Tracking progress in rational medicine use-an assessment of key indicators between 2012 and 2021 in Dodoma region.
- Mwanza, Tanzania: Tanzania Journal of Health Research & Catholic University of Health and Allied Sciences [CUHAS – Bugando] 022/8/2
- Tanzania Journal of Health Research Volume 23 .
Abstract:
Background: Health care systems cannot operate without medicines. Stock-outs of medicines in Tanzania are common and efforts focus on strengthening supply chain and availability of medicines at point of care. However, appropriate use of medicines will ultimately determine quality of health care. Irrational prescription of medicines is harmful to patients and leads to waste of limited resources. Objective: This study tracked medicines use over time.
Methods: A cross-sectional baseline study was conducted in 6 districts of Dodoma Region Tanzania in 2012 using WHO methodology. A repeat study in 2021 using the same WHO questionnaires included a random sample of 132 health care facilities. Data collected was analysed using STATA version 13.0.
Results: The number of prescribed medicines per patient encounter slightly increased from 1.9 in 2012 to 2.2 in 2021, while prescription conforming to the National Essential Medicine List (NEDLIT) declined from 98% to 91.2%. Generic prescription decreased from 97% to 63.9%, p-value <0.001. Antibiotic prescription increased from 66.0% to 80.9%, p-value <0.001. Injection use increased from 9.0% to 14.1%, p-value <0.001. Average consultation and dispensing time increased. Correct labelling of prescriptions remained unacceptably low at 2.2%. Patient knowledge about prescribed medicines decreased from 49.0% to 21.3% (p-value<0.001). Availability of reference material increased for STG/NEDLIT. Access time to health care facilities by patients decreased.
Conclusion: The study showed improvement in availability of STG/NEDLIT, better accessibility to health facilities and patient care with longer provider-patient interactions. However, prescribing, and dispensing practice declined significantly for antibiotics and injections, generic prescribing, labelling of medicines and patient information. Findings show a disappointing trend of medicines use. Results should guide specific responsive actions at all levels. Quality of care cannot be improved unless limited resources are used more responsibly.