In many countries, people treat three quarters of all illnesses by using medicines without first seeing a health worker. This is called ‘self-medication’. They may obtain medicines from their home, friends or relatives, a market stall, local shop, traditional healer or a pharmacy. Though some of these sources may provide good quality and appropriate medicines, others may supply inappropriate and potentially dangerous medicines.
If medicines are obtained from unsupervised sources they may be…
Dangerous Medicines can harm people if they are used incorrectly.
Inappropriate The medicines may not be able to help their condition, or they may be unsuitable because of the age or medical condition of the person.
Incorrect quantity People may buy too much or too little.
Poor quality The medicines may have been manufactured incorrectly, stored in poor conditions or may even be ‘counterfeit’ medicines – containing no genuine ingredients at all.
Unnecessary People may waste money on unnecessary medicines such as cough medicines and tonics which are of little or no benefit.
Banned Medicines which have severe side effects may be banned but can sometimes still be found in shops and markets.
Lacking information Medicines may be sold without the appropriate information, advice or warnings.
What are the community’s beliefs?
Before trying to improve the use of medicines, it is very important to understand what people in the community believe about them. For example, it would be useful to understand why people buy medicines from the market or local shop instead of from the clinic. They may give the following reasons:
Easier The local shop is nearer than the clinic and you do not have to queue. The clinic is also only open in the morning when most people are working.
Cost People cannot afford to pay for doctor’s fees so they decide themselves what is wrong and which medicines they need. Medicines are often cheaper at the local shop and shop keepers may give credit.
Attitude People may find the staff at the clinic do not really listen to their problems or are rude. They may prefer the attitude of the shop keeper.
Acceptability The clinic only provides generic medicines in unattractive packaging which people may not like. People may also request antibiotics as capsules or injections simply because they believe they will work better. However, while antibiotics have no effect on colds or viruses, injections with unsterile needles may lead to infections. Shopkeepers may also just sell enough antibiotics for a couple of days, instead of a whole course. If the person does not buy more drugs to complete the course, they may not be cured properly and the infection may start to develop resistance to the drugs.
"Always take a full course of antibiotics, don’t help to build drug resistance!"
Improving medicine use in the community
Once you have a greater understanding of the community’s views about medicines, you can begin to plan to improve their use. Some ideas might include:
Working with local drug sellers Local drug sellers need to sell medicines to make money. Since it will be difficult to persuade them not to sell medicines, try and help them recommend the most appropriate medicines. This may take a long time.
Improving the service at health facilities See if opening times can be changed to make it easier for people to come – maybe in the early evening. Encourage staff to be understanding and communicate well with patients. Consider improving the packaging of the medicines.
Increasing public awareness about medicine use Choose several key messages (for example: ‘Keep medicines away from children’, ‘Why injections are dangerous’ or ‘When to use antibiotics’) and use a variety of ways to share the information. This could include posters, radio programmes, leaflets, role plays, school projects or competitions to design a T-shirt or postage stamp.
Governments can set up regulations about medicine advertising, medicine quality and who can sell medicines. However, if these regulations are not enforced they may be of little use.
This article was adapted from Issue 12 of Practical Pharmacy. This is a free newsletter available to health workers and pharmacists. Editor: Georgina Stock, 66 Chiltern Rd, Baldock, Herts, SG7 6LS, UK. E-mail: [email protected]