Developed by: World Health Organization (WHO)

Objective: To improve the quality and cost efficiency of care and define the most effective roles and responsibilities of a DTC.

Output: A model structure and organisation of a DTC and how it can be managed, as well as a series of assessments to help a DTC investigate the use of medicines.

Additional information: Inappropriate use of medicines wastes resources and seriously undermines the quality of patient care. In developing countries, medicines may account for 30-40% of the health budget. A DTC can significantly improve medicine use and reduce costs in hospitals and other health care facilities by providing a forum to bring together all the relevant people to work jointly to improve health-care delivery. As such, a DTC may be regarded as a tool for promoting more efficient and rational use of medicines. In many developed countries, a well-functioning DTC has been shown to be one of the most effective structures in hospitals able to address drug use problems. However, in many developing countries DTCs do not exist and in others they do not function effectively.

The guidance provided in this manual is aimed at all kinds of DTC - whether in public or private hospitals and at all levels, from district to tertiary referral level. Since health systems in different countries vary widely, not all the information included in this manual will be relevant for all DTCs. Several assessment tools for investigating medicines use by a DTC are included in the manual.

Process and resources:

• A DTC can only work in health systems where there is a national policy to support DTCs, for example, that DTCs be one of the accreditation criteria for hospitals as teaching institutions.
• A multi-disciplinary team of doctors, pharmacists, hospital managers and other professionals with the necessary technical skills is needed to form a DTC.
• A DTC training course was developed by MSH’s Rational Pharmaceutical Management Plus in collaboration with the WHO in 2001 and revised in 2007. All the training modules can be accessed at: http://www.msh.org/projects/rpmplus/Resources/TrainingInitiatives/All-DTC-Training-Guides.cfm
• Running an international training course of two weeks costs about US$100 000 for 30 participants. It is envisaged that once two national personnel are trained, they could conduct national training courses and undertake follow-up activities for about US$30,000 per country.

Link to the tool:  http://apps.who.int/medicinedocs/en/d/Js4882e/