Background
Methods
Setting
Sampling
Data collection instruments and process
Data analysis
Results
Psychotropic drug supply chain in Nepal
Perceptions on need, quality, availability and use of psychotropic drugs
Stakeholders | Need | Quality / Effectiveness | Availability | Use/stigma |
---|---|---|---|---|
Producers, promoters and distributors | Medicine along with other alternative healing. | Both drugs produced in Nepal and imported from outside are of good quality and are effective. | Available where mental health services are being provided. | There is negative societal attitude towards people who use psychotropic drugs. |
Policy makers and government actors | Yes for severe cases only, for other cases as a last resort. | Drugs are of good quality, although people believe that foreign drugs are more effective. | Available at the district level where mental health services are available. | There is stigma for people with mental illness which affects the access and use of psychotropic drugs. |
Service providers | Medicine for severe cases, counseling and other therapy for minor cases. | Some medicines produced in Nepal are of low quality and less effective. | The availability of drugs have increased drastically, but not to all areas of Nepal. | There is not only stigma for those who use psychotropic drugs but also to those who provide mental health services. |
Service users and family members | For severe cases only Medicines with other therapies are needed. | Medicines are of good quality and are effective. | Drugs are available at the district or at regional centers only. | There is huge stigma for those who use psychotropic drugs. Consequently, patients and family members try to hide as much as possible. |
Need of psychotropic medicines for the treatment of mental health problems
"If there is no such environment, or if there is no family or social support, or if the social or family support doesn’t help the problem, then as a last resort there is always medication".
"medicine is the most important, followed by family support and understanding".
Quality and effectiveness of psychotropic drugs
Availability of psychotropic drugs
Use of psychotropic drugs
Perceptions on barriers to the effective psychotropic drugs supply chain
Stakeholders | Barriers to effective supply chain management of psychotropic drugs |
---|---|
Producers, promoters and distributors | • There is market competition. Need to spend money for bonuses and incentives. There is not much profit in psychotropic drugs but there are more hassles in its production, import and record keeping. • The drugs imported by one agent cannot be imported by another agent despite high market demand for that drug. • There is substitution of drugs by retailers due to higher bonuses and incentives by other companies. • Nepal is dependent on India for raw materials which is a challenge for independent manufacturing of psychotropic drugs in Nepal. |
Policy makers and government actors | • The drugs are prescribed in brand names with the hidden motives for incentives. • The storekeepers at district level have limited knowledge on drugs as they do not have medical background. • The inappropriate use or misuse of psychotropic drugs could increase if prescription authority is provided to primary health care workers without proper training and supervision. • The supervision and monitoring of psychotropic drugs at the district level is minimal so there are chances of misuse. |
Service providers | • Old generation psychotropic drugs listed in government’s free drug list have lots of side effects compared to the new generation drugs available on the market. • Some patients overdose on the drugs while others refuse to take psychotropic drugs due to side effects. • There are limited health workers in the district who can effectively diagnose and prescribe psychotropic drugs. Many medical officers do not feel confident in prescribing psychotropic drugs. • Patients are sometimes used by drug addicts to get the psychotropic drugs. |
Service users and family members | • Psychotropic drugs are effective but they have lots of side effects. • Due to stigma it is difficult for patients and family members to share that they are using psychotropic drugs. • Psychotropic drugs are not available at the community level, therefore, patients have to travel far distances to buy the drugs. • Doctors focus more on medication even for cases that could be managed by counselling and other social support interventions. |