Establishment of a Directorate of Rational Drug Use in Oman

1. Establishment of a Directorate of Rational Drug Use in Oman by Dr Brian C Gunn Senior Clinical Pharmacist Advisor

2. Background • Lack of locally trained health personnel • Recruitment mainly from Middle East and Asian sub-continent • Variety of backgrounds and experiences • Dramatically rising expenditure on medicines • Almost doubled in one year alone • Free services leading to high public demand and expectations • Rapidly expanding and developing health services • Lack of control over prescribing and dispensing in the private sector • General lack of human resources

3. Recruitment of Key Personnel • Director – Pharmacist • Clinical pharmacology background • Primary Care Physician • Research experience in RDU - had conducted patient KAP study in Muscat governorate • Senior Clinical Pharmacist • RDU experience in different countries, clinical and academic experience, high computer literacy • Senior Clinical Pharmacologist • Academic and industrial experience • Auditor All have teaching experience

5. Main Functions • Research & assessment • Qualitative and quantitative • Training • Monitoring and supervision • Recommendation of policy and encouragement of good practice in all sectors

6. Plan of Operations • Terms of reference • Standard operating procedures • Baseline studies • Induction workshops and training seminars for all cadres • Research and audit • Interventions • Where appropriate

8. Prescribers • Many are expatriates • Variety of backgrounds and training • Bring own country experiences to Oman • Often face problems with local patients • Sometimes lack of support from administration

9. Pharmacists & Assistant Pharmacists • Many are expatriates • No clear job descriptions • Tend to be mainly involved with administration and supply • Under-utilised resource • Training strong on science but relatively weak on management skills • Clinical skills just being developed

10. “Together we realise rational drug use” “Together we realise rational antibiotic use” Logos

11. Oman Health Situation • Rapidly evolving health system (started 1970) • Political will to achieve excellent health care system • Many positive changes in short period • Excellent infrastructure • Strong commitment to use of IT • Most PHC units are now computerised

12. Public • Free medication often leads to high demand and abuse • Locals have much leverage over expatriate health workers • Wide variety of education and literacy • Strong traditional beliefs and expectations about health and medication in general • Lack of health-system controls • Large and under-regulated private sector

13. Major Successes • Training Programmes in RDU for all cadres • National Reduction in Antibiotic Consumption • Publication of ONF and Pharmacotherapy Charts 2003 & 2004 • New guidelines issued for NSAIDs and Atypical Antipsychotics • Dedicated workshops on rational antibiotic use • Networking with university, private sector, other institutions

14. Major Successes [Cont.] • Establishment of induction examinations for all new MOGPs • Financial analysis of PHC facilities • Training of key pharmacists in field research and drug management • Gradually increasing awareness and acceptance of DRDU role People are now “talking the talk” and “walking the walk “ of rational drug use

15. Spin Offs • Some health regions now conducting own PRDU workshops • Almost all regions doing RDU research • Many interventions ongoing or have already been carried out

16. Constraints • Lack of human resources and difficulty in recruitment [big job – small team] • Tendency to spread ourselves too thin • Rapidly changing priorities • Getting the information we need at the time we need it and in a convenient form • Dependency on a number of different directorates, departments and levels of administration

17. Constraints (cont’d) • Lack of robust measures to prove successful outcomes • Public education has been slow to get started • At start up only one member of the team had been on an international RDU training course

18. Summary, Conclusions & Recommendations • Not burdened with many duties outside of rational drug use • Freedom to plan operations • Report directly to policy making level • Need to be persuasive & non-confrontational • DRDU acts as a “Rapid Response Unit” • Avoid an “FBI” or “drug policeman” approach • Avoid being “fire-fighters”

19. “A program of rational use requires a permanent multidisciplinary approach and a network of functional epidemiologic monitoring” Dr Luis Bavestrello F. Chile

20. Thank You