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close this bookEssential Drugs -Practical Guidelines (MSF, 1993, 286 p.)
View the document(introduction...)
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View the documentPreface
close this folderPart one:drugs, infusions, vaccines
View the documentOral drugs
View the documentInjectable drugs
View the documentInfusion solutions and Electrolytes
View the documentVaccines and sera
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View the documentOrganization and management of a pharmacy
View the documentPreservation and quality of the drugs
View the documentPrescription, cost, compliance
View the documentUse of antibiotics in precarious situations
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View the documentThe New Emergency HeaIth Kit (WHO)
View the documentBibliography
View the documentPharmaco-therapeutical index WHO essential drug list (7th list, 1992)
View the documentAlphabetical index (with indicative prices)

The New Emergency HeaIth Kit (WHO)

Lists of drugs and medical supplies for a population of 10,000 persons for approximately 3 months

Introduction

In recent years the various organizations and agencies of the United Nations system have been called upon to respond to an increasing number of large-scale emergencies and disasters, many of which pose a serious threat to health. Much of the assistance provided in such situations by donor agencies, governments, voluntary organizations and others is in the form of drugs and medical supplies. But the practical impact of this aid is often diminished because requests do not reflect the real needs or because these have not been adequately assessed. This can result in donations of unsorted, unsuitable and unintelligibly labelled drugs, or the provision of products which have passed their expiry date. Such problems are often compounded by delays in delivery and customs clearance.

The World Health Organization, which is the directing and coordinating authority for international health work within the United Nations system, took up the question of how emergency response could be facilitated. After several years of study, field testing and modifications, standard lists of essential drugs and medical supplies for use in an emergency were developed. The aim was to encourage the standardization of drugs and medical supplies used in an emergency to permit a swift and effective response with supplies that meet priority health needs. A further goal was to promote disaster preparedness since such standardization means that kits of essential items can be kept in readiness to meet urgent requirements.

The WHO Emergency Health Kit, which resulted from this work, was originally developed in collaboration with the Office of the United Nations High Commissioner for Refugees (UNHCR) and the London School of Hygiene and Tropical Medicine. It has now been revised in collaboration between the Action Programme on Essential Drugs (WHO, Geneva), the Emergency Preparedness and Response Unit (WHO, Geneva), the unit of Pharmaceuticals (WHO, Geneva), the Office of the United Nations High Commissioner for Refugees, UNICEF, Mcins Sans Frontis, the League of Red Cross and Red Crescent Societies (Geneva), the Christian Medical Commission of the World Council of Churches and the International Committee of the Red Cross. A review of the experience of previous users of the kit, prepared by the London School of Hygiene and Tropical Medicine, as well as field experience of UNICEF and Mcins Sans Frontis, were also considered during the revision. Major suppliers of the kit were consulted on the specifications of its contents.

The kit has now been adopted by many organizations and national authorities as a reliable, standardized, inexpensive, appropriate and quickly available source of the essential drugs and health equipment urgently needed in a disaster situation. Its contents are calculated to meet the needs of a population of 10,000 persons for three months. It has been renamed the: "New Emergency Health Kit" because of the number and diversity of United Nations agencies and other bodies which have adopted this list of drugs and medical supplies for their emergency operations and which participated in its revision.

This booklet provides background information on the development of the kit, a description of its contents, comments on the selection of items, treatment guidelines for prescribers and some useful checklists for suppliers and prescribers. Chapter 1 (Essential drugs and supplies in emergency situations) is intended as a general introduction for health administrators and field officers. Chapter 2 (Comments on the selection of drugs, medical supplies and equipment included in the kit) contains more technical details and is intended for prescribers.

Publication of this document was made possible by financial contributions received from the United Nations High Commissioner for Refugees, the Government of the Netherlands, the WHO Emergency Preparedness and Response Unit and the WHO Action Programme on Essential Drugs.

Chapter 1: Essential drugs and supplies in Emergency situations

What is an Emergency?

