The reported advice of the Union health ministry to the State governments to initiate the process of establishing Medicine and Therapeutics Committee (MTC) is a welcome step. The medicines are integral part of the healthcare. The modern healthcare is unthinkable without the availability of essential and quality medicines within the health facilities. There has been disturbing reports: 3.2 per cent of Indian falls below the poverty line every year due to high medical bills. 70 per cent of the Indian spend their out of pocket expenditure on healthcare and purchasing medicines. This is all due to non-availability of adequate quantity of essential and quality medicines in public health facilities forcing public to seek healthcare in private sectors. Irrational use of medicines along with non availability compounds the medicine related issues that leads to economic crisis on the individual. The World Health Organization (WHO) has been advocating the establishment of effective Medicine and Therapeutics Committee in hospitals to redress the medicine related issues to promote rational use of medicines and optimize the use of resources.
In India, on an average around 10 per cent of the hospital budget is spent on medicines. Most of this money is wasted on irrational medicines. The poor selection of medicines (without considering relative efficacy and cost effectiveness), inefficient procurement practices, not prescribing according standard clinical guidelines, poor dispensing practices resulting in medication errors and poor compliance to the medications by the patients are few of many medicines related issues. Some of these issues occur from lack of an effective forum that brings together healthcare professionals such as clinicians and pharmacists in one hand and hospital administrators on the other to balance the demand for quality care with financial constraints. MTCs are a forum to bring together all stakeholders in taking decisions about medicine use.
The MTC is a multidisciplinary body and usually consists of members to represent all stakeholders, including the major clinical departments, the administration and the pharmacy. A committed and dedicated chairperson and secretary are important for effective functioning of MTC. A respected senior medical officer is an ideal choice as chairperson and the chief pharmacist as secretary. The qualification of pharmacist is often an issue but with availability of new generation pharmacists qualified with doctor of pharmacy would be very helpful for hospitals. The persons identified for the membership in MTC should not have conflict of interest. They should not be influenced by inappropriate medicine advertisements, promotional activities or personal financial interest. The declaration of interest by the members would increase its credibility. Adequate financial and administrative supports are essential for effective functioning. The hospital authorities or the governments need to specify the terms of reference of MTC with clarity on its goal, objectives, scope of authority, functions and responsibilities.
The MTC may be entrusted with many responsibilities. But the priority areas include developing and implementing an efficient and cost effective formulary system; ensuring the use of only efficacious, safe, cost effective and good quality medicines; ensuring the best possible medicine safety monitoring programmes; and developing and implementing interventions to improve medicine use by prescribers, dispensers and the patients. The development of standard treatment protocols and essential medicines list is normally the first priority. Safety monitoring programmes include monitoring, evaluating and preventing adverse drug reactions and medication errors. Investigating the medicine use pattern and conducting medicine utilization review and subsequent feedback help the system promoting appropriate use of medicines.
MTC for hospital
It may be easy to constitute an MTC for hospital, in practice it is difficult to develop and implement strategies to change medicine use practices. The staff need to be encouraged with recognition, at least senior clinicians need to be made part of the system identifying medicine use related issues like prescribing too many medicines, over use of antibiotics or injections., medication errors and adverse drug reactions, frequent stock outs, poor quality of medicines etc.. Once the senior clinicians are made part of identifying the issues, they would be under obligation to redress them. Convincing data on irrational use of medicines negatively affecting patient outcome and increase hospital’s medicine budget would help them accepting improved use of medicines could lead to improved patient outcomes and/or decreased medicines’ budget.
A country with more than 5000 pharmaceutical companies, known as pharmacy of the third world, has the problem of non-availability of adequate quantity of essential medicines for its public health facilities. Indian pharma is ranked at 14th largest in the world in terms of sales value and 3rd by volume. It exports medicines to more than 200 countries including USA, UK, Canada, EU. Despite of all these achievements, the Indian population does not have adequate access to essential medicines.
With limited resources a large number of patients are to be served in government health facilities. In fact, though the state governments have decreased the medicines’ budget over the years, there is no dearth of fund as sufficient fund is made available through NRHM. It is essential to promote appropriate use of drugs (rational drug use) within the hospital to optimize drug use. In order to develop and monitor policy on medicine use within the hospital, the constitution of Medicine and Therapeutics Committee is advocated. This is also known as Drugs and Therapeutics Committee or, Pharmacy and Therapeutics Committee. Though it has been the practice to have such committees in developed countries and found to be effective as well in safeguarding and promoting efficient and rational use of medicines, it is a new concept for India. The Delhi Society for Promotion of Rational Use of Drugs (DSPRUD) in association with WHO has been conducting MTC course for last few years in an attempt to develop expertise who can serve as member in such committees. The Government of India must show the path to the states by establishing such effective committees in Central government run hospitals. The evidence of benefits of such MTCs would encourage the state governments establishing MTCs promoting public health.
(The authors are with Department of Pharmacy Practice, Annamalai University, Annamalai Nagar, Tamil Nadu 608 002)