NTA Level 5 • Semester 1 • PST05101

Managing Drug Donations

Medicines and Medical Supplies Management • Source Session/Topic 12

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Session 12: Managing Drug Donations

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Explain drug donation

• List its associated benefits and problems

• Explain the core principles in drug donation

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Explanations of Drug Donations (30 minutes)

|Activity: Buzzing (5minutes) |

| |

|ASK students to pair up and buzz on the following question for 3 |

|minutes |

| |

|What do you understand by drug donation? |

| |

|ALLOW few pairs to respond on the question and let other pairs add on |

|points not mentioned WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Drug Donations

• Drug donations are usually given in response to acute emergencies, but

they can also be part of development aid

• Most pharmaceutical donations are given with the best of intentions but

can nevertheless create problems at the receiving end. Often, donated

pharmaceuticals are not relevant to the needs of the recipient, or they

arrive unsorted or close to expiry. They may be labeled with a brand name

or in a language that is not understood. Many pharmaceutical donations

counteract government policies or violate national regulations of the

recipient country and can be expensive for the country to store or

destroy

• Guidelines for pharmaceutical donations are needed for a number of

reasons. Donors and recipients do not communicate on equal terms, and

recipients often need assistance in formulating their needs. Many donors

do not understand the potential difficulties at the receiving end and

need guidance. Medicines require special regulations because they are

different from other donated items. Pharmaceutical donations that occur

without input from the recipient countries should be discouraged

STEP 3: Core Principles for a Useful Pharmaceutical Donation. (20 minutes)

|Activity: Buzzing (5minutes) |

| |

|ASK students to pair up and buzz on the following question for 3 |

|minutes |

| |

|What are the core principles for useful donation of pharmaceuticals? |

| |

|ALLOW few pairs to respond on the question and let other pairs add on |

|points not mentioned WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The four core principles for a useful pharmaceutical donation are;

o A donation benefits the recipient to the maximum extent possible

o A donation should be given with full respect for the wishes and

authority of the recipient

o Items that are not acceptable in the donor country for quality-

related reasons are also not acceptable as donations: there

should be no double standards in quality

o Effective communication between the donor and recipient is

necessary before any donation

• These principles have been translated into a set of guidelines for

pharmaceutical donations. First, recipients should review and adopt

these guidelines and present them officially to the donor

community. Only then can they be implemented and enforced. Second,

recipients should develop and publish administrative procedures for

pharmaceutical donations. Third, recipients should indicate to the

donors, as clearly as possible, how they want to be helped,

specifying the medicines they need, the quantities, and the

priorities. Donors should inform the recipients well in advance

which pharmaceutical donations are coming, and when.

STEP 4: Benefits And Problems of Drug Donations (60 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into manageable groups |

| |

|ASK students to discuss in groups on the following question: |

| |

|What are the benefits and problems of drug donations? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW each groups to present |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Benefits of Drug Donations

• Medicine donations can save lives and ease suffering when well-

coordinated and managed.

• In cases where recipient countries are not able to ensure adequate

medicines access, donations can bring major benefits to those in need

• They help to eradicate the situation of out of stock medicines

• Medicine donations can become strategic benefits to recipient countries.

They are often used to support the rebuilding of health systems or to

ensure access of population to health products they otherwise wouldn’t

have

• Good donation practices may provide savings in development support

budgets, enabling these resources to be used for other purposes

• To donors there is a benefit of tax deduction

• Builds good relationship between countries

Problems of Drug Donations

These are based on the following categories;

Pharmaceutical donations in emergency situations

• Donated pharmaceuticals are often not relevant for the emergency

situation, for the disease pattern, or for the level of care that is a

they available

• Health workers and patients are not always familiar with the donated

pharmaceuticals

• The pharmaceuticals are often not registered for use inhe recipient

country and may not comply with local treatment guidelines

• The pharmaceuticals that arrive are frequently unsorted, difficult to

identify, unknown in the recipient country, labelled with brand names, or

labelled in a language that is not locally understood

• The quality of the pharmaceuticals does not always comply with standards

in the donor country. Donated pharmaceuticals may have expired or may

expire before they reach the patient; they may be returned

pharmaceuticals (half-finished packages that have been returned to the

pharmacy or free samples given to health professionals) or they may be

unwanted by the donor because they are close to expiration or the product

is being discontinued (donating such products is also known as drug

dumping). Donations may spoil or become damaged, which may be impossible

to detect in the recipient country

• The distribution plan often ignores normal administrative procedures. For

example, the distribution system may bypass the central government stores

or otherwise conflict with the plan of the national authorities

• Donated pharmaceuticals may have a high declared value reflective of the

market value in the donor country rather than the world market price.

