Proposed strategy
The first step should be to avoid calls for open tenders, even where stringent guidelines are in operation, and to prefer limited calls for tenders from a restricted list of prequalified suppliers (1). In this event quality assurance factors would apply equally to distributors and manufacturers.
Safety and quality assurance
A systematic audit of the manufacturer should be made through documentary evaluation via the site master file or effective auditing according to GMP. This must stress process validation and competence to manufacture products fit for their intended purpose.
Registration in the country of origin
Any manufacturer not applying for a marketing authorization in the country of origin should nonetheless provide sufficient elements of the master file to complete an evaluation. The importing country should evaluate this file in line with its own criteria for bioequivalence, expected uses, medical information, labelling and sampling.
The exporting country should be able to assure drug quality through an evaluation of the information contained in the master file and be able to inspect the manufacturer on that basis. Furthermore, it should be the responsibility of the relevant authorities to ensure that there is a clear and qualitative difference between a manufacturing licence for medicines and healthcare products and the licence for non-medical products.
Mutual recognition of inspections
Inspections should be promoted to ensure conformity with the reference data. Developing countries should be encouraged to adhere to the Pharmaceutical Inspections Convention (PIC) treaty.
In conclusion, quality assurance is an important tool in the control and evaluation of drugs. This is the only approach that can currently provide assurance that the product is safe for human use. However, this approach has a price and competition for supplies needs to take place among suppliers known to apply quality assurance procedures. Furthermore, manufacturers must collaborate more fully with drug regulatory authorities to ensure quality when drugs are exported. This will ensure that drug quality in developing countries will be more standardized and rational.
If it is important to ensure that the demands made on manufacturers and suppliers of quality medicinal products are met, it is equally important that the authorities demanding the drugs accept the costs implied in assuring quality. It is a fallacy to believe that quality production and assurance can be achieved at no great investment. The following factors need to be understood in the drug procurement process:
• Quality has a cost;
• Procurement from non-validated suppliers carries a health risk for the patient;
• Cheap medical products also carry a health risk;
• Procurement should be restricted to selected suppliers, not through open tender;
• Suppliers should be validated according to a country's defined quality supply standards
• In the absence of local standards, use those promoted by WHO.
• Conformity with international standards, as promoted by WHO, should be demanded