The term "emergency" is applied to various situations resulting from natural, political and economic disasters. The New Emergency Health Kit is not intended for the acute phase of epidemics, war, earthquake, floods, etc. but is designed to meet the needs of a population with disrupted medical facilities in the second phase of a natural or other disaster, or a displaced population without medical facilities. It has also been used in countries with acute shortages of drugs due to economic reasons.

It must be emphasized that, although supplying drugs and medical supplies in the standard kits is convenient in the second phase of an emergency, specific local requirements need to be assessed as soon as possible and further supplies must be ordered accordingly.

Quantification of drug requirements

Morbidity patterns (the relative frequency of different illnesses) may vary considerably between emergencies. For example, in emergencies where malnutrition is common morbidity rates may be very high. For this reason an estimation of drug requirements from a distance can only be approximate, although certain predictions can be made based on past experience. For the present kit estimates have been based on the average morbidity patterns and the use of standard treatment guidelines. The quantities of drugs supplied will therefore only be adequate if prescribers follow these guidelines (given in Annexes 1-3).

Contents of the kit

The New Emergency Health Kit consists of two different sets of drugs and medical supplies, named a BASIC UNIT and a SUPPLEMENTARY UNIT(The previous version consisted of three lists: A = basic drugs; B = supplementary drugs; C = medical supplies and equipment for basic and supplementary lists). To facilitate distribution to smaller health facilities on site, the quantities of drugs and medical supplies in the basic unit have been divided into ten identical units for 1,000 persons each.


FIGURE

The BASIC UNIT contains drugs, medical supplies and some essential equipment for primary health care workers with limited training. It contains twelve drugs, none of which are injectable. Simple treatment guidelines, based on symptoms, have been developed to help the training of personnel in the proper use of the drugs. Copies of these treatment guidelines, an example of which is printed in Annexes 1-3, should be be included in each unit. Additional copies can be obtained from the Action Programme on Essential Drugs, WHO, Geneva, and from UNICEF Copenhagen (see Annex 7 for addresses).

The SUPPLEMENTARY UNIT contains drugs and medical supplies for a population of 10,000 and is to be used only by professional health workers or physicians. It does not contain any drugs or supplies from the basic units and can therefore only be used when these are available as well.

The selection and quantification of drugs for the basic and supplementary units have been based on recommendations for standard treatment regimens from technical units within WHO. A manual describing the standard treatment regimens for target diseases, developed in collaboration between Mcins sans Frontis and WHO, is available from Mcins sans Frontis at cost price and is to be included in each supplementary unit.

To facilitate identification in an emergency, one green sticker (international color code for medical items) should be placed on each parcel. The word "BASIC" should be printed on stickers for basic units.

Referral system

Health services can be decentralized by the use of basic health care clinics (the most peripheral level of health care) providing simple treatment using the basic units. Such a decentralization will:
1) increase the access of the population to curative care; and 2) avoid overcrowding of referral facilities by solving all common health problems at the most peripheral level. Basic treatment protocols have been drawn up to allow these health workers to take the right decision on treatment or referral, according to the symptoms (see Annexes 1-3).

The first referral level should be staffed by professional health workers, usually medical assistants or doctors, who will use drugs, supplies and equipment from both the basic and the supplementary units. It should be stressed here that the basic and supplementary units have not been intended to enable these health workers to treat rare diseases or major surgical cases. For such patients a second level of referral is needed, usually a district or general hospital. Such facilities are normally part of the national health system and referral procedures are arranged with the local health authorities.

Procurement of the kit

The New Emergency Health Kit can be provided from a number of major pharmaceutical suppliers, some of which will have a permanent stock of kits ready for shipment within 48 hours. It may however be desirable to secure procurement at the regional level to reduce the cost of shipping. The procuring agency should ensure that manufacturers comply with the guidelines for quality, packaging and labelling of drugs (see Annex 6).

It is important to note that many drugs in the kit can be considered as examples of a therapeutic group, and that other drugs can often serve as alternatives. This should be taken into consideration when drugs are selected at the national level, since the choice of drugs may then be influenced by whether equivalent products are immediately available from local sources, and their comparative cost and quality. National authorities may wish to stockpile the same or equivalent drugs and supplies as part of their emergency preparedness programme. The kit can also serve as a useful baseline supply list of essential drugs for primary health care.

