1. Promoting Rational Drug Use in the Community Conducting a rapid appraisal to analyse problems and identify possible solutions

2. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 2 Objectives: Participants will be able to: 1. Describe the main methodological characteristics of rapid appraisals and their historical origins 2. Outline how rapid appraisals can be used to focus and analyse drug use problems and identify possible solutions 3. Develop a problem analysis diagram

3. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 3 Steps in an effective communication intervention

4. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 4 Rapid appraisal The Session: wIntroduction: What is RAP? wWhat are the historical roots of RAP wHow can RAP be use to focus and analyse drug use problems?  Activity: Develop a problem analysis diagram

5. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 5 What is a rapid appraisal?  Quick way to get info: –How do people describe the problem? –What are reasons for the problem? –What are possible solutions?  Using mix of qualitative and quantitative methods  Often participatory approach  Quick = 2 weeks - 3 months

6. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 6 Characteristics of RAP  Efficient: essential information only  Flexible: learn-as-you-go  Participatory:stakeholder participation in data gathering and analysis  Interactive: team members and disciplines work together  Triangulated: mix of methods

7. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 7 History of RAP  Early 1980s: RRA - Mainly used in agriculture  Mid 1980s: Increasingly used in health field/popular among NGOs  Late 1980s: PRA - more influence to target group, more attention for power  Early 1990s: PRA used by mainstream development agencies  Mid 1990s: more reflexive: attention for attitudes and behaviour of researchers and facilitators

8. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 8 Objectives: RAP on a drug use problem  Describe problems and sub-problems see how different stakeholders see the problem  Focus on core problem (or a series of sub problems) for intervention;  Analyse the core problem(s), by –identifying stakeholders’ perception of main causes –collecting additional information on these factors

9. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 9 Objectives RAP continued  Identify stakeholders ideas for possible solutions: –target audiences –proposed messages –communication channels  Identify factors which: – can facilitate interventions – are likely constraints to change

10. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 10 Steps (Manual: “Activities”) to conduct a RAP 1) Review literature, unpublished reports, secondary data 2) Key informant interviews: further describe problem and sub ‑ problems; gain insight into reasons for present practices 3) Multi-stakeholder workshop: focus on a core problem(s), further define causes;develop a problem analysis diagram 4)Fieldwork on a core problem as a basis for community health education interventions 5)Finding solutions

11. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 11 Step 1 ‑ Review of available data:  What do we know about problem in local settings?  Have studies on problem been done elsewhere?  What reasons for the problem were identified?  What sub ‑ problems have been described?  What population groups are affected?  What can you learn from drug sales statistics in your country?  Have studies been done on community members' perception of the problem in your country?  What data are still lacking?

12. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 12 Step 1 continued Sources of secondary data:  Computerised literature search, e.g. in Medline and Popline  INRUD Drug Use Bibliography (Over 4,200 entries)  IRENE: New website on intervention studies for RDU  Documentation centres, e.g. UNICEF  Ask key informant for unpublished reports  Review sales statistics

13. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 13 Step 2 - Key Informant Interviews Key informants are:  people who are affected by the problem  community leaders  teachers  community health workers  pharmacists, other drug sellers  staff of health programmes  researchers specialised in community health  staff of consumer organisations and health and development NGOs.

14. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 14 Example of sub-problems: Key informant interviews on use of ABs  In self-care people tend to use antibiotics for non-severe conditions that could be treated with home remedies or less strong drugs. People use antibiotics because they fear conditions will worsen and become life threatening.  Antibiotics are sold illegally by informal providers, who may or may not know how to use these drugs correctly.  Consumers have "learnt" which antibiotics to take for which conditions from observing prescriptions given for former illness episodes.  Economic reality leads patients to buy a few "magic capsules" expecting instant cure from powerful drugs.

15. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 15 Sub-problems continued:  Health workers over-prescribe antibiotics for self ‑ limiting conditions, because they fear criticism by clients if they fail to treat the illness adequately.  When prescribed: people don't comply with the advice to use a full course of antibiotics. They don't see why they should continue to buy medicines when condition has improved.  Neither health workers nor informal providers give people adequate advice on WHY they should take a full course of the medicines, and thus do not motivate the consumers to take the (biomedically) right action.

16. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 16 Step 3: Multi-stakeholder workshop Suggested objectives:  Review the list of problems identified in step 2 and identify core problem(s)  Develop a problem analysis diagram  Review factors contributing to the problem  Are there additional factors to be added to the diagram?

17. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 17 Group Activity: developing a problem analysis diagram  Review background information  Define core problem and related sub- problems  Identify community/individual factors related to core problem  Identify health institution/national factors  Play around with factors till they form a coherent diagram  Formulate a main objective and specific questions for fieldwork

18. WHO Conducting a rapid appraisal to analyse problems and identify possible solutions Promoting Rational Drug Use in the Community 18 Problem analysis