(OWTOIMPROVETHEUSEOF - WHO

1 I(OW TO IMPROVE THE USE OF MEDICINES BY CONSUMERSA ndrew ChetleyHealthlink WorldwideAnita HardonUniversity of AmsterdamCatherine HodgkinRoyal Tropical Institute, the NetherlandsAne HaalandCommunications specialistDaphne FresleSpecialist in public healthWHO/PSM/ World Health Organization 2007 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.)))

2 Dotted lines on maps represent approximate border lines for which there may not yet be full mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its named authors alone are responsible for the views expressed in this editor: Ane Haaland Cover illustration by Victoria FrancisDesigned by minimum graphicsPrinted in SwitzerlandThis document has been produced with the financial assistance of the European Community.

3 The views expressed herein are those of the authors and and can therefore in no way be taken to reflect the official opinion of the European #ONTENTSA cknowledgements vAbbreviations viCredits for graphics viiSection 1. Introduction1 Chapter 1. How communication works9 Section 2. Communication methods23 Chapter 2. Face-to-face communication34 Chapter 3. Drama and other folk media53 Chapter 4. Developing effective print materials67 Chapter 5. Mass media86 Section 3. Strategies for developing an enabling environment105 Chapter 6. Working with journalists115 Chapter 7. Advocacy and networking 127 Chapter 8. Managerial and regulatory strategies144 Section 4. Bringing it all together157 Chapter 9. Planning the process161 Chapter 10. Pretesting174 Chapter 11. Monitoring and evaluation192 Chapter 12. Conclusions213 Annexes 223 Annex 1. Bibliography225 Annex 2. Useful links234 Annex 3. Boxes, tables and figures243#/.

4 4%.43v!#+./7,%$'%-%.43!CKNOWLEDGEMENTST hanks to Trudie Gerrits, University of Amsterdam, Ayyaz Kiani, TheNetwork, Pakistan, Benoit Marchand, Acci n Internacional por la Salud, Nicaragua, Richard Laing and Kath Hurst of the WHO Department of Medicines Policy and Standards who commented on the various drafts of this manual and helped to improve it. Thank s also to t he many par t ic ipant s and t ra iner s involved in t he inter nat ional Promoting Rational Drug Use in the Community (PRDUC) courses that have been held in Thailand, Uganda and South Africa and the national courses held in India and Nicaragua since 2000. This manual builds on course material developed dur-ing that time and the feedback from the courses.(/7 4/ )-02/6% 4(% 53% /& -%$)#).%3 "9 #/.35-%23vi!BBREVIATIONSAIDSA cquired immune deficiency syndromeANMA uxiliary nurse midwivesARVsAntiretroviralsBCCB ehaviour change communicationCBIACara Belajor Ibu Aktif (Mothers Active Learning Method), IndonesiaCHSC ommune health stationDOTD irectly observed treatment DOTSD irectly observed treatment short-courseDSPRUD Delhi Society for the Promotion of the Rational Use of Drugs (India)

5 EEEntertainment-educationEHCNE uropean Health Communication NetworkFGDF ocus group discussionHAIH ealth Action InternationalHIVH uman inmmunodeficiency virusIDDI odine deficiency disorderIECI nformation, education and communicationIGDI nteractional group discussionIMCII ntegrated management of childhood illnessITNI nsecticide treated bednetMOHM inistry of HealthMSCMost significant change MSFM decins Sans Fronti resMTCTM other-to-child transmissionNGON ongovernmental organizationORSOral rehydration solutionORTOral rehydration therapyOTCOver-the-counterPATHP rogram for Appropriate Technology in Health (USA)PHTP ublic health technicianPM&EParticipatory monitoring and evaluationPRDUCP romoting rational drug use in the communityPSATCell phone prompted self administered therapySTGS tandard treatment guidelinesSSRIS elective serotonin re-uptake inhibitorsSTIsSexually transmitted infectionsTDRS pecial Programme for Research and Training in Tropical DiseasesUNDPU nited Nations Development ProgrammeVHWV illage health workerWHOW orld Health OrganizationYVSY outh variety showvii#REDITS FOR GRAPHICS#2%$)43 Haaland A, Molyneux C (2006).

6 Quality information in field research. WHO/TDR. Artist: Bosco Kahindi. Drawings on pages: 3, 10, 11, 12, 16, 17, 18, 27, 29, 32, 34, 48, 61, 62, 70, 81, 82, 102, 109, 116, 124, 128, 136, 141, 142, 146, 150, 160, 167, 177, 192, 195, 210, 213, 217, 219, 221. Uganda Essential Drugs Manual.* Pages: 3, 15, 22, 25, 37, 59, 75, 92, 94, 100, 199, A et al. (1999). Training community providers in better drug use for fever and cough. Community Drug Use Project, Makerere Institute of Social Research, Kampala, Uganda. Artist: Maureen Origumisiriza. Pages: 3, 16, 38, 46, 51, 84, 101, 130, 132, 133, 135, 147, 153, of Health. Operational research project on training shopkeepers to treat childhood fevers, Kilifi, Kenya (1996). Artist: Vicki Marsh. Pages: 4, 5, 10, 27, 42, 58, 80, 137, 175, 204, (unpublished). Visual perception studies, Kenya and Tanzania (1996). Pages: 16, 148, A with Oladele Akogun and Oladimeji Oladepo (2000).

