Table 1.

Summary of methods used in a country situational analysis

Background

Development of the situational analysis approach in South-East Asia was requested by Member States [38, 39] and involves the systematic collection of data by a government multi-disciplinary team over 2 weeks using a pre-designed workbook tool [21] and supervised by WHO. The workbook tool (Additional file 2) builds on other tools [14, 23, 24] and was developed by WHO/SEARO during situational analyses done in 11 countries during 2010–13 and piloted for use by government staff in eight countries during 2014–15.

Methods

Visits are made to:  • all major MOH units and other agencies responsible for medicines management (supply, selection, use, regulation, policy, insurance and professional training) to understand what policies are in place and what each unit does.  • healthcare facilities, aiming to visit 20 facilities, two of each type of public facility (primary care centres and sub-centres, secondary and tertiary hospitals, with half of the facilities being primary care centres) plus private pharmacies (results not reported in this paper) in at least two provinces/regions, as selected by the MOH.

Data collection and Analysis

At the central level, staff are interviewed about the health system, what their unit does and what policies are in place.  At each health facility (whether hospital or health centre), the team reviews 30 primary care outpatient encounters (using whatever documentation is available at the facility, e.g. prescriptions held in the pharmacy or by the patient, paper slips in the pharmacy, patient records, or outpatient registers). The means for standard indicators of medicines use [23, 24] are calculated for each facility and each category of facility. Also, antibiotic use in 30 outpatient cases of upper respiratory tract infection is reviewed, although this is difficult in some countries where diagnosis is not recorded on the prescription. The basis for a diagnosis of upper respiratory tract infection is also recorded e.g. acute viral respiratory infection, pharyngitis, sore throat, rhinitis, runny nose, cough, cold, otitis media, earache, sinusitis, acute laryngitis and acute bronchitis.  The medicines’ supply and regulatory systems are also reviewed and health workers interviewed about medicine management policy implementation.  A descriptive analysis is done each day and presented by the team at a national workshop at the end of 2 weeks, and a country report published on the WHO/SEARO website after government approval [21, 38].