Healthy Skepticism Library item: 19901

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Publication type: Journal Article

Bonati M, Forte GB, de Joncheere K, Magnusson E
Drug donations to Bosnia-Hercegovina are often inappropriate
BMJ 1996 Oct 19; 313:(7063):1011

Abstract:

EDITOR,-The programme for pharmaceuticals of
the World Health Organisation’s Regional Office
for Europe recently carried out a situation analysis
of the pharmaceuticals in Bosnia-Hercegovina.
One striking finding was the large amount of
unused drugs that originated from donations. This
finding is not exclusive to Bosnia-Hercegovina, and
urgent action is needed to prevent such situations
in countries in transition.
donations to
Bosnia-Hercegovina are
often inappropriate
EDITOR,-The programme for pharmaceuticals of
the World Health Organisation’s Regional Office
for Europe recently carried out a situation analysis
of the pharmaceuticals in Bosnia-Hercegovina.
One striking finding was the large amount of
unused drugs that originated from donations. This
finding is not exclusive to Bosnia-Hercegovina, and
urgent action is needed to prevent such situations
in countries in transition.
In Bosnia-Hercegovina 70-80% of drugs were
reported to have been provided by humanitarian
organisations, charities, and groups of people.
The widespread belief was that drugs are the
main means of curing illness and that any drug is
better than nothing. Drugs for primary health
care, such as some antibiotics (penicillins), analgesics,
and antipyretics, have been-and still are
being-supplied in large quantities, which has
led to oversupply. Meanwhile, critical and long
term shortages of cytotoxic agents, psychotropic
drugs, and other antibiotics (cephalosporins and
macrolides) have occurred, although these drugs
are included in the national essential drug lists.
An absolute lack of drugs in the form of syrup,
drops, and ointment has also been reported.
In a number of cases, donated drugs were distributed
inadequately. Thousands of salbutamol
suppositories were stockpiled in Banja Luka;
about 50 000 bottles of 500 ml of amino acid
infusion approaching its expiry date were
donated to Kosevo Hospital in Sarajevo; and
large amounts of antimalarials were kept in the
hospital in Bihac.
Because of the lack of dental cement during
the war, teeth were extracted instead of being
filled. Thus the large boxes of dental floss that
were supplied remained unused: about 25 000
rolls were counted in the central medical
warehouse in Sarajevo.
There is an estimated 250 tonnes of unused
drugs in the Mostar area and 25 tonnes in Banja
Luka, while the local authorities report an additional
20 tonnes in Bihac and 100 tonnes in
Sarajevo. Incinerating these would be costly. The
WHO helps the authorities to find an appropriate
way of disposing of the unused drugs.
There are several ways of improving the quality
and appropriateness of drug donations and
access to medicines for the patients. These
include strengthening needs assessments and the
coordination among humanitarian agencies and
the receiving country; managing the drugs
supplied more efficiently; and developing and
enforcing regulations based on the interagency
guidelines for drug donations published by the
WHO.
MAURIZIO BONATI
Head
Laboratory for Mother and Child Health,
Istituto di Ricerche Farmacologiche Mario Negri,
20157 Milan,
Italy
GILLES B FORTE
Adviser
KEES DE JONCHEERE
Regional adviser for pharmaceuticals
Programme for Pharmaceuticals,
World Health Organisation,
Regional Office for Europe,
DK-2100 Copenhagen,
Denmark
EINAR MAGNUSSON
Director
Pharmaceutical Affairs,
Ministry of Health and Social Security,
IS-150 Reykjavik,
Iceland