This page details Nyaya Health's approach to pharmaceutical procurement. 

Essential Medicines

Click here to access our essential medicines list: 

http://spreadsheets.google.com/ccc?key=0AtZQBHyI2oBYdG9rZDBlaVFLQXdETnlzeWkwRlhEMWc&hl=en 

For comparison, see the WHO essential medicines list

Related Nyaya Health Resources

The pharmaceutical system should be designed in concert with the overall triage and treatment plan, which we describe on these pages:

PharmacyData

Triage

PrimaryCareProtocols

ProcurementManagement

Points pertaining to when Not to stock certain medicines

Symptomatic medicines for common conditions

It is critical to establish solid prescribing patterns for these-- acetaminophen/paracetamol, NSAIDs, PPIs/H2 blockers, anti-histamines-- since they are incredibly common and are typically prescribed in non-evidence-based ways by rural quacks in resource-deprived areas. We ultimately chose in the beginning to develop Triage and Treatment protocols to address common conditions and prescribe many of these medicines but not dispense them.

IV PPIs

Most UGIB's don't require immediate endoscopy (within 12-24 hours), but could be done once stabilized. Those that do require immediate endoscopy are likely to require blood and aren't likely to survive anyways. We could have 10 doses on hand, given the first two with some fluids and refer.

Anti-spasmodics

Very little role except perhaps in someone who was so incapacitated s/he couldn't walk.

Anti-emetics

These could be of value when used judiciously while the patient is in the clinic. If the patient is well enough to go home, then they likely don't need it, but if they are on their back in the clinic it is worth treating the emesis.

Stock finasteride in a primary/acute care clinic?

I've had patients come in to the rural clinic in south africa with a big bladder and obstruction from BPH, and the appropriate management would be stick in foley, start a BPH agent, and then pull it in a week or so for voiding trial. This can turn someone's life around and otherwise we have to refer them to Dhangadi for a simple primary care problem.

Alpha blockers are several fold cheaper and may work faster (though have more side effects and is more complicated to titrate). so we'll go with terazosin, which is what is available there. i'll write up a really quick protocol on how to do that and counsel patients, b/c it's a med that requires a lot of counseling and titration.

We'll plan to keep a small supply around (2 weeks) for the one person a year with this issue and can order more once we need it.

Any need to stock SSRIs?

I don't think so. In the beginning of scaling up primary health services, mental health services are very difficult to provide, so I can't think of a good reason to have these around. I could definitely see having amitriptyline around for true peripheral neuropathic pain (or desipramine, which is the preferred agent due to equal efficacy with lower side effects). If we see any HIV, we're bound to see loads of peripheral neuropathy. Same of course with DM.