WHO/INRUD indicators showed poor accuracy in assessing prescribing practices in ambulatory care in Namibia. There is need for appropriate models and/or criteria to optimize medicine use in ambulatory care in the future.

Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

Background: Routine monitoring of medicine use is costly. Medicine use monitoring in most low- and middle-income countries is heavily reliant on donor support, which is not sustainable. Innovative models to close gaps in monitoring of medicine use are critical towards strengthening pharmaceutical services.Objective: To pilot an inter-institutional collaborative model for monitoring medicine use in Namibia over a three-year period, 2013–2015.Methods: An interventional analytical design that piloted an inter-institutional collaborative model for monitoring medicine use in public health facilities in Namibia was followed. Three key stakeholders – the Ministry of Health and Social Services (MoHSS) division of pharmaceutical services, University of Namibia School of Pharmacy and United States Agency for International Development–funded Systems for Improved Access to Pharmaceutical Services (SIAPS) project – collaboratively designed and implemented a concept model, tools and guidelines for routine medicine use assessment. The model integrated medicine use monitoring as a component of the annual rural placements of Bachelor of Pharmacy students at public hospitals. The pharmacists at the hospitals and MoHSS provided support and supervised the students prior to, during and after the placement. Each student undertook a mini-project on medicine use at the facilities which included data collection, analysis as well as reporting using the World Health Organization or International Network of Rational Use of Drugs indicators. These were subsequently aggregated by the university with technical assistance from SIAPS and findings reported to the Ministry. Data collected by the students on hospital placements were entered in Microsoft Excel® template for descriptive analysis for patient care indicators. All students discussed their findings with health facility supervisors.Results: The collaborative efforts enhanced local institutional and students’ capacity on analysing, reporting and presentation of data on medicine use. A total of three medicine use surveys (MUS) involving over 1938 patients were conducted from 2013 to 2015. The local capacity to conduct medicine use evaluation (MUE) was increased among 74 pharmacy students. At least 15 public hospitals in 12–14 regions participated in the MUS. Findings reveal 83% of prescribed medicines were dispensed; 53%–57% patients were satisfied with medicine information; 50%–59% of patients felt they waited too long (consultation time of more than 3 h) before getting their medicines; over 80% patients did not know how to take their medicines correctly; 56%–80% of dispensed medicines were labelled correctly.Conclusions: A multisectoral collaborative model is cost-effective in medicine surveys, if there are mutual benefits. Student placements provide an opportunity to build local capacity for routine MUE. Ministries of Health should utilise this innovative approach to assess service delivery.

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