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Sociology of Law: Theories and Concepts

Sociology of Law Theories and ConceptsIntroductionThe three degreeical thinkers of Sociology, Marx, Weber and Durkheim have i function in common regarding the Sociology of Law their theories were part and parcel of a more fundamental sociological perspective and theory of society. Marx will be the odd one among the three because, the work of Marx is on conjectural ground not evidently connected to the aspirations of sociology, but diachronicly Marxs writings have informed a respectable body of sociological writings until this day. Marx made a contribution to brotherly science by suggesting the dickalist theory of law in contributing to and justifying well-disposed inequality. Durkheims work orients around the key dimensions of complaisant issues as involving both factual and normative dimensions of society. Whereas Weber is considered as the founding father par excellence of the advanced(a) sociology of law. When Weber observed that sociable life in the modern era had beco me more and more rationalized in a purposive-rational sense, he no single contemplated the central role of economy, stat, and bureaucracy, but along with it also discussed the role of law as the substructure of modern political authority. Weber specific everyy outlined the characteristics of a formally rationalized legal organization that is primarily guided by the application of procedure.Sociology of LawThe sociology of law is often depict as a sub-discipline of sociology or an interdisciplinary approach within legal studies. While some socio-legal scholars see the sociology of law as necessarily belonging to the discipline of sociology, others see it as a scene of action of research caught up in the disciplinary tensions and competitions between the two established disciplines of law and sociology. Yet, others regard it neither as a sub-discipline of sociology nor as a assort of legal studies and, instead, present it as a field of research on its give birth right within a broader mixer science tradition. For example, Roger Cotterrell describes the sociology of law without grapheme to mainstream sociology as the systematic, theoretically grounded, empirical study of law as a set of social practices or as an aspect or field of social experience.Irrespective of whether the sociology of law is defined as a sub-discipline of sociology, an approach within legal studies, or a field of research in its own right, it clay intellectually dependent mainly on mainstream sociology, and to lesser extent on other social sciences such as social anthropology, political science, social policy, criminology and psychology, i.e. it draws on social theories and employs social scientific methods to study law, legal institutions and legal behaviour.More specifically, the sociology of law consists of various sociological approaches to the study of law in society, which empirically examines and theorizes the fundamental interaction between law and legal institutions, on the one hand, and other (non-legal) social institutions and social factors, on the other. Areas of socio-legal inquiry include the social climb upment of legal institutions, forms of social control, legal regulation, the interaction between legal cultures, the social construction of legal issues, legal profession, and the relation between law and social change.The sociology of law also goods from and from time to time draws on research conducted within other fields such as comparative law, critical legal studies, jurisprudence, legal theory, law and frugals and law and literature.The determinate ThinkersThe roots of the sociology of law can be traced back to the works of sociologists and jurists of the turn of the previous century. The relationship between law and society was sociologically explored in the germinal works of both Max Weber and Emile Durkheim. The works of Karl Marx was not immediately influential in the development of the sociology of law as no direct historical pa th led from his thought to subsequent sociological schools of thought. Marxs work was later appropriated by critical sociologists who sought to break with the consensual thinking that they felt characterized a great deal of mainstream sociology in the years after World War II. The writings on law by these classical sociologists are foundational to the entire sociology of law today. A keep down of other scholars, mainly jurists, also employed social scientific theories and methods in an attempt to develop sociological theories of law. Notably among these were Leon Petrazycki, Eugen Ehrlich and Georges Gurvitch.Marxs theory is not to be tacit merely as a theory of the economy, for his analysis of capitalism is meant to provide the basis for an analysis of society. The economic organization of society is its material core from which all other social developments in matters of politics, culture, and law can be explained. This is summarized in Marxs famous dictum that the infrastructu re of a society determines it superstructure. Thus, the division between the economic classes of owners and non-owners appears at the societal level as a class antagonism between the relatively small but powerful bourgeoisie and the relatively greathearted but powerless proletariat. The bourgeoisie can articulate its economic power also at the political, cultural, and legal level because of its control over all primary(prenominal) institutions of society, such as government, the legal system, art science, and education. The economic, according to Marx, notwithstanding the destruction of capitalism in favor of a communist mode of production, whereby the workers collectively own and control the means of production, world ensure a successful revolution of society in to a more just social order.Marx did not develop a comprehensive perspective on law and his ideas on law are scattered throughout his writings. Marxs theory of the state provides the most useful entre into his perspecti ve on law. Congruent with his materialist perspective, Marx asserts that the economic conditions of society determine what type of state will develop, which in a capitalist society implies that the state will be controlled by the bourgeoisie as an instrument to secure economic rights and to moderate class conflict. For him the capitalist state represents and secures the power of the dominant economic class which now also becomes the politically dominant class. Interestingly, Marx argues that the democratic republic, rather than being a more egalitarian form of the capitalistic state, for it totally disregards the property preeminence that have arisen under capitalism.Marxs notion on law is instrumentalist, similar to that of his notion of state. He views the legal system in function of its role as an instrument of control serving bourgeois interests. Rather than abiding by a principle of the rule of law that holds that it is just for the law to be applied evenly and fairly to all, Marx maintains that capitalist law actually enhances the conditions of inequality that mark capitalist society. Marx contends that the capitalist legal system contributes to inequality because capitalist law establishes and applies individualized rights of freedom, which benefit those who own while disfavoring those who are without property. The formal equality that is granted in law by treating the various parties that are in contract with one another(prenominal) or with the state as equal contributes to sustain and develop the economic inequalities that exist among legal subjects. Legal doctrine justifies the practices of capitalist law on the basis of a notion of justice claimed to be universally valid but which in actuality serves the interests of only the dominant economic class. The ideology of capitalist law is in the long run accepted widely even among those members of society who are economically disadvantaged and thus additionally subject to the inequalities brought abou t by the legal system.For Max Weber, a so-called legal rational form as a type of domination within society, is not attributable to people but to abstract norms. He understood the body of coherent and calculable law in terms of a rational-legal authority. Such coherent and calculable law formed a set up for modern political developments and the modern bureaucratic state and demonstrable in parallel with the growth of capitalism. Central to the development of modern law is the formal rationalisation of law on the basis of general procedures that are applied equally and fairly to all. Weber specifically outlined the characteristics of a formally rationalized legal system that is primarily guided by the application of procedures. His analysis of law is an intrinsic part of his sociology, in terms of both its perspective of the study of society and its theoretical propositions on the conditions of modern society. Modern rationalised law is also codified and