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Given ongoing south-south learning exchanges that are taking place between some of the African and Latin American countries, particularly with Brazil, perhaps it would be of relevance to highlight the Brazilian experience: --As it widely acknowleged, the reliable distribution of AIDS treatment drugs through the public system in Brazil has contributed since the early 2000s to significantly reduce AIDS-related hospitalizations, incidence of opportunistic infections, and mortality. Also, it would be appropaite to cite the results of a cross-sectional study using WHO drug indicators by Oliveira Silva Naves and Silver (Rev. Saúde Pública vol.39 no.2 São Paulo Apr. 2005) in the Federal District of Brazilia, that has a population of 2 millon inhabitants. The results show: --Significant progress has been achieved in assuring a fair drug stock for most primary care centers, physician's compliance with the Essential Drug List, and use of the generic denomination while prescribing: Of prescribed and non-dispensed drugs, 85.3% and 60.6% were on the local essential drug list (EDL) respectively. On average 83.2% of 40 essential drugs were in stock. The mean number of drugs per prescription was 2.3, 85.3% of prescribed drugs were on the EDL, 73.2% were prescribed using the generic denomination. --Drugs for specific vertical programs such as tuberculosis, as well as for contraception programs, were regularly supplied to the centers. --The observed proportion of antibiotics (26.4%) and injectable drugs (7.5%) prescribed may be considered acceptable according to WHO recommendations (20-30% and less than 10%, respectively). Moreover, most antibiotics and injectable drugs prescribed were recommended for primary care treatment. But, there is still much to be improved. The most dramatic problems identified by the study at that time were related to the extremely poor level of patient knowledge and understanding. Less than one in five patients understood what drug they were to take and how to take it. Similar results were found in other Brazilian cities such as Campo Grande, Salvador, Ribeirão Preto, and Fortaleza. As noted in the study, this low level of information can have serious consequences regarding the effectiveness and efficiency of the investment in essential drugs. Silva et al in another study cited in this study reported that, after outpatient visits in Rio Grande do Sul, only 34% had good knowledge regarding the drugs obtained. According to Fletcher, the term compliance refers to the degree in which patients follow the prescribed medical advice. Although initial analysis indicates that noncompliance to prescribed actions might suggest negligence or unwillingness to submit to medical advice, the study rightly notes that in fact many factors may contribute to that such as inadequate knowledge or prescription understanding. That, in turn, may be related to factors such as short visit and dispensing times, no pharmaceutical care practices in place, no pharmacy-generated labelling at the time of prescription, high frequency of illegible prescriptions, illiteracy, poorly trained workers performing the task of drug dispensing and low population schooling. Again, as suggested in my blog, this calls for strengthening processes and systems, including the adoption of clinical guidelines tied to funding allocations to the facilities or teams (an incentive to promote rational use of drugs). --The study concludes by stating that major progress in the quality of pharmaceutical assistance can be achieved by relatively low cost through investments in improving information to patients and more rational use.