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NEW WHO GUIDELINES FOR GOOD DRUG DONATION PRACTICE
DURING EMERGENCIES
Press
release WHO/45 - 3 September 1999
Good drug donations
save lives and are very much needed, especially in times of emergencies. Sufficient
essential drugs to meet the needs of 1.5 million people for three months were sent to
Albania early on in the Southern Balkans crisis, for example.
However, a recent survey by the World Health Organization of 108 drug donation lists
submitted to the Albanian Ministry of Health during May 1999 found that: some 50% of these
lists only mentioned trade names, many of which were unknown to local health
professionals; only 56% included information on shelf-life, of which about 41% of the
drugs had a remaining shelf-life of less than one year; and 18% of donations contained
small packs of free samples or drugs returned to pharmacies. None of these practices are
acceptable, WHO argues.
A similar picture also emerges elsewhere. A 1997 study by Epicentre and Pharmaciens Saris
Fronti~rcs estimated that 50-60% of drugs donated in Bosnia were inappropriate. Likewise,
drug donation problems have been reported from Rwanda, Somalia and Honduras and could
happen in the wake of the Turkish earthquake disaster because WHO principles on drug
donations are not adhered to.
"As soon as any disaster reaches our television screens, many drugs, the great
majority sent with the best of intentions, are dispatched to the scene of the emergency.
However, there also have been problems with some drug donations. They fail to meet the
most urgent real health needs and, once in the country, they clog up already overloaded
distribution systems and become difficult to dispose of," said Dr Quick of WHO.
WHO urges: follow
the guidelines
"For this reason, WHO has for years
promoted good drug donation practices. And on the basis of a recent global survey of
experiences with the Interagency Guidelines for Drug Donations, issued by WHO in
1996, we have revised them to make them easier to follow," added Dr Quick. This
survey showed that six donor countries and 13 recipient countries had developed their own
drug donation guidelines. Forty per cent of all responding organizations had changed their
donation practices to follow the guidelines. Fortyfive per cent of recipients reported an
improvement in drug donation quality, while 52% now find it easier to refuse unwanted
donations. The revised Guidelines are based on consensus among 15 major United
Nations and international agencies active in emergency humanitarian relief.
Improvements in drug donations have indeed
been observed, but greater efforts are required if the situations seen in so many
countries are to be avoided. Put simply, more countries need to develop national
guidelines for drug donations, and more donors will need to change their practices.
WHO is therefore repeating its plea to donors to ensure that their donations:
- are of maximum benefit to the recipient;
respect the wishes and authority of the recipient;
strictly avoid any double standards in quality;
are based on effective communication between donor and
recipient.
WHO is also broadening its partnership to
promote good donation practices beyond the interagency group that developed the
guidelines. Other non-governmental organizations, pharmaceutical industries and donor
groups are being invited to adhere to the guidelines and WHO will continue to monitor
donation practice in emergency situations.
The release of the revised Guidelines is
particularly timely in the light of the flux of drug donations into Turkey following the
earthquake there. Large quantities of donated and unsolicited medical supplies are
hampering the restocking of regular or emergency medical structures, according to a report
from the International Federation of Red Cross and Red Crescent Societies.
Making a bad
situation worse: having to dispose of unwanted drugs
Unwanted drug donations
are bad enough, but if accumulated can become a major chemical waste problem. Disposal
should be in purpose-built facilities to minimize potential environmental contamination.
But such facilities are rare in low- and middle-income countries. M6decine Sans Fronti~res
reports that it was necessary to send an incinerator to Mostar in 1996 and Armenia in 1988
to dispose of unsuitable donations. The only other alternative is to ship such drugs to
another country. But the price is high: it will cost US$ two to four million to ship 1000
metric tons of inappropriate pharmaceuticals and medical supplies from Croatia for
appropriate disposal.
Responding to this situation, WHO has also issued its interagency Guidelines for Safe
Disposal of Unwanted Pharmaceuticals in and after Emergencies. Representing the
combined efforts of 13 agencies, the guidelines are aimed at ministries, health
authorities, environmental and waste management authorities, and experts at ministerial,
regional and local levels. They describe a number of disposal methods involving minimal
risks to public health and the environment. These include landfill, encapsulation,
inertization (i.e., rendering the product as safe waste), discharge to a sewer, and
incineration, and can all be used by countries with limited resources and equipment. But
this is one publication that WHO hopes will have a short shelf-life. If donors stick to
the organization's interagency Guidelines for Drug Donations, disposing of unwanted
drugs will be unnecessary.
Note: Copies
of the Revised Guidelines for Drug Donations (reference WHO/EDM/PAR/99.4) and Interagency
Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies (reference
WHO/EDM/PAR/99.2) are available from the Documentation Centre, Department of Essential
Drugs and Other Medicines, World Health Organization, 1211 Geneva 27, Switzerland. Both
sets of WHO guidelines are available at the WHO website at: http://www.who.int/dap/edmguidelines.html
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