impersonal in its applicat ion to specific cases. In general, Webers standpoint can be described as an external approach to law that studies the empirical characteristics of law, as opposed to the internal perspective of the legal sciences and the moral approach of the philosophy of law.Weber developed his perspective on law as part of a more general sociology. In the systematic nature and comprehensive scope of its contribution, Webers analysis is rivaled only by that of Emile Durkheim, whose sociology of law was likewise part and parcel of a more fundamental sociological perspective and theory of society.Emile Durkheim wrote in The Division of Labour in Society, that as society becomes more complex, the body of civil law concerned primarily with restitution and compensation grows at the expense of criminal laws and penal sanctions. oer time, law has undergone a transformation from repressive law to restitutive law. Restitutive law operates in societies in which there is a high degree of individual variation and ferocity on personal rights and responsibilities. For Durkheim, law is an indicator of the mode of integration of a society, which can be mechanical, among identical parts, or organic, among differentiated parts such as in industrialized societies. Durkheim also argued that a sociology of law should be developed alongside, and in close connection with, a sociology of morals, studying the development of value systems reflected in law.At sociologys heart is a concern for piety. For Durkheim, society cannot exist without moral bonds, whether these are bonds of shared belief or of mutual commitment reflecting the interdependence of individuals or social groups. Moral ideas are neither innate in the individual nor to be deduced from abstract first principles. They are inspired by the empirical conditions of social lie in particular times and places. To understand those conditions and the forces that shape social development is rationally to appreciate moralitys demands. Morality p rovides the normative framework of stable social relationships. In modern society these relationships are primarily domestic, economic and occupational and political relationship of citizenship. Morality expresses the requirements of living together in particular environments the domain of the moral begins where the domain of the social begins (Durkheim, 196160). For Durkheim, Moral ideas are the soul (lame) of the law(1909150). Law expresses what is fundamental in any societys morality. So the study of law like that of morality is central to sociology.ConclusionAmong the three classic thinkers Marx did not focus on law to any degree of intellectual satisfaction, while the sociological contributions of Weber and Durkheim are not only influential but foundational to the sociology of law.

Research into Rational Drug Prescribing in Yemen

Research into Rational Drug Prescribing in YemenCHAPTER 11.0 IntroductionIn Yemen as well as in many an(prenominal) other maturation countries the eccentric of wellness services which constitute social indicators of justice and equity is out-of-the-way(prenominal) from being satisfactory. In curb, ineffective, and inefficient utilise of doses comm wholly occurs at different wellness facilities (Abdo-Rabbo, 1993 Abdo-Rabbo, 1997). Ir reasonable prescribing is a habit, which is difficult to cure. This whitethorn authorize to ineffective preaching, wellness jeopardizes, patient non-compliance, medicine wastage, wasteful of resources and costless expenditure. According to the Yemeni constitution, patients contain the even out to wellness cargon and discretionment i.e. wholeow c atomic go 18, consent to treatment and satisfying safety. thitherfore, health workers should concentrate on fashioning patients better and patients should concentrate on geting better. he alth c ar in general and particularly the do medicates situation in any country is influenced by the availability, affordability, and admittanceibility of medicates as well as the prescribing practices. There be many individuals or factors influence the ir quick-scented prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug tuition and mis cultivation (Geest S. V. et al, 1991 Hogerzeil H. V., 1995).Improving sensible mapping of drugs (RUD) is a very complex task worldwide beca expend changing behavior is very difficult. The 1985 Nairobi conference on the acute practice of drugs marked the start of a global effort to promote quick-scented prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug part had been comelyly magazine-tested in developing countries (Laing et al., 2001).The selection of drugs to satisfy the he alth pauperizations of the population is an grievous comp unitynt of a guinea pig drug polity. The selected drugs argon c eached requisite drugs which argon the most asked for the health tending of the majority of the population in a given locality, and in a proper dosage forms. The national constitute of requirement drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and none, represent- effectiveness and allocated financial resources.WHOs mission in innate drugs and medicines policy is to help save lives and purify health by closing the huge gap between the potential that requirement drugs concord to offer and the reality that for millions of people particularly the poor and disfavor medicines argon un open, un affordable, unsafe or improperly utilise. The organization works to fulfill its mission in all important(p) drugs and medicines policy by providing global guidance on indwelling drugs and medicines, and working with countries to implement national drug policies to contain equity of access to of the essence(p) drugs, drug quality and safety, and rational handling of drugs. Development and effectuation of national drug policies are carried out inside the overall national health policy context, with fretting taken to ensure that their goals are consistent with all-embracinger health objectives. All these activities ultimately contri stille to all four WHO strategic directions to sheer the excess mortality of poor and marginalized populationsreduce the leading risk factors to human healthdevelop sustainable health systems,anddevelop an enabling policy and institutional environment for securing health gains.The greatest impact of WHO medicines activities is, and will continue to be, on trim excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems.The people of our world do non need to bear the present level of illness. Most of the severe illness that af fects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care including essential medicines, vaccines and technologies. Millions footnot they privynot get the help they need, when they need it. As a result they beat unnecessarily, make out poorer and may die young. A countrys health service send packingnot respond to peoples postulate unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very cardinal measure of the quality of the health service. It is hotshot of the key indicators of equity and social justice.(Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on investigating of Medicines, Brasilia, 4 April 2000).1.1 Background1.1.1 Brief biography of antibiotic drug drugsAccording to the original explanation by Waksman, antibiotics substances which are produced by microo rganisms and which exhibit either an disallowory or ruinous effect on other microorganisms. In a wider, though not universally accepted definition antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth processes (Reiner, 1982).Up to now, more(prenominal)(prenominal) than 4,000 antibiotics create been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only almost 100 are utilize clinically as the healing(predicate) utility not only depends on a high gear antibiotic activity and withal on other important properties such as right-hand(a) tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are accordingly rehearsed a large extent and constitute the largest figure of medicaments with respect to turnover value. Today, antibiotics are also applyd in veterinary medicine and as additives to animal feed. In the past they were delectationd addition, as plant protection brokers and as food preservatives.In this freshen we have confined ourselves to a apprise description clinically utilizable antibiotics. These belong to various classes of chemical compounds, differ in origin, mechanism of fill and spectrum activity, and are thus important and representative examples of known antibiotics.1.1.2 Problem instructionThis study examines drug white plague in Yemen and factors leading to conflicting part of medicines particularly antibiotics and the prescribing anatomy. It defines rational drug use and describes policy developments, which aim to encourage appropriate use.In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on reservation patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that worthys their own requirements for an suitable period of fourth dimension and at the lowest cost to them and their lodge (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It involves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient distance of time according to standard treatment. Furthermore, it involves supervise the effect of the drug both on the patient and on the illness.There is plentiful evidence of the inappropriate use of drugs, not through self-medication or wildcat prescribing, but inadequate aesculapian checkup prescribing and dispensing.Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and wi th expectations about the care they typically receive they typically leave of absence with a package of drugs or with a prescription medicine to obtain them in a private market. In old study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported meter and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the community and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in almost shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs.1.1.2.1 foreign Drug utilizeIncreasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as modify health, cornerstone lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992 WHO, 1988). hostile drug use may include under-use, over-use, over-supply, non-compliance, uncomely drug reactions and accidental and curative poisoning (DHHCS, 1992). It also includes medicating where on that point is no need for drug use, the use of newer, more costly drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985).1.1.2.2 select Use of MedicinesIn an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The declared aim of the policy is to optimise m edicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are a good deal required for prevention, control and treatment of illness. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a equipment casualty people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and durati on of drug therapy and the inadequate review of drug therapy once it has been initiated.1.1.2.3 The Requirement of Drug development for Quality Use of MedicinesA medicine has been describe as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been deuce of the factors consistently identified as required for rational drug use (Naismith, 1988 Soumerai, 1988 Carson et al, 1991 Dowden, 1991 Henry and Bochner, 1991 Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the can for appropriate prescribing decisions by medical practitio ners. checkup practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is available to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines.1.1.2.4 Problem with antibiotic useThe concerns regarding inappropriate antibiotic use can be divided into four areas efficacy, toxicity, cost, and resistance. unbefitting use of antibiotic can be due to Antibiotic use where no contagion is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery.Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection.The aggrieve drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia.The wrong dose or duration of therapy.S uch inappropriate use has a mensural effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were apply (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria.Inappropriate antibiotic use exposes patients to the risk of drug toxicity, patch giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and in time direct and indirect side do of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognize and have been described in reaction to antibiotic residues in food (Barragry, 1994).Life threatening side effects may be occur from the use of antibiotics for plainly simple infections, it is estimated, for example, that eight peop le per course in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993).The medical expediency of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolat e of Staphylococcus aureus was described only two years after the universe of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so quickly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The Brobdingnagian quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to emergence of infection due to to the highest degree untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has lately caused outbreaks in hospitals in London (Hiramatsu et al., 1997).Anti-infective are vital drugs, but they are over prescribed and overused in treatment of meek disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria get down resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999).Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule.How does one ensure that good drug are not naughtily used, misused, or even abused?How can drugs be used rationally as intended?What is rational use of drugs? What does rational mean?1.1.3 Rational Use of DrugRational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994).These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis) in defining effective and safe treatments (drugs and non-drugs) in selecting appropriate drugs, dosage, and duration in writing a prescription in giving patients adequate information and in planning to evaluate treatment responses. The definition implies that rational use of drugs especially rational prescribing should meet trusted criteria as follows (Ross et al., 1992) countenance indication. The decision to prescribe drug(s) is solely based on medical rule and that drug therapy is an effective and safe treatment.Appropriate drug.The se lection of drugs is based on efficacy, safety, suitability, and considerations.Appropriate patient. No contraindications exist and the likelihood of unfavourable reactions is minimal, and the drug is acceptable to the patient.Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed.Appropriate monitoring. The anticipated and un evaluate effects of medications should be appropriately monitored (Vance and Millington, 1986).Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or inconclusive prescribing. absurd prescribing may be regarded as diseased prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following formsThe use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections,The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS,The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in chills and fever diarrhea,The use of drugs of uncertain safety status, e.g., use of dipyrone,Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against morbilli or tetanus, failure to prescribe ORS for acute diarrhea,The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate.The use of unnecessarily expensive drugs, e.g., the use of a third gear generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated.Some examples of commonly encountered inappropriate prescribing practices in many health care settings include (Avorn et al., 1982).Overuse of a ntibiotics and antidiarrheals for non-specific childhood diarrhea,Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment,Drugs already prescribed, andExcessive use of antibiotics in treating minor respiratory tract infection.The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter.Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines.1.1.3.1 Factors underlying Irrational Use of DrugsThere are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving fro m patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992).Table 1.1 Factors affecting irrational use of drugImpact of Inappropriate Use of DrugsThe impact of this irrational use of drugs can be seen in many ways (Avorn et al., 1982).Reduction in the quality of drug therapy leading to increase morbidity and mortality,Waste of resources leading to reduced availability of other vital drugs and increased costs,Increased risk of cast-off(prenominal) effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis,Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs.1.1.3.2 The Rational Prescription (i.e. the right to prescribe)The rights to prescription writing must be ensuring the p atients five rights the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full give away and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not truncated, using approved titles only. process and dose frequency should be stated in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998).1.2 Overview on intrinsic Drug Concept (EDC) meaty drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year publish the first model sway of essential drug a nd WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE that mean safety , availability, need efficacy (John, 1997). The essential drug concept is important in ensuring that the abundant majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost (New Straits Times, 1997a).In hold out of this concept, the WHOissued a model drug contestation that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been print. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such exact revision, the number of drugs in the list carcass at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Yemen to focus on becoming self-reliant where generic equivalents of essential drugs can be manufactured and popularized to meet the health needs of the majority of the people.The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless o f national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug form _or_ system of government was toPrepare a list of essential drugs to meet the health of needs of the people.Assure that the essential drugs made available to the public are of good qualityImprove prescribing and dispensing practicesPromote rational use of drug by the publicLower cost of the drugs to the government and publicReduce foreign exchange expenditure1.3 Yemen Essential Drug List and Drug Policy in YemenThe Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurance at national level but also for establishing drug requirements at various levels within the health care system.The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price that these drugs are safe and effective and that they are prescribed and used rationally.The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and use this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The wink edition of the Yemen Drugs list and the Yemen bar Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996) MoPHP/NSTG, (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same tract (MoPHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated.Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994).The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the identification of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs lie in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences re main unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals.The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as new are minor variations of existing drug preparations and do not always represent a significant treatment improvement. In addition, the vast number brand name calling products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world.The regular supply of drugs to treat the most common diseases was a major problem for governments in low-inco me countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients touch in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other interested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country.The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has nResearch into Rational Drug Prescribing in YemenResearch into Rational Drug Prescribing in YemenCHAPTER 11.0 IntroductionIn Yemen as well as in many other developing countries the quality of health services which constitute social indicators of justice and equity is far from being satisfactory. Inappropriate, ineffective, and inefficient use of drugs commonly occurs at different health facilities (Abdo-Rabbo, 1993 Abdo-Rabbo, 1997). Irrational prescribing is a habit, which is difficult to cure. This may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasteful of resources and needless expenditure. According to the Yemeni constitution, patients have the right to health care and treatment i.e. appropriate care, consent to treatment and acceptable safety. Therefore, health workers should concentrate on making patients better and patients should concentrate on geting better.Health care in general and particularly the drug situation in any country is influenced by t he availability, affordability, and handiness of drugs as well as the prescribing practices. There are many individuals or factors influence the irrational prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug information and misinformation (Geest S. V. et al, 1991 Hogerzeil H. V., 1995).Improving rational use of drugs (RUD) is a very complex task worldwide because changing behavior is very difficult. The 1985 Nairobi conference on the rational use of drugs marked the start of a global effort to promote rational prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug use had been properly tested in developing countries (Laing et al., 2001).The selection of drugs to satisfy the health needs of the population is an important component of a national drug policy. The selected drugs are called essential drugs which are the most ne eded for the health care of the majority of the population in a given locality, and in a proper dosage forms. The national list of essential drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and quality, cost- effectiveness and allocated financial resources.WHOs mission in essential drugs and medicines policy is to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor and disadvantaged medicines are unavailable, unaffordable, unsafe or improperly used. The organization works to fulfill its mission in essential drugs and medicines policy by providing global guidance on essential drugs and medicines, and working with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs. Development and implementation of national drug policies are carried out within the overall national health policy context, with care taken to ensure that their goals are consistent with broader health objectives. All these activities ultimately contribute to all four WHO strategic directions toreduce the excess mortality of poor and marginalized populationsreduce the leading risk factors to human healthdevelop sustainable health systems,anddevelop an enabling policy and institutional environment for securing health gains.The greatest impact of WHO medicines activities is, and will continue to be, on reducing excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems.The people of our world do not need to bear the present burden of illness. Most of the severe illness that affects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care including essential medicines, vaccines and technologies. Millions cannot they cannot get t he help they need, when they need it. As a result they suffer unnecessarily, become poorer and may die young. A countrys health service cannot respond to peoples needs unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice.(Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on Investigation of Medicines, Brasilia, 4 April 2000).1.1 Background1.1.1 Brief history of antibioticsAccording to the original definition by Waksman, antibiotics substances which are produced by microorganisms and which exhibit either an inhibitory or destructive effect on other microorganisms. In a wider, though not universally accepted definition antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth pro cesses (Reiner, 1982).Up to now, more than 4,000 antibiotics have been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only about 100 are used clinically as the therapeutic utility not only depends on a high antibiotic activity but also on other important properties such as good tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are therefore used a large extent and constitute the largest class of medicaments with respect to turnover value. Today, antibiotics are also used in veterinary medicine and as additives to animal feed. In the past they were used addition, as plant protection agents and as food preservatives.In this review we have confined ourselves to a brief description clinicallyuseful antibiotics. These belong to various classes of chemical compounds , differ in origin, mechanism of action and spectrum activity, and are thus important and representative examples of known antibiotics.1.1.2 Problem StatementThis study examines drug use in Yemen and factors leading to inappropriate use of medicines particularly antibiotics and the prescribing pattern. It defines rational drug use and describes policy developments, which aim to encourage appropriate use.In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on making patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that meets their own requirements for an adequate period of time and at the lowest cost to them and their community (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It i nvolves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient length of time according to standard treatment. Furthermore, it involves monitoring the effect of the drug both on the patient and on the illness.There is plentiful evidence of the inappropriate use of drugs, not through self-medication or unauthorized prescribing, but inadequate medical prescribing and dispensing.Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and with expectations about the care they typically receive they typically leave with a package of drugs or with a prescription to obtain them in a private market. In previous study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported quantity and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the commu nity and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in some shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs.1.1.2.1 Inappropriate Drug UseIncreasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as improving health, can lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992 WHO, 1988). Inappropriate drug use may include under-use, over-use, over-supply, non-compliance, adverse drug reactions and accidental and therapeutic poisoning (DHHC S, 1992). It also includes medicating where there is no need for drug use, the use of newer, more expensive drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985).1.1.2.2 Quality Use of MedicinesIn an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The stated aim of the policy is to optimise medicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are often required for prevention, control and treatment of illness. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a price people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and duration of drug therapy and the inadequate review of drug therapy once it has been initiated.1.1.2.3 The Requirement of Drug Information for Quality Use of MedicinesA medicine has been described as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been two of the factors consistently identified as necessary for rational drug use (Naismith, 1988 Soumerai, 1988 Carson et al, 1991 Dowden, 1991 Henry and Bochner, 1 991 Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the basis for appropriate prescribing decisions by medical practitioners. Medical practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is available to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines.1.1.2.4 Problem with antibiotic useThe concerns regarding inappropriate antibiotic use can be divided into four areas ef ficacy, toxicity, cost, and resistance. Inappropriate use of antibiotic can be due to Antibiotic use where no infection is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery.Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection.The wrong drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia.The wrong dose or duration of therapy.Such inappropriate use has a measurable effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were used (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria.Inappropriate antibiotic use exposes patients to the risk of drug toxicity, wh ile giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and yet direct and indirect side effects of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognized and have been described in reaction to antibiotic residues in food (Barragry, 1994).Life threatening side effects may be occur from the use of antibiotics for apparently simple infections, it is estimated, for example, that eight people per year in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993).The medical benefit of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolate of Staphylococcus aureus was described only two years after the introduction of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so rapidly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The vast quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to emergence of infection due to virtually untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has deep caused outbreaks in hospitals in London (Hiramatsu et al., 1997).Anti-infective are vital drugs, but they are over prescribed and overused in treatment of minor disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria become resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999).Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule.How does one ensure that good drug are not badly used, misused, or even abused?How can drugs be used rationally as intended?What is rational use of drugs? What does rational mean?1.1.3 Rational Use of DrugRational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994).These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis) in defining effective and safe treatments (drugs and non-drugs) in selecting ap propriate drugs, dosage, and duration in writing a prescription in giving patients adequate information and in planning to evaluate treatment responses. The definition implies that rational use of drugs especially rational prescribing should meet certain criteria as follows (Ross et al., 1992)Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment.Appropriate drug.The selection of drugs is based on efficacy, safety, suitability, and considerations.Appropriate patient. No contraindications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient.Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed.Appropriate monitoring. The anticipated and unexpected effects of medications should be appropriately monitored (Vance an d Millington, 1986).Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. Irrational prescribing may be regarded as pathological prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following formsThe use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections,The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS,The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhea,The use of drugs of uncertain safety status, e.g., use of dipyrone,Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhea,The use of correct drugs with in correct administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate.The use of unnecessarily expensive drugs, e.g., the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated.Some examples of commonly encountered inappropriate prescribing practices in many health care settings include (Avorn et al., 1982).Overuse of antibiotics and antidiarrheals for non-specific childhood diarrhea,Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment,Drugs already prescribed, andExcessive use of antibiotics in treating minor respiratory tract infection.The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter.Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines.1.1.3.1 Factors Underlying Irrational Use of DrugsThere are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving from patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992).Table 1.1 Factors affecting irrational use of drugImpact of Inappropriate Use of DrugsThe impact of this irrational use of drugs can be seen in many ways (Avorn et al., 1982).Reduction in the quality of drug therapy leading to increased morbidity and mortality,Waste of resources leading to reduced availability of other vital drugs and increased costs,Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis,Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs.1.1.3.2 The Rational Prescription (i.e. the right to prescribe)The rights to prescription writing must be ensuring the patients five rights the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full name and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not abbreviated, using approved titles only. Dose and dose frequency should be stated in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998).1.2 Overview on Essential Drug Concept (EDC)Essential drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year published the first model list of essential drug and WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE that mean safety , availability, need efficacy (John, 1997). The essential drug concept is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy re levant to their health care needs, and at reasonable cost (New Straits Times, 1997a).In support of this concept, the WHOissued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC wi ll enable Yemen to focus on becoming self-reliant where generic equivalents of essential drugs can be manufactured and popularized to meet the health needs of the majority of the people.The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug Policy was toPrepare a list of essential drugs to meet the health of needs of the people.Assure th at the essential drugs made available to the public are of good qualityImprove prescribing and dispensing practicesPromote rational use of drug by the publicLower cost of the drugs to the government and publicReduce foreign exchange expenditure1.3 Yemen Essential Drug List and Drug Policy in YemenThe Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system.The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price that these drugs are safe and effective and that they are prescribed and used rationally.The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and implemented this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The second edition of the Yemen Drugs list and the Yemen Standard Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996) MoPHP/NSTG , (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same booklet (MoPHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated.Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994).The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the recognition of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs remain in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences remain unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals.The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as new are minor variations of existing drug preparations a nd do not always represent a significant treatment improvement. In addition, the vast number brand names products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world.The regular supply of drugs to treat the most common diseases was a major problem for governments in low-income countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients involved in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other inte rested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country.The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has n

