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WHPA Campaign against Spurious Medicines in India – A Report


Pradeep Mishra, WHPA/FIP; Dr KK Aggarwal, IMA; Dr Lalit Kanodia, Apollo Hospitals; Ms Manjiri Gharat, IPA; Ms Jasu S Patidar, INC; Dr Mohanta, IPA

 The World Health Professions Alliance WHPA brings together the global organizations representing the world’s dentists (FDI), nurses (ICN), pharmacists (FIP), physical therapists (WCPT) and physicians (WMA) and speaks for more than 26 million health care professionals in more than 130 countries. WHPA works to improve global health and the quality of patient care and facilitates collaboration among the health professions and major stakeholders.

 WHPA has partnered with Pfizer to develop and deliver this campaign to tackle Spurious Medicines in India. The campaign was run in collaboration with the healthcare professionals associations in India, specifically Medical Doctors (through the Indian Medical Association, IMA), Nurses (through the Indian Nursing Council, INC) and Pharmacists (through the Indian Pharmaceutical Association, IPA), to help shape a campaign to raise awareness of the public health threat associated with spurious medicines in India.

 Fine-tuning the scope and focus of the campaign

The first step of the campaign was to convene a meeting of an Advisory board so that the relevant Indian Healthcare Professionals Associations could benefit from the inputs of relevant stakeholders.

During this first meeting, the partners of the campaign agreed upon a Campaign Charter:

Campaign Charter:  This campaign and meeting has been convened to address the issue of spurious medicines, in the context of the threat presented to patients in India. The definition of spurious drugs is provided in Section 17-B of the Drugs and Cosmetics Act, 1940 of Government of India.

Throughout the whole campaign, careful consideration will be given to specifics of India, recognising the use of both traditional (this was not considered due to non representation of any one professional association to represent traditional medicine) and ‘western medicines’ (generics or branded) medicines.

 The original intention of the campaign was to raise awareness among patients in Indian on spurious medicines, qualitative research indicated that this would create a high level of anxiety among the population, as they would perceive that there was little they could do to prevent spurious medicines.

Further to a 2nd meeting where the conclusions of this qualitative research was presented, the campaign focus shift to raise awareness and educate healthcare professionals. During this meeting, the key messages were agreed, as well as the next steps for campaign development

 WHPA campaign – India

The second step of the campaign was to sign the Memorandum of Understanding (MoU) between the three healthcare associations (IMA, IPA, INC). The signing of the MoU denoted the partnership and trust between the organisations as well as the shared recognition of the importance of the issue. The associations agreed that to ‘start small but think big’: a pilot intervention would allow testing of messaging and approach to support more successful roll-out. The first pilot was made in Apollo Hospitals among all three healthcare groups. Based on the feedback of this first pilot, minor adjustments were made and the three Indian professional associations conducted pilots on education and awareness amongst their members.

The campaign included training programs as education and awareness interventions on how to minimize this threat with the interest to increase knowledge as well as change behaviours.

 Seven locations were chosen to conduct the training sessions for Doctors, Nurses and Pharmacists (community and hospital) respectively on spurious and counterfeit medicine. The content of training program, study material including the evaluation questionnaire was developed jointly by WHPA and stakeholder associations. The Sensitisation cum Training programme were conducted in sessions of two hours duration on an average.

 ·         Participants: Healthcare Professionals (Doctors, Nurses and Pharmacists)

·         Expected Sample size: 100 Doctors, 200 nurses and 100 Pharmacists

·         Actual Attendance: 677

Doctors- 70 including senior and junior practicing medical doctors

Nurses -252 including senior and junior practicing nurses

Pharmacists -355 including community and hospital pharmacists

 Assessing the campaign

The three healthcare professional group participants were subject to a pre-training test and post-training tests, in order to assess the interactive training cum awareness

 Description of the Pre test evaluation:

The session was preceded with a pre test evaluation consisting of questions covering the prevalence, societal consequences and regulatory aspects of the spurious medicines. The participants were explained of answering them as true / false or tick the most appropriate answer. Some of the questions in the pre test questionnaire were left blank.

 Scoring pattern: All questions were allotted equal marks (1 each) and every correct or partially correct entry in case of multi correct answer type questions was awarded a score of 1. All incorrect answers were marked as 0.

 Description of the Post test evaluation:

The sensitisation cum training session was followed by a post test to calculate the gain from the training session. Many of the questions in pre-test which were observed having been left blank were  answered for the post test. However, many of the participants marked only one or two of the correct answers in the multi answer type questions.

Training Impact: The training session caused an impact on the knowledge and perception about spurious medicines among the participants. Among the pharmacist groups the improvement in knowledge ranged from 14% (n-30) and 16.35% (n-51) to 21.43% (n-59). The pharmacists were convincingly conscious of spurious medicine prevalence and their consequences in public health. The sensitisation program increased their awareness about other factors relating to spurious drug such as their prevalence and the severity of the matter as is evident from the increased average scores in the post test.

A radical gain in knowledge was observed within the nursing fraternity with 9.33% (n-52) to 13.20% (n-191). A good number of conversions were observed with nurses for the knowledge about spurious drugs, their prevalence and societal consequences.

The knowledge gain in case of doctors (n-31) was not much of a difference so no significant results can be drawn. It remains as an area open to further investigation and improvements.

Results

The participants took active part in the pre test as well as the post test.  Good gain of knowledge was observed in the groups. Maximum conversion was observed with the awareness of the broader definition, scope and the severity of the spurious medicines.  Out of the 414 respondents, who participated in pre and post test 58% of the audience were nurses which will impact patient-drug-compliance greatly.  Being aware makes them being conscious of the quality of drugs in use which would certainly increase their involvement in finding out the prevalence of such drugs in the healthcare setting and increase the level of quality and help them march towards the noble cause of healing. Similarly the pharmacists who play a key role in drug distribution can reduce the prevalence of spurious drugs and counterfeit medicines using the visual inspection tools and awareness.

Inference

The training session does bear an impact on enhancement of knowledge and perception about spurious drugs among healthcare professionals from Pharmacy and Nursing fraternity. The current understanding of spurious drugs seems to be low, especially among nursing professionals, as can be accessed from the queries raised. (Including an initial query about ‘What is spurious drug? We don’t know what spurious drugs are, how we’ll be able to take the pre test!’) Good conversion from incorrect to correct answers depicts good people engagements through interactive presentation – hints towards effectiveness of training module and session.  Conceptual questions being answered correctly with good conversion, data based questions got negative conversion. The post training evaluation also allowed the participant to share their insights and suggestion on their contribution to control this menace. Maximum of the participants believed that drugs purchase source should be authentic and genuine and laid emphasis on the proof of purchase. The need to make healthcare professionals as well as consumers aware of the menace and the availability of visual inspection tools was felt by a large population amongst the participants. The mechanism to report suspects and motivating people to report suspects and ADRs preferably through a toll free number and handling the defaulters through fast track courts included other suggestions.

Conclusion

In all professional groups, the campaign enabled an improvement in knowledge and /or perception about spurious drugs and counterfeit medicines. The collaboration resulted in development of a handbook on spurious medicines in India, which can be used for education, awareness, detection and reporting of spurious medicines in India. This was probably a rare occasion that the three leading professionals associations in India have been involved in such a joint project and it was felt that this increased the trust among them, which may eventually lead to a formalised collaboration among these three professional associations.

Acknowledgement: Pfizer, Inc. USA