Quality of essential medicines in public health care facilities of Nepal - 2019.

Research Report.

SUMMARY: Introduction: Essential medicines are widely being consumed in various illnesses in health facilities of Nepal. Poor quality of essential medicines can have serious impact on public health. The quality of essential medicines available in health facilities of Nepal have been questioned several times. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. Methods: A cross sectional descriptive study was carried out in 21 districts representing all seven provinces. Altogether 62 health facilities including District/Zonal/Regional hospital, Primary Health Care Center and Health Post was included in this study. Districts were selected proportionately from all three ecological belts i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. Humidity, temperature record and other storage conditions information i.e. protection from sunlight, humidity, heat, maintenance of cleanliness and ventilation were recorded through observation. To collect medicine samples, sample list of 20 molecules was prepared such that the sample list includes all the major therapeutic category medicines which were mostly prescribe and used in various illnesses. Altogether 244 batches of 20 different generic medicines were collected and sent to laboratory for testing. Result: Out of 244 batches of 20 different generics of essential medicines, 37 batches failed to meet the required pharmacopeial standards which constitute 23 (62.16%) batches of medicines supplied by Government of Nepal and 14(37.83%) batches purchased from local resources. The generic name of failed medicines include Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet 50 mg, Metronidazole Tablets 400 mg, Paracetamol Oral suspension 60 ml, Paracetamol tablet 500 mg and Povidone Iodine solution. Among identified list of substandard medicines, the batches of Metronidazole tablets 400 mg and Povidone-Iodine solution were in highest number while paracetamol tablets constituted least number of batches. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines regarding sunlight protection, humidity protection, heat protection and maintenance of ventilation. Maximum temperature and humidity record was found to be 37°C and 86% respectively. Conclusion: High number of essential medicines (Thirty seven batches of seven different generics of essential medicines) available in health facilities was found substandard. The recommended medicine storage guidelines for protection of sunlight, humidity, heat and maintenance of ventilation along with recommended temperature and humidity were found to be followed by few health facilities and seemed to be highly ignored in Nepal. As majority of identified sub-standard medicines were purchased by Government of Nepal, there is dire need to take necessary steps towards ensuring quality of essential medicines that are supplied to health facilities of Nepal.