Factors that influence individual and group dynamics

Factors that influence individual and concourse dynamicsIntroduction arrangingal Behavior has begin a ch solelyenging hot topic among many groups who argon interested to resume the individual and group manner of pile running(a) as teams in compositions. The term governingal behavior whitethorn have many definitions. According to Debra (2008), organizational Behavior is the study of individuals and their behavior indoors the setting of the boldness in a perishplace setting. She describe it is an interdisciplinary field that includes sociology, psychology, communication and management. There argon also views that it is not only the study of how organizations behave, just now rather the study of individual behavior in an organizational setting. This includes the study of how individuals behave alone, as well as how individuals behave in groups.The purpose of this establish is to gain a greater understanding of those factors that influence individual and group dynamics i n an organizational setting so that individuals and the groups and organizations to which they belong may become more efficient and effective. It also includes the analysis of organizational factors that may have an influence upon individual and group behavior. However the literature review help the power of this raise to realize that much of organizational behavior research is ultimately aimed at providing human resource management professionals with the information and tools they need to select, train, and retain employees in a fashion that yields maximum utility for the individual employee as well as for the organization. Going beyond that this audition allow discuss Leadership and flip management aspects of organizational behavior.Author V.G.Kondalkar describes Organizational behavior is a field of study that investigates the impact that individuals, groups and organizational anatomical structure have on behavior within the organization, for the purpose of applying such knowledge towards improving an organizational effectiveness. There for organization behaviors jakes be discussed in different take aims including Individual, group and organization structure.Individual gatheringStructureStudying these distinct different levels, may helps to understand the organizational behavior at a broader port so that it could see the different aspects at all(prenominal) level which the managers sack up use to facilitate their day-to-day job.Individual level of analysisAt the individual level of analysis, organizational behavior involves the study of encyclopaedism, perception, creativity, motivation, personality, duty tour everyplace, task effect, cooperative behavior, deviant behavior, ethics, and cognition. At this level of analysis, organizational behavior draws heavily upon psychology, engineering, and medicine.Taking Google as an example to this, Google recruit individuals with better(p) academic and uninflected capabilities. By this they expect a knowledge organization. The individuals coming from this kind of back ground will naturally bring in a studious learning nuance. There will not be an explicit necessity to motivate them towards learning. Their business is that they invent technologies specially related to internet. Business gets the competitory edge over its competitors by their innovations. To align this strategy they also recruit supra kind of people. They always encourage an entrepreneur culture where they expect a flatter structure and less power distance between individuals. So that they expect ideas coming from bottom to up to generate always creative ideas.Individuals tush be propel by different means. Motivation towards expected behavior is where organization can most benefit. Herzberg came up with deuce factor theory where he define almost(prenominal) implicit and explicit factors for motivation. Providing examples to the in effect of indirect motivating factors, organizations like Google offer 20% of their employees work meter to involve in a project which each individual like. Given more facilities to child c are, cracking food, health and entertainment Google wants to provide as many as intrinsic motivators. This was very victoryful as they fulfill the individual needs to a greater extent so that employees can involve their work with their Saul morality. It was one Einstein said people who work if it is just to avoid punishment or to gain the rewarding of good work as like in most religious teachings they will address the morality of individuals. It is just the veneration that makes that work done.There for this essay argue if organizations can really address the morality of individuals like what Google triumphfully did, they can have the most effective and pleasant work force. It was also highlighted in order to have a moral organization it should recruit people who are capable and self disciplined. On the another(prenominal) hand it will definitely need the support from organization Leadership and culture.However individuals form groups. In other words group behavior is influenced by individual behavior. But obviously group behavior has more power and has more strength. There for to have the best fitting group behavior for the organization it must have the right individuals. This individual behavior paves this essay to the way towards how an organization can best benefit the group behaviors.Group level of analysisAt the group level of analysis, organizational behavior involves the study of group dynamics, intra- and intergroup conflict and cohesion, leadership, power, norms, interpersonal communication, networks, and roles. At this level of analysis, organizational behavior draws upon the sociological and socio-psychological sciences.When there are groups it is naturally the first thing come to mind is leadership. Organizations can have many different groups. some measure they can be formal and obvious many condemnations they are informal. Th ese groups plays a vital role in an organization as these groups can be treated as energy cells, which c erstntrate some pockets of power. These pockets are very important to determine the success of organization. On the other hand this is where organizational politics and leadership comes in. As far-off as organizations are concerned most critical decisions are coming from director board. For example these decisions can be sanctioned only by majority. To make decisions effective and comes in to play they have to get the support of subordinates. As the research to Prof Robert Reich, he finds that many times the subordinates do not support to the logical accuracy of decisions, barely they support to the personal traits or any other leadership traits. There most the time subordinates address issues with gut feelings. This is why group behavior is so important. If organizations can form groups which doesnt obey only to the gut feeling but put some effort to overcome mental resistanc es and come to some rational decisions such kind of organizations do better in business. Richard trading, one local company once employed only board members from two families. At the board they always had this power struggle. But ultimately the board was introduced with professionals and the group started performs than never before. Because their group directors didnt bump to their gut feeling. This provides how group behaviors can be best effective to organizations. If an organization really focus on these group behaviors they can turn them in to their benefits. close to the time informal group behaviors seen bringing negativities to the organizations. But effectively used these behaviors can be used for organizations advantages.Human resources if managed well hold the key to the success of the organization. According to (Cranny, Smith Stone, 1992 ) human resources output is higher when the employee s function as a team than it is the case when employees do not work as teams . A synergetic effect is what cores when organizations embrace team spirit. However creating functional and efficient teams calls for expertise, tolerance and a lot of motivation on the part of the organization. Teams enable employees to exploit their potential and therefore increase job slaying. A team consists of members with