ABSTRACT AND KEYWORDS
This supervised project focused on improving medication
prescribing practices in health facilities within the Katwa Health Zone.
First, a scientific study was conducted to identify deviations
from good prescribing practices and to better understand the problem. This was
a cross-sectional, descriptive, and comparative study carried out in health
facilities within the Katwa Health Zone. The study population consisted of all
prescriptions and consultation records produced between April 1, 2025 and March
31, 2026. A sample of 2,000 prescriptions was selected in accordance with World
Health Organization (WHO) recommendations, with 100 consultations per health
facility. The study covered 20 health facilities, including 7 health centers, 6
clinics and hospital centers, 5 health posts, and 2 hospitals. Among these
facilities, 4 were public, 6 faith-based or conventioned, and 10 privates; 12
were integrated and 8 non-integrated. Data were retrospectively collected from
consultation registers, prescriptions, and medical records using an electronic
questionnaire developed with KoBoToolbox. Data analysis was performed using
Microsoft Excel.
The results showed that the mean number of medicines
prescribed per prescription was 3.39, slightly above the WHO standard of 3
medicines. The highest means were observed in health posts (3.78), private
facilities (3.89), and non-integrated health facilities (3.84), while the
lowest were recorded in health centers (3.02) and public facilities (2.76).
The proportion of medicines prescribed by International
Nonproprietary Name (INN) was 17.3%, considerably lower than the WHO standard
of 100%. The proportion of prescribed medicines included in the National
Essential Medicines List (NEML) was 87.7%, also below the WHO standard of
100%.
The proportion of consultations involving at least one
antibiotic was 86.4%, nearly three times the WHO recommended level of 30%. The
highest proportions were observed in health posts (91.8%), private facilities
(91.4%), and non-integrated health facilities (91%), while the lowest were
recorded in health centers (80%) and public facilities (79.75%).
Injectable medicines were prescribed in 47.2% of
consultations, compared with the WHO standard of 10%. The highest proportions
were observed in health posts (60.6%), private facilities (64.7%), and
non-integrated health facilities (66.88%), whereas the lowest were found in
hospitals (32%) and conventioned facilities (25.5%).
Overall, the study highlighted irrational medicine use in
health facilities within the Katwa Health Zone, particularly characterized by
excessive antibiotic and injectable medicine prescribing and limited use of INN
prescribing.
The study also identified several factors that may contribute
to irrational prescribing practices. Only 10.2% of healthcare providers were
paid by the government, while 38% had received training in rational
prescribing, with the mean time since their last training ranging from 2.7 to
4.45 years. At the institutional level, 60% of health facilities had the
National Essential Medicines List available, while 65% participated in medicine
promotion or advertising activities. Furthermore, only 55% of health facilities
reported the zonal pharmacy or the Regional Distribution Center (RDC) as their
main source of medicine supply.
Based on these findings, a quality improvement project was
designed to improve medication prescribing practices in the Katwa Health Zone
and is scheduled to run from October 1, 2026 to September 30, 2027.
The overall objective of the project is to improve the quality
and rationality of medication prescribing in health facilities within the Katwa
Health Zone in order to promote appropriate, safe, and efficient medicine use.
With a budget of USD 8,978, the project specifically aims to reduce the mean
number of medicines prescribed per prescription to fewer than 3, reduce the
proportion of consultations involving at least one antibiotic to below 30% and
those involving injectable medicines to below 10%, increase the proportion of
medicines prescribed by International Nonproprietary Name (INN) to above 90%,
and strengthen prescribers' competencies in the use of therapeutic
guidelines.To achieve these objectives, the main activities will include
coordination with the Health Zone Management Team (BCZ/ECZS), an initial
assessment, development of monitoring and training tools, prescriber training
in three rotations, mentoring, supervision of health facilities, regular
monitoring of indicators, a mid-term evaluation, and a final evaluation.
Thus, this supervised project follows a process that moves
from scientific identification and analysis of the problem to the
implementation of a quality improvement intervention. Ultimately, it aims to
contribute to more rational medicine use, improved quality of care, and the
prevention of antimicrobial resistance.
Keywords: medication prescribing, rational
medicine use, WHO prescribing indicators, antibiotics, injectable medicines,
Katwa Health Zone.
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