Healthy Skepticism Library item: 18763
Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.
Publication type: Report
The expectations, the reality and the burden of drug donations.
Burnet Instiute 2010
http://www.burnet.edu.au/home/cih/resources/reports
Full text:
A very comprehensive study of the profile of donated medicines to
determine appropriateness and compliance with all aspects of the WHO
guidelines for donations has been prepared by Dr BVSH Benaragama and
Prof. Rohini Fernandopoulle in collaboration with the University of
Colombo Faculty of Medicine and the Medical Supplies Division, Ministry
of Health, Sri Lanka.
The manuscript was prepared by Dr Rohini Fernandopoulle.
The study shows that a majority of the donations (» 80%) were
unsolicited, came unannounced and in unsorted boxes. Around 50% of the
donations were non-discriminatory collections of unused drugs of private
individuals collected at various centres and transported via
international relief organizations. These donations were a mixture of
many different brands mixed with other relief items.
Forty three percent of products belonged to the “non list” category (not
listed in the MOH list, WHO — ML, HFL, WHO Emergency Medicines List)
and 38% of the drug substances were never registered for use in the
country and therefore could be considered totally irrelevant useless and
sometimes dangerous. Twenty eight metric tons (50.5% of the total
donations) did not have expiry dates. Among those with the expiry date
6.5% had expired on arrival and only 67% complied with WHO guideline
requirement that after arrival in the recipient country all donated
drugs should have a remaining shelf life of at least one year. A large
proportion of non essential drugs were irrelevant to the emergency
situation. Sixty two percent of the pharmaceutical products were
labelled in languages not understood locally, 81% were without package
inserts and 15% were without generic names. Stockpiling of unnecessary
or expired drugs cluttered up storage depots, resulting in shortages of
space for proper storage of essential medicines.
On the other hand medicines purchased by local residents and
organisations after consulting the Director MSD and over 90% of the
donations that were sent directly by Governments were on the MOH
expressed list, had the required shelf life of over 1 year and were 100%
utilized. The monetary value of one donation as claimed by the donor was
equivalent to approximately 50% of the public health drug budget of Sri
Lanka. However, all the tsunami donations reduced the total drug budget
for the year 2005 by only 4%. The cost of destruction of some of the
unwanted medicines was approximately SLR 2.5 million (1USD = SLR 102).
Many agencies/ individuals sought undue fanfare and publicity when
handing over donations.
The great expectations of the Government of Sri Lanka were that the
country would benefit both financially and materially from the
donations. However, the results of the study show the donations were
more a burden than of benefit to the country. The study also highlights
that although guidelines on “Good Donation Practices” (Christian Medical
Commission, WHO and some country specific guidelines) have been in place
and regularly updated on the available evidence since 1988 they have had
very little impact to date on the quality of pharmaceutical donations in
times of an acute emergency. This study has identified gaps in the
process and proposed recommendations to reduce the negative and
unintended consequences of drug donations in the future.
It is strongly recommended that the dumping practices of unwanted unused
medicines, expired drugs and radioactive products be strictly prohibited
and the all donor countries consider adapting the legal framework in the
European Union, which prohibits the collection and export of drugs that
have been issued to patients and returned to pharmacies.
