Access to drugs

• Investigate the reasons for the variations in availability in public health facilities - especially the minority of facilities that had less than 50% availability
• Investigate the reasons for the large variations in stock out duration in public health facilities - especially the almost one third with a stock out duration of greater than 3 months

Quality of drugs

• Identify storage deficiencies and design interventions for implementation to address these poor or not adequate storage conditions in public health facilities
• The Ministry of Health should strengthen mechanisms to ensure that no expired drugs are found on the shelves in both the public and private sectors

Rational drug use

• Investigate and develop interventions as to why 1 in 6 facilities can prescribe an average of less than 3 drugs per prescription and why 1 in 6 facilities need to prescribe an average of more than 3 drugs per prescription
• Investigate and develop interventions on the wide variations found in the use of antibiotics - especially why more than 1 in 5 facilities (21%) are prescribing antibiotics to more than half of the patients
• Identify, develop and continue implementing interventions to further decrease the number of patients receiving antibiotics
• Investigate and develop interventions on the wide variations found in the use of injections - especially why more than 1 in 10 facilities (10.5%) to greater than 70% of patients receive an injection, whereas in 1 in 5 facilities (21.1%) less than 20% of the patients receive an injection
• Identify, develop and continue implementing interventions to further decrease the number of patients receiving injections
• investigate and develop interventions as to why a minority of facilities are not prescribing consistently according to the EDL
• Develop, disseminate and enforce clear guidelines and training on the importance of labelling for dispensed drugs. This should include consumer-targeted and community-based information, education and communication campaigns
• Develop, disseminate and enforce clear guidelines and training on the importance of ensuring that patients know how to take their drugs correctly.
• These initiatives should include consumer-targeted and community-based information, education and communication campaigns.
• Investigate and develop interventions for the treatment of diarrhoea in children <5 years: why are 50% of children receiving antibiotics and why are 20% of children not receiving ORS?
• Investigate and develop interventions why more than one antibiotic is being prescribed fro mild/moderate pneumonia in 33% of cases
• Investigate and develop interventions to address the very poor adherence to the standard treatment guideline for ARI