Donor guidelines

Whatever the source of drugs, it is very important that:

- No drugs should be sent from a donor country without a specific request, or without prior clearance by the receiving country;
- No drugs should be sent that are not on the List of Essential Drugs of the receiving country, or, if such a national list is not available, on the WHO Model List of Essential Drugs;
- No drugs should arrive with a future life (before expiry date) of less than one year;
- Labelling of the drugs should be in the appropriate language(s) and should at least contain the generic name, strength, name of manufacturer and expiry date (see Annex 6);
- Labelling on the outside package should contain the same information, plus the total quantity of drugs in the package.

Immunization in emergency

Experience in past emergencies involving displacements of populations has shown measles to be one of the major causes of death among younger children. The disease spreads rapidly in overcrowded conditions, and serious respiratory tract infections are frequent, particularly in malnourished children. An adequate supply of essential drugs may reduce the mortality rate, but measles can be prevented by immunization. A measles immunization programme should therefore be given high priority in the early phase of an emergency. The WHO Expanded Programme on Immunization (EPI), UNICEF, the Office of the High Commissioner for Refugees (UNHCR) and OXFAM have collaborated in the development of the Emergency Immunization Kit, which may be used to set up an emergency immunization programme against measles. This kit contains cold chain and injection equipment for 5,000 immunizations and may be ordered from OXFAM. Vaccines are not included.

Post emergency needs

After the acute phase of an emergency is over and basic health needs have been covered by the basic and supplementary units, specific needs for further supplies should be assessed as soon as possible. In most cases this will necessitate a quick description and, if possible, quantification of the morbidity profile. It should characterise the most common diseases and should identify the exposed and high risk groups in the population (e.g. children below 5 years of age and pregnant women). These high risk groups should be the first target of the continuing health care programme. Any other factors that may influence requirements should also be taken into account, e.g. the demographic pattern of the community, the physical condition of the individuals, seasonal variations of morbidity and mortality, the impact of improved public health measures, the local availability of drugs and other supplies, drug resistance, usual medical practice in the country, capabilities of the health workers and the effectiveness of the referral system.

Much time and money may be saved by adapting re-order forms to the specific needs of the situation and by standardizing re-order procedures for all locations and health teams, regardless of whether supplies are available locally or must be ordered from abroad.

Chapter 2: Comments on the selection of drugs, medical supplies and equipment included in the kit

The composition of the New Emergency Health Kit is based on epidemiological data, population profiles, disease patterns and certain assumptions borne out by emergency experience. These assumptions are:

· The most peripheral level of the health care system will be staffed by health workers with only limited medical training, who will treat symptoms rather than diagnosed diseases and who will refer to the next level those patients who need more specialized treatment.
· Half of the population is 0-14 years of age.
· The average number of patients presenting themselves with the more common symptoms or diseases can be predicted.
· Standardized schedules will be used to treat these symptoms or diseases.
· The rate of referral from the basic to the next level is 10%.
· The first referral level of health care is staffed by experienced medical assistants or medical doctors, with no or very limited facilities for inpatient care.
· If both the basic and first referral health care facilities are within reasonable reach of the target population, every individual will, on average, visit such facilities four times per year for advice or treatment. As a consequence the supplies in the kit, which are sufficient for approximately 10,000 outpatient consultations, will serve a population of 10,000 people for a period of approximately three months.

Selection of the drugs

Injectable drugs

There are no injectable drugs in the basic unit. Basic health workers with little training have usually not been taught to prescribe injections, neither are they trained to administer them. Moreover, the most common diseases in their uncomplicated form do not generally require an injectable drug. Any patient who needs an injection must be referred to the first referral level.

Antibiotics

Infectious bacterial diseases are common at all levels of health care, including the most peripheral, and basic health workers should therefore have the possiblity to prescribe an antibiotic. However, many basic health workers have not been trained to prescribe antibiotics in a rational way. Cotrimoxazole is the only antibiotic included in the basic unit, and this will enable the health worker to concentrate on taking the right decision between prescribing an antibiotic or not, rather than on the choice between several antibiotics. Cotrimoxazole has been selected because it is active against the most common bacteria found in the field, especially S. pneumonind H. influenzor acute respiratory infections. It is also stable under tropical conditions, needs to be taken only twice daily and its side-effects (exfoliative dermatitis or bone marrow depression) are uncommon. In addition to this it is less expensive than other antibiotics. The risk of increasing bacterial resistance must be reduced by rational prescribing practice.

