Your reply was very quick. This e-mail system is amazing. You ask about my
Zimbabwe experience. I worked for 18 years in the Ministry of Health at
every level except the Health Centre so I do know what you are talking
about. The system in Zimbabwe sounds very similar to what you describe in
I agree with you that doctors should be able to prescribe anything he is
experienced with. But doctors are taught to prescribe generically, medical
journals and textbooks use generic not brand names. The more different
things that a doctor may be called upon to do the more important it is to
make things consistent. If doctors come from different countries they may
know different brand names but should all know the same generic names.
Convincing your Ministry to allow certain trained prescribers to prescribe
drugs which are normally not prescribed in a district hospital is not an
arguement for brand name prescribing it is for increasing the list of drugs
that can be prescribed at district hospital level. Many countries have their
essential drug list levelled by primary, district, referral and specialist
The issue about the different colours of the same drugs with each years
tender is a real problem but it is one whether you have a generic or a
brandname policy unless the same company wins the tender for more than one year.
I agree with you about the problem of compliance for chronic medications. I
would be interested to hear how you managed strict enforcement of
compliance. I always found it very difficult for a condition such as
hypertension which is not symptomatic if the patient does not comply with
When worrying about ensuring drug availability all aspects of drug supply
have to be considered. Issues such as selection, procurement methods,
distribution systems, promoting rational use, ensuring quality assurance etc
etc are all important. Procuring generic drugs is clearly more cost
effective for drugs which are off patent. So that is why I support generics
in the public sector and I encourage the use of generics in the private sector.
I wonder what other people think of these issues.
School of Public Health
University of Boston
Note from the moderator: The topic is very important and interesting. But
could we broaden the discussion? Are there opinions from others than
Richard and Eberhard only?
Hilbrand Haak, e-mail: firstname.lastname@example.org