To guide the use of medicines, there are standard treatment guidelines known as Standing Orders which are applicable at the PHC level only. There is also a National Drug Formulary published in 1994. Plans are underway to update the formulary and develop standard treatment guidelines for all levels of the health care system.
The concept of rational use of medicines forms part of the basic training curricula of medical and pharmacy schools and both have mandatory continuing education, which includes rational use of medicines.
Some universities, non-governmental organizations (NGOs), secondary and tertiary health facilities have developed drug information centres for the provision of drug information mainly to health professions. These centres use basic textbooks to provide drug information and some publish drug bulletins. NAFDAC provides drug information to consumers. The main challenge is the sustainability of these services and capacity to provide accurate and current information to clients.
Although there is a high level of self-medication and uncontrolled sale and use of medicines, especially antibiotics and injections, there has been little or no public education on rational use of medicines.
The practice is that nurses or community health workers prescribe and dispense drugs in most primary health care facilities; but drug prescribing in secondary and tertiary health facilities is the exclusive preserve of doctors.
In the 60s, due to the inadequate number of pharmacists, Patent and Proprietary Medicine Vendor’s Licenses (PPMVL) were issued to designated categories of persons which authorised such persons to sell mainly over-the- counter drugs. Generally, there has been an improvement in access to medicines in rural areas due to the large number of medicine sellers; unfortunately, a large proportion of these are not licensed vendors. Worse still, they have gone beyond their mandate by stocking and selling prescription and controlled medicines.
Although prescription drugs, which include antibiotics and injections, are not to be sold over-the-counter, they are freely available in the informal private sector (from drug hawkers, vendors and stores). Thus, the challenge is to ensure a rational distribution of medicines.