7 Reporting with pictures. Concept paper for researchers and health policy decision makers. WHO/TDR. Artist: John A. Nwagboso. Pages: 9, 14, 18, 21, 27, 36, 39, 43, 59, 69, 71, 79, 80, 95 111, 159, 167, 181, 186, of Health, Temeke Municipal Hospital, Dar-es-Salaam and LHL (Asso-ciation for Heart and Lung Disease, Norway) (2006). Booklet series on TB com-munication. Artist: Mosses Luhanga. Pages: 14, 55, 92, 110, 112, 113, 119, 127, 134, 136, 154, 162, Bureau, USAID 1993. Communicating about health: A guide for facilita-tors.* Pages: 16, 197, 206, 212, 220. Drawn for this : Mosses Luhanga. Pages: 16, 59, 61, 65, 107, 108, 115, 117, 118, 119, 122, 125, 132, 135, 137, 147, 149, 156, 161, 170, 105, 201, 202, 203, 205, 213, 218, Lok Sujag photographs. Pages: 19, rational drug use in the community course training module on mass media communication (1998). Pages: 22, 87, 88, 89, 90, 91, 92, 99, 100, and Agriculture Organization (1996): Artists as experts.

8 * A participatory methodology to produce traditional and popular media. Pages: 53, 54, 55, 63, D, Bower B. (1982): Helping health workers learn.* Hesperian Founda-tion. Artists: David Werner, Pablo Chavez, Regina Faul-Jansen, Marie Ducruy. Pages: 57, 58, 63 67, 72, 73, 74, 75, 76, 77, 78, 79, 83, 94, 107, 118, 129, 133, 144, 164, 166, 168, 194, 196, 203, 205, 208.* Materials and illustrations in these manuals can be used free of charge for non-commercial purposes, when sources are acknowledged.(/7 4/ )-02/6% 4(% 53% /& -%$)#).%3 "9 #/.35-%23viiiHaaland A, UNICEF Burma (1982). Pretesting communication materials.* Artists: U Tin Win, U Aye Ko, Narendra Basnet, Ane Haaland. Pages: 60, 96, 164, 175, 176, 178, 179, 180, 181, 182, 183, 184, 185, 187, Primary health care series (1985). Introduction to training. Clean water and clean community.* Prevention and care of diarrhoea.* Artist: June : 68, (1995). Towards the healthy women counselling : June Mehra.

9 Page: 71. UNICEF and NDS, Nepal (1976). Communicating with pictures in Nepal.* Artists: Ane Haaland, Diana Fussell. Pages: 78, (1996): Health workers for change. A manual to improve quality of : June Mehra. Pages: 82, 93, 96, 98, 130, 140, 145, 146, 152, 164, 207, 213, 215, , Temeke Municipal Hospital, Dar-es-Salaam and LHL (Association for Heart and Lung Disease, Norway) (2006). Booklet series on TB communication. Artist: Maureen Origumisiriza. Page and UNDCP (1997). Women affected by substance abuse. Health work-ers can make a difference. Artist: June : 92, 94, , private photo. (Pretesting instructions for antimalarials with the Malaria Consortium, April 2006). Photographer: Ane Haaland. Pages 149, East Asia and Pacific Regional Office (1985). Programme communica-tion.* Pages: 163, A (2002). Report to WHO/TDR and Novartis Pharmaceuticals on pretest-ing instructions for Coartem instructions. Page: of Health (1996).

10 Operational research project on training shop-keepers to treat childhood fevers, Kilifi, Kenya. Artists: Maureen Origumisiriza, Vicki Marsh, Ane Haaland. Page: 204.* Materials and illustrations in these manuals can be used free of charge for non-commercial purposes, when sources are 1)NTRODUCTION33%#4)/. ).42/$5#4)/.%ssential medicines are one of the vital tools needed to improve and maintain health. However, for too many people throughout the world medicines are still unaffordable, unavailable, unsafe and improperly used. An estimated one third of the world s population lack regular access to essential drugs, with this figure rising to over half in the poorest parts of Africa and Asia. When avail-able, the medicines are often used incorrectly: around 50% of all medicines are prescribed, dispensed or sold inappropriately, while 50% of patients fail to take their medicines appropriately (WHO 2002a).Since the beginning of the 1980s the essential drugs concept has become one of the cornerstones of international and national health policy influencing decision-making in both developing and industrial-ized countries.