1. INRUD International Network for Rational Use of Drugs

2. “ Better health through research”  INRUD is a cooperative international venture to address in an innovative way the problem of inappropriate use of drugs, with an interdisciplinary approach.  By using a network approach, it is hoped that effective and realistic policy and program options to improve rational use of drugs can be identified.

3.  Indonesia   Nigeria  Ghana  Zimbabwe  Tanzania  Uganda   Philippines  Thailand Inauguration: 1990 Nepal Bangladesh Support Groups: MSH (Arlington), Drug Policy Group-Harvard (Boston), WHO-EDM IHCAR (Stockholm), Clinical Pharmacology-University of Newcastle (Australia),

4. Strategy  An interdisciplinary focus, linking clinical and social science;  Activities originating from country-based core group of individuals representing MOH, universities, NGOs, and private sector institutions;  Belief in the importance of sharing relevant experiences and in technical cooperation among participant individuals;  Emphasis on understanding behavioral aspects of drug use, particularly the beliefs and motivations of providers and consumers;  Promotion of well-designed research studies to understand these behavioral factors, leading to reproducible interventions to improve drug use;  Development of useful tools for research, including standard research methodologies, simplified sampling and data collection strategies, and user-accessible computer software.

5. Factors influencing drug use Informational & marketing: Unbiased information Influence of industry Work environment: Workload & staffing Drug availability Infrastructure Provider-patientinteractions: Cultural beliefs Patient demands Characteristics of providers: Knowledge deficits Acquired habits DRUG USE Social structure of providers: Peer norms & Relation Authority, Power

6. INRUD framework - for changing drug use problem FORMATIVESTUDIESINTERVENTIONSTUDIESFOLLOW-UP 1. Define problems with drug use patterns 2. Identify motivating factors, underlying causes 3. List possible interventions 4. Choose intervention (s) to test 5. Conduct controlled study of intervention (s) IMPLEMENTCost-effectiveinterventions on larger scale REVISE & RESTUDY Partially effective or costly interventions DROPIneffective,uneconomicalinterventions

7. IGD to reduce inappropriate injection use Month IGD Dissemination of IGD results Implementation of other district-wide RDU program Source: Long-term impact of small group interventions, Santoso et al., 1996

8. Significant reduction of inappropriate injections: 1987-1999 Source: Evaluation of NDP implementation, Ministry of Health of Indonesia, 1999

9. Courses on Promoting Rational Drug Use

10.                                PRDU Course participants 1990-2000           600 from 41 countries

12. International Conference on Improving the Use of Medicine (ICIUM) Chiangmai, 1-4 April 1997  Jointly sponsored by: WHO-DAP, INRUD, USP, The ARCH Project  Presentations of research projects related to promoting rational drug use (published & unpublished)  Evaluation on the achievement so far  Summary and recommendation: –Best research methodology: RCT, time series –Small-group interventions for behavioral aspect of drug use –Lots have been done for public primary health care –Few have been done for private sector, hospital setting, and chronic diseases http://www.who.int/programmes/dap/icium/

13. What INRUD offers?  Sharing knowledge and experience on research methodology, effective strategies to improve drug use problems  PRDU Course  INRUD Newsletter  Consultancy