title: Effectiveness of pharmacy interventions in improving availability of essential medicines at the primary healthcare level.
abstract: OBJECTIVE
  To assess the effectiveness of pharmaceutical systems interventions in improving the availability of essential medicines at the primary care level.
  
  
  METHODS
  Literature search for examples of pharmaceutical systems interventions in low and middle income countries that evaluated the impact of specific interventions on medicines' availability. Qualitative and quantitative studies were included.
  
  
  RESULTS
  Seventeen studies were included, on privatisation of drug distribution, user-fees, revolving drug funds (RDFs), supervisory visitation programmes, staff training initiatives, community-directed interventions (CDIs) and disease-specific drug programmes. We found no studies on non-monetary staff incentives or the use of national pharmacy standards. Generally, the quantity and quality of evidence was low; evidence was strongest for supervisory visitation programmes and CDIs.
  
  
  CONCLUSIONS
  Several interventions have the potential for improving medicines' availability without requiring large-scale international cooperation or global policy change. The absence of evidence in this field does not prove lack of effect. There is a need for more systematic studies of multi-faceted pharmaceutical interventions to improve drug availability in the context of difficult health systems, such as structured supervision of remote health facilities, CDIs, staff training, integration of disease-specific programmes, implementation of national pharmacy standards, non-monetary staff incentives and measures to ensure cost is not a barrier to access. A standardised approach to measuring the availability of essential medicines is needed.
authors.affiliation: Centre for International Child Health, Department of Paediatrics, University of Melbourne, Parkville, Vict., Australia. michael.nunan@rch.org.au
authors.forename: Michael
authors.initials: M
authors.lastname: Nunan
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
mesh_terms: D003906:Developing Countries; D018954:Drugs, Essential / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D010593:Pharmaceutical Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D017150:Public Sector
chemical_list: D018954:Drugs, Essential