The prescribing and dispensing of medicines were irrational. Although copies of the EDL were not available in most health facilities, compliance to the drugs list was almost total showing an EDL that contains both essential and non-essential medicines. STGs were also lacking in most of the facilities surveyed. Therefore, the following are recommended to improve the rational use of medicines:

• Rationalisation of the EDL to include only essential medicines and not a list of most drugs available in the country

• Proper distribution of copies of the EDL to all levels of the health care delivery system to guide selection of drugs.

• The development and wide dissemination of standard treatment guidelines to improve the use of medicines at all levels of health care

• Institutionalisation of training on rational use of medicines for sustained impact.

• Public education on rational use of medicines with special emphasis on reduction in injection and antibiotic use.

• Establishment of drug information centres, and drugs and therapeutic committees in secondary health facilities

• Development and wide dissemination of guidelines for use of antimicrobials

• Training of drug sellers in rational use of medicines for treatment of some common priority diseases (malaria, diarrhoea) to improve service delivery

• For sustainability, ensuring the inclusion of rational use of drugs in the curriculum of all health professionals and strengthening the capacity of trainers to provide both pre and post service training.