Experience with drug donations in India
"Yes" to help. "No" to waste
Von Norbert Rehlis
More and more people are travelling in developing countries, they often visit health facilities and meet people engaged in health and development projects. The result of such an experience is often a generous desire to help, and after returning home they send parcels with so-called humanitarian aid . This is not always as useful as the donors hope - as shown by the experience with drug donations sent to India described in this article.
Trying to respond to the difficult situation of underprivileged communities, where lack of basic medicines is a problem, donors often do not ask the beneficiary what is really needed. They simply embark on activities, and continue them without any critical attitude. When they are confronted with the fact that the rationale of their help is not altogether sound, some donors argue that the material value of aid is not really so important. But this is only half of the truth. Any help costs something, and the available resources should be used in the most cost-effective way.
On a visit to health facilities in India I had the opportunity to observe that inappropriate help creates problems. First of all, I noticed a lack of priority drugs, while at the same time there were large stores of other medicines. Most of the drugs (even those from the latest transport) had already passed their expiry date. I even found packets of medicaments that had lost their validity 15 years ago! Of some antibiotics only a few tablets had been sent, there was not even enough for one single full course of treatment. Among supplies of antihelminthics, I discovered with horror drugs against parasites for dogs. To add to this story, I found a number of unknown drugs impossible to identify, due to missing generic names, with no instructions in a language that could be understood by the local medical staff.
Guidelines on Drug Donations required
Experiences like this emphasise the importance of guidelines giving basic rules for drug supplies. In order to help both donors and recipients improving the benefit of drug donations, the World Health Organisation WHO published in 1996 together with international relief agencies such as ICRC, CMC and MSF, the "Guidelines on Drug Donations". They serve organisations and governments of "donor" and "recipient" countries dealing with drug donations to produce their own guidelines.
As an alternative to sending parcels of medicines, would-be donors should consider making a financial contribution. It is possible that the drug could be bought on the spot. Buying locally is much better, because it helps to promote the local pharmaceutical industry, development and sustainability, and eliminates high transport costs. In cases where the drugs are locally not available, it may be possible to channel aid through a larger professional drug supplying agency, which can reduce the costs.
According to WHO application of cost-effectiveness criteria, of quantification as a basis for ordering and the use of generic products can save up to 90 percent of all project costs. Therefore appropriate guidelines should be widely distributed to be available for everyone. Because it is difficult to reach individual donors, the best solution is to distribute the guidelines to the staff of health facilities and missionary centres, who pass them on to their donors to inform them about the rules for sending donations.
Beneficiaries must know their priority drugs and in what quantity they are needed. Therefore the average use of a certain drug per 1000 patients should be known, which requires collecting data on drug use. This "adjusted consumption" method is often sufficient. To summarise: if humanitarian aid is to produce good results, donors and beneficiaries should be partners and should cooperate very closely.
The wide distribution of guidelines for donors and recipients of donations should be a priority for health and development organizations. Especially in post-communist European countries, which are slowly improving their economies, now starting to help others, there is very little experience available in this field. To share experience can avoid repeating old mistakes and allows a better use of the existing resources.
Norbert Rehlis, MD, Humanitarian Aid Foundation Redemptoris Missio (Medicus Mundi Poland)