Brunei's Local News - Brudirect.com

Bandar Seri Begawan - Besides the rising costs of medicines pushing up budget allocations, the Ministry of Health is also facing a shortage of medicines.

To combat wastage, a formidable challenge in public health, Deputy Minister of Health Pehin OKPLD Dato Paduka Hj Hazair Hj Abdullah called for an implementation of a sound strategy.

He said that this needs to be implemented and must fully involve everyone, including community members, NGOs and the private sector. The education of all stakeholders - members of the public, community, medical doctors, government officials and other healthcare providers, are also important.

The education for promoting the rational use of medicines, if continued in a dedicated manner, would bear large dividends, as Brunei offers almost

free medicare to citizens.

The budget for medicines has gone up to $44 million (including the supplementary budget of $17 million) in 2007/08 to $60 million (including the $30 million supplementary budget and $5 million for Named-Patient Basis Prescribing) for 2008/2009.

The deputy minister was speaking at a welcoming ceremony for a training course on the Principles of Pharmacoeconomics and Its Effective Application - Introductory and Intermediate Level, which was jointly organised by WHO and the Department of Pharmaceutical Services.

Pehin OKPLD Dato Paduka Hj Hazair added the escalating costs of medicines certainly pose a challenge to the ministry in its efforts to provide high quality healthcare by maintaining adequate supplies of medicines.

Despite all efforts to ensure continuous and enough chain supplies for stocks of drugs and medicines in hospitals, health centres and clinics, drug supplies are occasionally affected due to multi-factorial reasons - some being exogenous and others endogenous.

Among the many reasons why medicines might go out of stock are: pharmaceutical procurements based on open international tenders result in a large number of offers, some of which may be reasonably priced but suffer low quality; and sometimes, products delivered are not in compliance with international standards of efficacy, quality and safety.

Other reasons may include delays in deliveries often encountered when dealing with new and unknown suppliers, through open tenders, manufacturing problems, supply/demand imbalances, raw material problems, the fact that some patients do not readily accept alternative medicines, and also improper stocktaking and distributions of medicines.

Each of these problems, he said, has its own characteristics and must be dealt with on an individual basis.

In an effort to ensure the continuous supplies of medicines, the ministry also uses a holistic approach, whereby prescribers are reminded to be prudent and rational, with their choice of therapy and it should be ensured that treatment choices are evidence-based.

With this approach, patients could be more educated about their medicines - on their proper use and storage, adhering to prescribed therapies in order to optimise treatment and avoid wastage. All these are through leaflets, brochures, as well as patient-education in mass media and counselling.

Finding alternative sources of drug supply is also another holistic way to ensure continuous supplies of medicines, like direct purchases from the manufacturers, especially under critical conditions, said the Deputy Health Minister.

Earlier in his speech, Pehin OKPLD Dato Paduka Hj Hazair said the ministry through its Drug Advisory Committee as well as the Drug and Therapeutics Committee, is committed to rationalising drugs and minimising the costs of maintaining an adequate supply of drugs to the public.

Some of these efforts include reviewing the Ministry of Health's National Standard Drug List every two years, producing standard treatment guidelines and medicines, as well as using guidelines to promote rational and evidence-based uses of medicines.

He added the Brunei Darussalam's National Standard Drug List (NSDL) has 825 different chemical entities, comprising 1,287 different preparations.

In addition, should a patient require a medicine that is not in the NSDL list, the patient can prescribe under the so-called Named Patient Basis Prescribing, a scheme that allows a doctor to prescribe a drug outside the NSDL to a particular named patient.

Later in his speech, the deputy minister added the irrational use of medicines could certainly contribute significantly to wastage, ineffective treatments and denying other patients that may need such medications. This is indeed a very formidable challenge in public health.

"This is a challenge that could be overcome by a sound strategy, formulated through multidisciplinary and multi-sectoral approaches.

Such a strategy must be embedded with certain principles, as well as a framework of ethical and rational use of medicines. In addition, community members and people themselves can control its implementation.

He added that the most important factor for the successful implementation of these programmes is education. "We need effective education to create awareness about the proper use of medicines. Also, information on their rational use need to be provided at the school level for the citizens of tomorrow," he stated.

Healthcare professionals need to be sensitised to the issues of patients' non-compliance and possible lack of understanding on the patients' part on how to become more effective in communication.

He also urged for healthcare professionals to spend more time with patients for the proper use of prescribed medications, their possible adverse events and the perils of discontinuing courses of treatments against doctors' advice. -- Courtesy of Borneo Bulletin