For Quality, Essential, Generic Medicines

        After the patient expires, they realise that they had been wrong all along, that they had mistaken malaria for kala-azar or vice-versa. These doctors have even mistaken malaria for tuberculosis. Prodyot himself made such a serious blunder. He had been burdened with painful thoughts ever since the child died.

        The way they served the prescribed drugs at Benoy's left a lot to be desired. If one of the ingredients was not available, they would put in anything they wished, or just make it without it. None of the mixtures were made as they should be, the various ingredients did not dissolve properly. They brought the drugs in one lot and used them for one year, long after they had lost their potency. The modern drugs which required to be kept at a special temperature or away from light were not kept according to specification. Ignorance, neglect and profit-motive reigned supreme, even where it was a question of life and death. Prodyot has reason to believe that on top of everything Benoy sold spurious drugs.

        And his charges were exorbitant, poor village people were innocent victims of his greed for money. If they took anything on credit, the figure in Benoy's book swelled gradually. When Prodyot looked at their pale faces, he felt at once pity and outrage. He often felt that these stupid people did not deserve to live. Let them die. No matter how much you try to convince them, they would not understand. They would never see beyond herbal drugs, amulets, magic cures and Jeevan Mashay's intuition.

        Something should be done about it ! So Prodyot had decided to start a dispensary and a clinic with the help of his friend and the local doctors. There was no reason why it should not run ....

- Arogyaniketan, Tarashankar Bandopadhyay

The need for consumer action cannot be over-emphasised in view of the aggressive and unethical marketing practices employed by the pharmaceutical companies. Consumer awareness is an important pre-requisite for consumer action. Consumers, individually or as a group, can play a key role in protecting themselves and preventing unethical promotion of drugs, and unnecessary suffering caused by dangerous drugs or by irrational use of drugs.

Prescribers in turn can facilitate patient compliance of drugs by doing several things. For an illustrative list, see the box overleaf.


Aids to Improving Patient Adherence to Treatment


Patient leaflets

Patient leaflets reinforce the information given by the prescriber and pharmacist. The text should be in clear, common language and in easily legible print.

Pictorials and short descriptions

If the patient cannot read, try pictorials. If they are not available, make pictorials or short descriptions for your own P-drugs, and photocopy them.

Day calendar

A day calendar indicates which drug should be taken at different times of the day. It can use words or pictorials: a low sun on the left for morning, a high sun for midday, a sinking sun for the end of the day and a moon for the night.

Drug passport

A small book or leaflet with an overview of the different drugs that the patient is using, including recommended dosages.

Dosage box

The dosage box is becoming popular in industrialised countries. It is especially helpful when many different drugs are used at different times during the day. The box has compartments for the different times per day (usually four), spread over seven days. It can then be refilled each week. If cost is a problem, the box can be made locally from cardboard. In tropical countries a cool and clean place to store the box will be necessary.

Even if the patient aids described here do not exist in your country, with creativity you can often find your own solutions. The important thing is to give your patients the information and tools they need to use drugs appropriately.

Source : Guide to Good Prescribing. WHO Action Programme on Essential Drugs, Geneva, 1995.