Drugs not included in the kit

The kit includes neither the common vaccines nor any drugs against communicable diseases such as tuberculosis or leprosy. The vaccines needed and any plans for an expanded programme on immunization should be discussed with the national authorities as soon as possible; the same applies for programmes to combat communicable diseases. In general no special programme should be initiated unless there is sufficient guarantee for its continuation over a longer period.

In addition, drugs in the kit do not cover some specific health problems occurring in certain geographical areas, e.g. specific resistant malaria strains.

Selection of renewable supplies

Syringes and needles

Considering the risk of direct contamination with hepatitis and AIDS during handling, needles are dangerous items. The health risk for the staff should be limited by the following means:

· Limiting the number of injections;
· Using disposable needles only;
· Strictly following the destruction procedures for disposable material.

It is less dangerous to handle syringes than needles. For this reason a system with resterilisable nylon syringes and disposable needles has been chosen for the supplementary unit. However, in the very first stage, when sterilization procedures are not yet established, some provision will be necessary for giving injections by means of fully disposable materials. A small number of disposable syringes are therefore provided in the supplementary unit and their destruction should be supervised by the person in charge.

Gloves

Disposable protective gloves are provided in the basic unit to protect health workers against possible infection during dressings or handling of infected materials. In any case a dressing should be applied or changed with the instruments provided in the kit. Surgical gloves, which should be resterilizable, are supplied in the supplementary unit. They are to be used for deliveries, sutures and minor surgery, all under medical supervision.

Selection of equipment

Resuscitation / Surgical instruments

The kit has been designed for general medicine under primitive conditions, and for that reason no equipment for resuscitation or major surgery has been included. In situations of war, earthquakes or epidemics, specialised teams with medical equipment and supplies will be required.

Sterilization

A complete sterilization set is provided in the kit. The basic units contain two small drums each for sterile dressing materials. Two drums are included to enable the alternate sterilization of one at the first referral level while the other is being used in the peripheral facility. The supplementary unit contains a kerosene stove and two pressure sterilizers, a small one for sterilizing 2 ml and 5 ml syringes, and a larger one for the small drums with dressing materials and the instrument sets.

Dilution and storage of liquids

The kit contains several plastic bottles and a few large disposable syringes which are needed to dilute and store liquids (e.g. benzyl benzoate, chlorhexidine and gentian violet solution).

Water supply

The kit contains several items to help provide for clean water at the health facility. Each basic unit contains a 20 litre foldable jerrycan and a plastic bucket. The supplementary unit contains a water filter with candles and 2.5 kg of chloramine powder to chlorinate the water.

Chapter 3: Composition of the New Emergency Health Kit

The New Emergency Health Kit consists of ten basic units and one supplementary unit.

10 basic units (for basic health workers) for a population of 10,000 persons for 3 months (1 basic unit for 1,000 persons for 3 months). The unit contains drugs, renewable supplies and basic equipment packed in one carton.

1 supplementary unit (for physicians and senior health workers), for a population of 10,000 people for 3 months. One supplementary unit contains:

- drugs (approximately 130 kg)
- essential infusions (approximately 180 kg)
- renewable supplies (approximately 60 kg)
- equipment (approximately 40 kg)

NB: The supplementary unit does not contain any drugs and medical supplies from the basic unit. To be operational, the supplementary unit should be used together with ten basic units


FIGURE

Basic unit (for 1,000 persons for 3 months)

