National Approach to the Rational Use of Medicines

The Omani Experience

Ph. Batool Jaffer SuleimanDirector, Rational Use of Medicines

MoH, Sultanate of Oman

ICIUM Conference 2011, Antalya, Turkey

15 November 2011

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Steps in Establishing DRUM

Concern about misuse of medicines at all levels In 1996 a WHO Consultancy recommended that a

team be established in MoH to monitor use of medicines.

Minister of Health gave his full support A Ministerial Decree in April 2000 established an

independent Directorate of Rational Drug Use (DRDU) reporting directly to the Under-Secretary of Health Affairs

(in 2006 DRDU was renamed to DRUM)

Ministry of Health

HE The Minister

Undersecretary for Health Affairs

DGPA&DC DRUM DGMS

Undersecretary for Administrative & Financial Affairs

Undersecretary for Planning Affairs

Partial organogram to show pharmaceutical sector of MOH including DRUM and the reporting relationships

Pharmaceutical Sector

3 Core Functions of DRUMTraining, Research & Publications. Examples

• Induction courses & workshops for all cadres of health professional

• Public Education Campaigns• Initial baseline studies• Intervention studies• Specific problem monitoring• Clinical audits• Oman National Formulary & Therapeutic

Guidelines5

6Working Interrelationships

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Prescribers (prior to 2000)

81% were expatriates Variety of backgrounds and training No GPs were trained in RUM No induction examination for GPs

Often face problems with local patients: Language Attitudes and beliefs

4.5 average no. of drugs/prescription and 60% prescriptions contained an antibiotic

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Pharmacists & Assistant Pharmacists

72% & 49% were expatriates in 2000

There were no clear job descriptions

Under-utilised resource

Weak on management skills

No clinical pharmacists before 2000• Now 4 pharmacists/year are sent for training• Target was to have 1 CP / 50 beds by the end of health

plan (2006 – 2010)

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Public

Free medication, high demand & irrational use

Different levels of literacy Strong traditional beliefs No robust registration system at health

facility level

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Major Successes of National Approach on RUM

RUM now part of 5 year health plans

34% of pharmacists & 37% of asst. pharmacists are expatriate (2010)

Reduction in average no. of drugs/prescription to 2.9-1.8 (2010)

32% of public sector GPs trained in RUM (2010)

Prescriptions contained Antibiotic came down to 37%-15% (2010)

Publication of Oman National Formulary 2003 and 2009 Publication of Oman Nurses Formulary (2008)

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Major Successes cont’d

Handbook of pharmacotherapy guideline charts for common illnesses in PHC (2004: revised & reprinted 2011)

New guidelines issued for NSAIDs Deletion of unsuitable medicines Changes to the curriculum in pharmacy

training Specific job descriptions Networking & collaborating with university,

colleges, private sector, other institutions Bi-annual newsletter “Pharmaco Logical” on

Rational Use of Medicines

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Major Successes cont’d

Now every new GP has to be examined at the time of recruitment on RUM (written & oral).

Financial analysis of PHC facilities

Gradually increasing awareness and acceptance of DRUM role

Establishing of an internet newsgroup for all RUM issues

http://health.group.yahoo.com/group/rduoman

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Lessons learnt

Political will and support Mainstreaming RUM in health system:

Dedicated department and national approach

Multiple interventions To be seen as support rather than policing

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