambia. Procurement activities have been limited; this is an important thrust for future work. Management assistance to Russian pharmacy owners and operators has improved their access to drugs and their overall capacity to compete in a free market. To promote rational use of drugs, MSH has developed standard treatment guidelines, incorporated lessons on rational use into curricula for health care providers, trained providers, provided drug information to consumers, and established drug review programs in hospitals. To help provide developing countries with unbiased drug information, USP developed monographs for 37 drugs included in the WHO Model List of Essential Drugs not previously included in the USP Drug Information (USP DI); additional monographs are being developed. USP also helped adapt the USP DI so it includes country-specific indications and dosing schedules into existing drug monographs. These efforts have been very fruitful in Mozambique and Russia, less so in Nepal. USP has also helped establish drug information centers (DICs), mostly to serve target populations at the facility and regional levels (efforts have been reasonably successful), but also, to a limited extent, to serve as relay centers within national drug information networks, but the likelihood of establishing effective networks (even at the local level) appears remote. In addition to the above country-level activities, a number of central-level efforts have been launched in two areas. (1) Studies and operations research efforts have focused on developing a method for estimating the drug and expendable supply costs of reproductive health programs. The usefulness of the method will depend on its country specificity. (USAID is interested in assistance from the project in research on HIV/AIDS, integrated management of childhood illness, and antimicrobial resistance.) Operations research has included important studies on restructuring supply systems in Ecuador and Zambia, a widely-hailed feasibility study of drug cost-sharing in Nepal, and assessments of the pharmaceutical sector in Ghana, Mozambique, Ecuador, El Salvador, the Eastern Caribbean, and Russia. (2) Efforts in tools development and information dissemination have included presentations at conferences and workshops and preparation of manuals, documents, and computer software. The project has contributed significantly to achieving strategic objectives (SOs) at both the central and Mission levels. At the central level, it has contributed most directly to SO2 (increased use of safe pregnancy, women"s nutrition, family planning, and other key reproductive health interventions) and SO3 (increased use of key child health and nutrition interventions). The project has also contributed to SO1 (increased use by women and men of voluntary practices that contribute to reduced fertility). Its contribution to SO4 (increased use of proven interventions to reduce HIV/STD transmission), is likely to become more direct as developing countries seek guidance on the rational use of antiretrovirals and medications to treat opportunistic infections. Under the component, MSH has significantly increased its expertise and staff in pharmaceutical management, particularly in direct support of country programs, and USP has strengthened its institutional capacity to provide TA in developing countries, and is now an international drug information authority. Overall, the component has been a strong and effective collaborator with other projects and donors, responsive to the needs of USAID and host countries, and well served by USAID management. Its expanding portfolio of country programs and the leveraged resources of other donors and programs are evidence of increasing demand for its services.