Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province

Abstract

Background

The South African National Drug Policy (SA-NDP) was introduced to promote rational medicine use (RMU). This study evaluates the quality of prescribing in the public healthcare sector in South Africa's Limpopo province following the World Health Organization's (WHO) rational prescribing standards. In addition, the prescribing practices in South Africa were compared to other African countries.

Methods

A prospective cross-sectional survey of patients' prescriptions was conducted in Limpopo, South Africa, from October to December 2018. Findings were compared with the WHO reference values (WHO-RV), and the International Network of Rational Use of Drugs (IRDP) tool was used to measure the degree of rational prescribing. The optimal IRDP value was defined as 1. Study findings were compared with results from a previous study conducted in Limpopo and studies from Ethiopia and Eritrea.

Results

Six hundred prescriptions were reviewed. The mean (SD) age was 43.9 ± 24.4 years (females = 56.5%). The average number of drugs prescribed (4.3, IRDP = 0.47) was higher than the WHO-RV (< 2). Generic prescribing (43%, IRDP = 0.43) and medicines prescribed from the essential medicines list (EML) (90%, IRDP = 0.90) were less than the WHO-RV (100%, respectively). Antibiotics (28%, IRDP = 1) and the number of injections prescribed (8%, IRDP = 1) were below the WHO-RV (< 30% and < 20%, respectively). The number of medicines prescribed was higher compared to previous years (4.3 vs. 3.4). Antibiotic prescribing declined (28% vs. 63.4%). Generic prescribing (43% vs. 41.7%) and medicines prescribed from the EML (90% vs. 93.1%) did not improve. A higher number of medicines were prescribed in this study compared to Ethiopia (1.7) and Eritrea (1.8), and a lower number of antibiotics were prescribed compared to Ethiopia (58.2%) and Eritrea (54.5%). Generic prescribing was low compared to Ethiopia (95.6%) and Eritrea (94.9%). All studies showed reduced injection prescribing (6.6–15.9%) and similar prescribing from the EML (90–95%).

Conclusions

There is an increased potential for drug-drug and adverse reactions with the increased number of prescribed medicines; however, the patient's clinical needs may warrant using multiple medicines. There is a need for generic prescribing to reduce medicine expenditure.

Keywords:

• Medicines use
• Prescribing pattern
• WHO indicators
• Generic prescribing
• Prescribing quality

Acknowledgements

We acknowledge the Staff of the Pharmacy Services in the Western Cape Department of Health. We also acknowledge the support from Ms. M. Mannya, a pharmacist at the Lebowakgomo Hospital, and Mr. M.L. Molokomme, a pharmacist assistant at Botlokwa Hospital.

In Memory of Vutomi Valoyi, his contribution to rational medicine use in Limpopo is invaluable.

Author contributions

OOA, VV, and RC conceived the idea of the manuscript; VV, YJ and RC were involved in the data collection process; OOA, VV and RC were involved in the data analysis; OOA wrote the first draft; OOA, AW, YJ and RC revised the manuscript.

Funding

OOA received support from the South African Research Chairs Initiative of the Department of Science and Technology and the National Research Foundation of South Africa (Grant No. 98918) for this publication.

Availability of data and materials

The data and materials used are available upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethics approval was obtained from the University of Western Cape Research Ethic Committee (Ref no: BM18/4/5). The Limpopo Provincial Department of Health granted permission for the study to assess patients' prescription information in the clinics in Limpopo (Ref no: LP_2018_06_008). The patients were not approached directly; hence, informed consent was not required.

Consent for publication

All authors have read and approved the submission of this manuscript.

Competing interests

The authors declare no competing interests.

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