Means available to evaluate drugs
In many developing countries, central purchasing depots have been created and rely on a system of open tendering. However, if this allows drugs to be obtained at a very low price, it does not address the need for quality products. Further shortcomings to this kind of method include:
• numbers of suppliers in all countries worldwide will respond to open tenders.
• there is a lack of quality control laboratories in developing countries. Where these are present, they suffer from underresourcing in staff, material and finances.
• a large proportion of drugs on open tender do not have a marketing authorization in the country of manufacture.
• even if drugs do have a marketing authorization, the requirements for authorization may differ between countries. Furthermore, a product may be marketed in packaging which will change when supplied in bulk to developing countries or humanitarian aid programmes. For example, products which are supplied in 28-day patient packs with information leaflets are supplied in bulk packs of maybe 1000 tablets.
• export certificates may not conform to the requirements of the importer and verification of the file with the actual practices of the manufacturer are almost always precluded.
Three approaches are available for the evaluation of drugs:
1. Proof of quality control at various stages, i.e. receipt of raw material, in-production process, and finished product.
2. Audit of the manufacturer to include process validation of manufacturing and quality assurance.
3. Registration of the drug in the country of manufacture and in the importing country. Where a product is not for local use, the registration authority must ensure that the same laws and regulations which apply to the manufacture and sale of products on the local market also apply to products to be exported/imported.
An association of these approaches will strengthen the objectives of providing quality drugs at the lowest price.