Building the national drug policy on evidence--a cross sectional study on assessing implementation in Lao PDR.

The National Drug Policy (NDP) of Lao PDR, endorsed in 1993, has since 1995 been implemented through an intervention program in five pilot areas out of 18 provinces, including training of health personnel. The aim was to assess the impact of the NDP program to get evidence for revising the policy. In a cross sectional design, comparisons were made between the pilot province of Luangphrabang (LPB) and the non-pilot province of Sayabury (SBR). In each province, three districts were purposively chosen. Four pharmacies at the public hospitals were included, while 20 private pharmacies were randomly selected. A set of 29 combined indicators was utilized. One hundred and ten prescriptions for under-five children with simple diarrhea and 240 adult outpatient prescriptions were sampled. Furthermore, twelve health care managers were interviewed on knowledge and attitudes. LPB health managers had better knowledge of NDP concepts. Significantly more essential drugs (ED) were available in the private pharmacies in the pilot province. The proportion of prescriptions of ED in hospitals was higher in the pilot province (95% in LPB vs 86% in SBR; p<0.001). Fewer drugs per patient were prescribed in the pilot province (2.7 vs 3.3, p<0.001), and the management of simple diarrhea in children was significantly more in accordance with Standard Treatment Guidelines. The pilot province performed significantly better regarding several aspects of quality and rational use of drugs, probably related to the implementation program. National as well as regional and global diffusion of research findings is recommended towards evidence-based national drug policies.