Drugs

Acetylsalicylic acid, tab 300 mg. tab

3,000

Aluminium hydroxyde, tab 500 mg tab

1,000

Benzyl benzoate, lotion 25%. bottle 1 litre

1

Chlorhexidine (5%). bottle 1 litre

1

Chloroquine, tab 150 mg base. tab

2,000

Ferrous Sulfate + Folic Acid, tab 200 + 0.25 mg. tab

2,000

Gentian Violet, powder. 25 g

4

Mebendazole, tab 100 mg. tab

500

ORS (Oral Rehydration Salts).sachet for 1 litre

200

Paracetamol, tab 100 mg. tab

1,000

Sulfamethoxazole + Trimetoprim, tab 400 + 80mg (cotrimoxazole) tab

2,000

Tetracycline eye ointment 1% tube 5 g

50

Renewable supplies

Absorbent cotton wool. Kg

1

Adhesive tape 2.5 cm x 5 m. roll

30

Bar of soap (100-200 g). bar

10

Elastic bandage (crepe) 7.5 cm x 10 m.unit

20

Gauze bandage 7.5 cm x 10 m,. roll

100

Gauze compress 10 x 10 cm, 12 ply, nonsterile.unit

500

Ballpen, blue or black.unit

10

Exercise book A4 unit

4

Health card + plastic sachet. unit

500

Small plastic bag for drugs. Unit

2,000

Notepad A6. unit

10

Thermometer (oral/rectal) Celsius / Fahrenheit unit

6

Protective glove, nonsterile, disposable.unit

100

Treatment guidelines for basic list.unit

2

Equipment

Nail brush, plastic, autoclavable.unit

2

Bucket, plastic, approx. 20 litres.unit

1

Gallipot, stainless steel, 100 ml.unit

1

Kidney dish, stainless steel, approx. 26 x 14 cm unit

1

Dressing set (3 instruments + box). unit

2

Dressing tray, stainless steel, approx. 30 x 15 x 3 cm.unit

1

Drum for compresses approx. 15 cm H, 014 cm unit

2

Foldable jerrycan, 20 litres.unit


Forceps Kocher, no teeth, 12-14 cm.unit

2

Plastic bottle, 1 litre.unit

3

Syringe Luer, disposable, 10 mlunit

1

Plastic bottle, 125 ml.unit

1

Scissors straight/blunt, 12-14 cm. Unit

2

Supplementary unit (for 10,000 persons for 3 months)

Drugs

Anaesthesics

Ketamine, inj. 50 mg/ml.10 ml / vial

25

Lidocaine, inj. 1%. 20 rnl / vial

50

Analgesics

Pentazocine, inj. 30 mg/ml1 ml / ampoule

50

Probenecid, tab 500 mg. tab

500

Recall from basic unit:

Acetyl salicyclic acid, tab 300 mg.(10 x 3,000)

30,000

Paracetamol, tab 100 mg. (10 x 1,000)

10,000

Anti-allergics

Dexamethasone, inj. 4 mg/ml 1 ml / amp.

50

Prednisolone, tab 5 mg. tab

100

Epinephrine (adrenaline), see "respiratory tract"

Anti-epileptics

Diazepam, inj. 5 mg/ml.2 rnl / arnpoule

200

Phenobarbital, tab 50 mg. tab

1,000

Anti-infective drugs

Ampicillin, tab 250 mg tab

2,000

Ampicillin, inj. 500 mg /vial. vial

200

Benzathine benzylpenicillin, inj. 2.4 MIU / vial.vial

50

Chloramphenicol, caps 250 mg. caps

2,000

Chloramphenicol, inj. 1 g / vial. vial

500

Metronidazole, tab 250 mg tab

2,000

Nystatin, non-coated tablet.100,000 IU / tab

2,000

Phenoxymethylpenicillin, tab 250 mg tab

4,000

Procabenzylpenicillin, inj. 3-4 MU / vial.vial

1,000

Quinine, inj. 300 mg/ml.2 ml / amp.

100

Quinine sulfate, tab 300 mg tab

3,000

Sulfadoxine + pyrimethamine, tab 500 mg + 25 mg tab

300

Tetracycline, caps or tab 250 mg.caps or tab

2,000

Recall from basic unit:

Mebendazole, tab 100 mg(10 x 500)

5,000

Cotrimoxazole, tab 400 + 80 mg. (10 x 2,000)

20,000

Chloroquine, tab 150 mg (10 x 2,000)

20,000

Blood, drugs affecting the Folic acid, tab 1 mg.