diverse experience, skills and qualification. These diverse work group and synergy effects have contributed effectively to the organizations like Microsoft to gain competitive advantage by means of creativity and different thinking. It is accepted around the world that diverse work forces are part to facilitate rising idea generation and creativity. As understood the benefits of group behaviors to the organization enhanced through essence of diversification, companies like Microsoft earned best advantages. Microsoft in their web site acknowledges that they encourage synergy effects to the organization in the ways and means of diversity.Communication is also another area that organizations can immensely advantage of. Group and team theory of communication have also been studied to determine the best ways to form groups . The choice of communication representative is driven by the target recipient . It is important for organizations to understand the dynamics of each form of communication which will enable them to send messages effectively .Communication existence an integral part of human existence is the medium through which understanding is gained. In an organization , communication is important since it is the means by which people are able to work together to achieve common goals .Schermerhorn , Hunt , and Osborn (2005 ) defines a team as a formal group of people working together with an aim of achieving common goals . Teams are important in that, they improve performance in an organization , they enhance communication and they make an organization more competitive in that they draw from a wide range of talent . This paper looks at conflict resolution process in teams with an aim of analyzing how conflicts affect teams.Provided above this section of the essay argue that today organizations can best advantage if they effectively manage the effects of organization politics, synergy, diversity and communication at organizations group behaviors.Organization level of analysisAt the organization level of analysis, organizational behavior involves the study of topics such as organizational culture, organizational structure, cultural diversity, inter-organizational cooperation and conflict, channelise, technology, and international environmental forces. At this level of analysis, organizational behavior draws upon anthropology and political science. But the evolution of political nature was described during the group level analysis. Diversity and cultural level things will be discussed in the latter part. However this section mostly focuses in to the structural impact to the organization behavior.Structure in g uileless is the degree of complexity, formalization and centralization in the organization.Complexity is the degree of vertical, horizontal and spatial differentiation in an organizationFormalization is the degree to which jobs within the organization are standardized.Centralization is the degree to which decision making in concentrated at a single point in the organizationProvided above elements of structure it is obvious the structure may interact to people in terms of span of control and power distribution. As discussed before power is coming from others, or subordinates. The reason to power can be different. It can be informal like referent, expert, charismatic, or it can be formal Coming from position. Any way the correct planning of power may help organization to achieve their desired results.Elements of Organizational BehaviorThe organizations base rests on managements philosophy, values, vision and goals. This in turn drives the organizational culture which is composed of t he formal organization, informal organization, and the social environment. The culture determines the type of leadership, communication, and group dynamics within the organization. The workers perceive this as the quality of work life which directs their degree of motivation. The final outcome are performance, individual satisfaction, and personal growth and development. All these elements combine to build the archetype or framework that the organization operates from.Cultural elementA social system is a complex set of human relationships interacting in many ways. Within an organization, the social system includes all the people in it and their relationships to each other and to the outside world. The behavior of one member can have an impact, either directly or indirectly, on the behavior of others. Also, the social system does not have boundaries it ex deepens goods, ideas, culture, etc. with the environment around it.Culture is the conventional behavior of a society that encompa sses beliefs, customs, knowledge, and practices. It influences human behavior, even though it seldom enters into their conscious thought. People depend on culture as it gives them stability, security, understanding, and the ability to respond to a given situation. This is why people fear change. They fear the system will become unstable, their security will be lost, they will not understand the new process, and they will not know how to respond to the new situations.Individualization is when employees successfully exert influence on the social system by challenging the culture. But when challenging culture it must be deliberate because normally culture is seen as an iceberg to most management specialists. This nature of culture is very illusive and organization must best understand the culture if they are to do best in business. Cultural dimensions will be different from country to country and also from region to region, may be from organization to organization. This best explains w hy the same model may be success in one culture but not will be success in another culture.Models of Organizational BehaviorThere are four major models or frameworks that organizations operate out of, Autocratic, tutelary, Supportive, and CollegialAutocratic The basis of this model is power with a managerial orientation of authority. The employees in turn are oriented towards obedience and dependence on the boss. The employee need that is met is subsistence. The performance result is minimal.Custodial The basis of this model is economic resources with a managerial orientation of money. The employees in turn are oriented towards security and benefits and dependence on the organization. The employee need that is met is security. The performance result is passive cooperation.Supportive The basis of this model is leadership with a managerial orientation of support. The employees in turn are oriented towards job performance and participation. The employee need that is met is status a nd recognition. The performance result is awakened drives.Collegial The basis of this model is partnership with a managerial orientation of teamwork. The employees in turn are oriented towards responsible behavior and self-discipline. The employee need that is met is self-actualization. The performance result is moderate enthusiasm.Although there are four separate models, almost no organization operates just in one. There will usually be a predominate one, with one or more areas over-lapping in the other models.The first model, autocratic, has its roots in the industrial revolution. The managers of this type of organization operate mostly out of McGregors Theory X. These kind managers does believe that employees are not good, cannot work their own and should be unplowed under tight controls etc. The next three models begin to build on McGregors Theory Y who believe employees are capable, and they must be provided with good environment to work as a result they will work and produce good result. However each models has evolved over a period of time and there is no one best model. In addition, the collegial model should not be thought as the last or best model, but the beginning of a new model or paradigm.ChangeIn its simplest form, discontinuity in the work place is change, (Knoster, Villa, 2000). According to Lord Buddha there is no matter of course everything is subjected change. This will not only explain the uncontrollable and unexpected but eternal law of change, but also its describe change is unavoidable. There for organization also cant deny this truth. When the attitudes, expectation, trends and styles, change with people factor, the other PESTEL variables can also be change as a result. As a result facing change itself is become a big challenge for many organizations. However the researches evident that 70% of change processes are unsuccessful. Thus change is requisite for organizations.Almost all people are nervous about change. Many will resist it consciously or subconsciously. Sometimes those fears are well founded the change really will have a negative impact for them. In many cases, however, the target world for the change will come to realize that the change was for the better.The pace of change is ever increasing particularly with the advent of the Internet and the rapid deployment of new technologies, new ways of