This valuation may result in high import taxes and overheads for storage

and distribution in the recipient country, and the inflated value of the

donation may be deducted from the recipient government’s pharmaceutical

budget

• Pharmaceuticals may be donated in the wrong quantities or be otherwise

unusable, and some stocks may have to be destroyed. Disposing of

pharmaceuticals is not only wasteful; it is expensive for the recipient

to safely destroy pharmaceutical stock.

The underlying causes for these problems: The most prominent cause is

probably the common but mistaken belief that any type of pharmaceutical

is better than nothing at all or, similarly, that expired pharmaceuticals

are good enough for people in need. Second, pharmaceutical donations are

often made despite the lack of a stated need or prior clearance by the

recipient. Third, in many donor countries, donated pharmaceuticals are

tax-deductible (at full market price). This last factor is why so many

donated pharmaceuticals arrive close to or past their expiry date and why

such products are typically not high-use, high-volume items.

Pharmaceutical donations initiated by pharmaceutical manufacturers in

exchange for tax breaks are likely to consist of medicines and supplies

that are not commonly viewed as essential. Inappropriate pharmaceutical

donations create logistical problems because the donated products must be

sorted, stored, and distributed, sometimes using precious human. Or they

may pose an environmental threat if they have to be destroyed. Often, the

total transport costs are higher than the value of the pharmaceuticals.

Stockpiling of unused pharmaceuticals can encourage pilfering and

blackmarket sales. Even donations that are appropriate in every other way

can cause problems when they far surpass the quantities that are needed.

Pharmaceutical donations as part of development aid

The ideal situation occurs when the recipient country can indicate specific

medicines and quantities needed, without any restriction on the selection

and country of origin of the pharmaceuticals. Unfortunately, these

conditions seldom apply. The choice is often restricted to manufacturers

or suppliers in the donor country. Even if the medicines are listed

generically on the national list of essential medicines in the recipient

country, the donated items are often brand-name products or different

formulations that may not be registered in the recipient country. The

donation may then interfere with the implementation of national

registration, quality assurance, and inspection schemes. If the selection

of medicines is restricted by the donor, the donation may not be in

accordance with national programs promoting standard treatment guidelines

and rational medicine use.

Donations of returned pharmaceuticals

Many nongovernmental groups in developed countries collect unused

medicines (returned medicines or free samples) and send these products in

emergency situations or, on a regular basis, to institutions in

developing countries. At the receiving end, such donations can frustrate

all efforts to manage and administer pharmaceutical stocks in a rational

way. Donating returned medicines is a clear example of double standards:

in no developed country would the use of such products be permitted. In

addition, these medicines are a problem for doctor and patient. The

prescriber is forced to use countless different medicines and brands in

ever-changing

dosages; patients on long-term treatment suffer because the same medicines

may not be consistently available. For these reasons, this type of

donation is generally discouraged and even forbidden in some countries.

The immense effort required to sort such donations is largely wasted

because most of the products are unusable.

STEP 5: Key Points (15 minutes)

• Medicine donations can save lives and ease suffering when well

coordinated and managed. In cases where recipient countries are not able

to ensure adequate medicines access, donations can bring major benefits

to those in need

• The best way to avoid having to dispose of unwanted pharmaceutical

donations is to stop inappropriate donations from occurring;

unfortunately, however, even with increased recognition of problematic

donations in the face of large-scale disasters

• There are several problems related to medicines donations such as; may

contain expired drugs, may increase additional cost for local government

to dispose the unwanted drugs, In case of excess drug donation, the

storage capacities may be insufficient, the prescribing pattern of local

physicians may change and prescribe more donated drugs that are not even

essential for specific disorder and some medications are labeled in a

language other than English which are not understood by the prescriber

STEP 6: Evaluation (10 minutes)

• What is drug donation?

• What are the associated benefits and problems of drug donations?

References

MSH and WHO (2012) Managing Access to Medicines and Health Technology,

3rd Edition. Kumarian Press

Guidelines for medicine donations 3rd edition WHO

World Health Organization (WHO), Regional Office for Africa

Brazzaville 2004, Management of Drugs at Health Centre Level Training

Manual.

United Republic of Tanzania Ministry of Health and Social Welfare,

Strategy for Development and Implementation of an Integrated Logistics

System for Essential Health Commodities: Government Printers, Dar es

Salaam

USAID | DELIVER PROJECT, Task Order 1. 2011. Tanzania: 2020 Supply

Chain Modeling—Forecasting Demand from 2020–2024. Arlington, Va: USAID

| DELIVER PROJECT, Task

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