doing business and new ways of conducting ones life. Organizational Change Management seeks to understand the sentiments of the target population and work with them to promote efficient delivery of the change and enthusiastic support for its results.There are two related aspects of organizational change that are often confused. In Organizational Change Management we are concerned with winning the hearts and minds of the participants and the target population to bring about changed behavior and culture. The key skills required are founded in business psychology and require people people.Provided the signi ficance of peoples factor, as discussed throughout this essay it is ultimately peoples behavior which may affect the organizations behavior at the most severest context. There for it is only the effective leadership which can address these diversities of people behaviors may brings the most success to the organization. Following will discuss how leadership is best effective at todays organizational behaviours.Leadership and Organizational BehaviorOne can also argue that Organizational Behavior is the study and application of knowledge about how people, individuals, and groups act in organizations. It does this by taking a system approach. That is, it interprets people-organization relationships in terms of the whole person, whole group, whole organization, and whole social system. Its purpose is to build better relationships by achieving human objectives, organizational objectives, and social objectives. As you can see from the definition above, organizational behavior encompasses a wide range of topics, but ultimately its the leadership which can make determine the successful integrating of all these variable to produce more optimum results.To begin with, the concept of organizational leadership, as described here, is not entirely new. For almost a century, versatile observers have glimpsed the self-organizing characteristics of groups, and their natural tendency, more or less of their own accord, to design and direct their own affairs. More than that, there have also been suggestions in the literature that leadership and authority are to be viewed as distinctly separate phenomena.In an intelligently managed organization, that leadership isnt a randomly operating process its a propulsive force given motion by purpose, and by a joint effort to accomplish it. That is its natural tendency, its bias. But it is managements role to ensure that this organizational leadership has a substantive and meaningful core around which to form itself and to give it traction for advancing the organization toward its stated ends.Using these as a basis, organizational leadership can provide the functions of leadership to an organizationally beneficial degree that cannot be matched by individual charismatic leaders alone. It is also far more reliably focused on the organizations ability to accomplish its own purposes and ensure its own sustainability (rather than resulting in the perversion of those to the interests of senior executive leaders).ConclusionThis essay critically analyses the effects of organization behavior in todays context by different aspects. It very clearly proves people are the key factor of the endeavor of organization behavior. Individual behavior will influence the group behavior. Formations of groups may crates pockets of power. Power can be formal or even informal. But the right on personalities can influence more effectively the organization. Leadership is best effective where if organization gather many power groups around the personality which can thunder the business to the most effective direction. However organizations are always to change. People create resistive forces most the time to the change. Leadership is successfully useful to curve the resistive forces to the organization change objectives.

African American History :: essays research papers

Beridas story exemplifies the issues facing women in Africa in general and Kenya in particular, especially with respect to gender and class in many another(prenominal) ways. Berida explains in her story the loweringships that women have in providing for themselves as well as their families. Some of the hardships that Berida talks about are in the article The African and Kenyan Contexts. The article states that, across the continent, people of many African nations have been troubled by low levels of economic productivity, environmental degradation, inadequate physical and social infrastructure, the exigencies of geomorphological adjustment, and the battering of declining commodity prices. The hardships that are discussed are in the areas of education, economics, and ecological.One of the most important issues discussed is economics. Everyone in the world today needs money to survive. Berida explains how she had to work hard day and night to provide for her for her family. She was the breadwinner in the family because her husband was an alcoholic and would spend all the money. She tried to make money any way she could. Berida and other women would go from city to city buying and selling goods for more than what they had paid for them to make a profit. Berida also worked for others, farming when she could not afford to buy and sell. When the trade bloodline it depends on what the state of the economy is in to make good profits. African cities tend to be very poor and do not receive jockstrap from the government or other countries. All of the money that Berida do went to food, clothing, and education for her children.Compared to European Nations there are few educated people in Africa. upbringing in Africa is very expensive and many families cannot afford to send their children to school until they graduate. Although Berida had very little education she did what she could to keep her children in school. Depending on how much Berida made when her trading bus iness was good, some of her children received more education than others. Berida feels that poor families should not have too many children because a decent education cost too much. Females in most families had to stop going to school to help take care of the younger children and out their parents while the younger children go to school. The little education that one has the less chance there is of getting a decent job.

Emotional Inteligence Essay -- Emotional Intelligence

An increasing percent of the population begins to know the idea of emotional intelligence. This design was firstly developed by two American university professors, John Mayer and Peter Salovey (1990) and they concluded that, people with high emotional quotient are supposed to learn more than quickly due to their abilities. Another psycologist named Daniel Goleman (1995) ext block offed the theory and also made it well-known. In his articles and books, he argued that people with high emotional quotient do better than those with let loose emotional quotient. In this essay, it will be argued that high emotional intelligence can influence work performance positively to a relatively high extent. Both benefits and limitations of a high level of EI in the workplace will be discussed and a conclusion will be drawn at the end of this essay.The definition of emotional intelligence given by Salovey and Mayer (1990) focuses on the ability to understand ones own and others emotions and also t o manage ones own emotions positively. On the other hand, Golemans definition (1995) covers more aspects, including 25 abilities and skills such as trustworthiness, communication and empathy. The former definition is more scientific and detach sequence the latter one is called the corporate definition because its contents accommodate the interests of large corporations. However, the academic findings of the two professors are not widely known while Golemans edition is commonly accepted due to his best-seller book Emotional Intelligence (Goleman 1995). The following essay will be mainly based on Golemans definition.High emotional intelligence can ameliorate work performance and its varied aspects can contribute to work differently. One aspect of emotion... ...igence Isses in Paradigm building, The emotionally intelligent workplace how to select for, measure, and improve emotional intelligence in individuals, groups, and organizations, Jossey-Bass Ch.2Goleman D.(2001) An EI-based theory of performance, The emotionally intelligent workplace how to select for, measure, and improve emallenge emotional intelligence in individuals, groups, and organizations, Jossey-Bass Ch.3Fernandez-Araoz C.(2001) The challenge of hiring senior executives, The emotionally intelligent workplace how to select for, measure, and improve emallenge emotional intelligence in individuals, groups, and organizations, Jossey-Bass Ch.6Arnold J., Silvester J., Patterson F., Robertson I., Cooper C. and Burnes B. (2005) shape Psychology Understanding Human Behaviour in the Workplace 4th edition, Pearson Education Limited Essex