5,000

Recall from basic unit:
Ferrous sulfate + Folic acid, tab 200 + 0.25 mg. (10 x 2,000) 20,000

Cardiovascular drugs

Methyldopa, tab 250 mg. tab

500

Hydralazine, inj. 20 mg/ml.1 ml / amp.

20

Dermatological

Polyvidone iodine 10%, sol., 500 ml bottle

4

Zinc oxyde 10% ointment. kg

2

Benzoic acid 6% + salicylic acid 3% ointment. kg

1

Recall from basic unit:

Tetracycline eye ointment, 1% (10 x 50)

500

Gentian violet, powder 25 g. (10 x 4)

40

Benzyl benzoate, lotion 25%, litre. (10 x 1)

10

Diuretics

Furosemide, inj. 10 mg/ml. 2 ml / amp.

20

Furosemide, tab 40 mg.tab

200

Gastro-intestinal drugs

Promethazine, tab 25 mg. tab

500

Promethazine, inj. 25 mg/ml.2 ml / amp.

50

Atropine, inj. 1 mg/ml.1 ml / amp.

50

Recall from basic unit:

Aluminium hydroxyde, tab 500 mg (10 x 1,000)

10,000

Oxtocics

Ergometrine maleate, inj. 0.2 mg/ml.1 ml / amp.

200

Psychotherapeutic drugs

Chlorpromazine, inj. 25 mg/ml. 2 ml / amp.

20

Respiratory tract, drugs acting on

Aminophylline, tab 100 mg. tab

1,000

Aminophylline, inj. 25 mg/ml.10 ml / amp.

50

Epinephrine (adrenaline), inj. 1 mg/ml.1 ml / amp.

50

Solutions correcting water, electrolyte and acid-base disturbances

Compound solution of sodium lactate (Ringer's Lactate), inj. sol., with giving set and needle 500 ml / bag

200

Glucose, inj. sol. 5%, with giving set and needle 500 ml / bag

100

Glucose, inj. sol. 50%.50 ml / vial

20

Water for injection.10 ml / plastic vial

2,000

Recall from basic unit:

ORS (Oral Rehydration Salts).(10 x 200)

2,000

Vitamins

Retinol (Vitamin A), caps 200,000 IU caps

4,000

Ascorbic acid, tab 250 mg. tab

4,000

Renewable supplies

Scalp vein infusion set, disposable, 25G (D 0.5 mm). Unit

300

Scalp vein infusion set, disposable, 21G (D 0.8 mm).unit

100

IV placement canula, disposable, 18G (D 1.7 mm). Unit

15

IV placement canula, disposable, 22G (D 0.9 mm).unit

15

Needle Luer IV, disposable, 19G (D 1.1 mm x 38 mm). unit

1,000

Needle Luer IM, disposable, 21G (D 0.8 mm x 40 mm). unit

2,000

Needle Luer SC, disposable, 25G (D 0.5 mm x 16 mm) unit

100

Spinal needle, disposable, 20G (64 mm - D 0.9 mm). Unit

30

Spinal needle, disposable, 23G (64 mm - D 0.7 mm). Unit

30

Syringe Luer resterilisable, nylon, 2 ml. unit

20

Syringe Luer resterilisable, nylon, 5 ml. unit

100

Syringe Luer resterilisable, nylon, 10 ml.unit

40

Syringe Luer, disposable, 2 ml. unit

400

Syringe Luer, disposable, 5 ml.unit

500

Syringe Luer, disposable, 10 ml.unit

200

Syringe conic connector (for feeding), 60 ml unit

20

Feeding tube, CH5 (premature baby), disposable. unit

20

Feeding tube, CH8, disposable. Unit

50

Feeding tube, CH16, disposable. unit

10

Urinary catheter (Foley), n°12, disposable unit

10

Urinary catheter (Foley), n°14, disposable unit

5

Urinary catheter (Foley), n°18, disposable.unit

5

Surgical gloves sterile and resterilisable n°6.5 pair

50

Surgical gloves sterile and resterilisable n°7.5 pair

150

Surgical gloves sterile and resterilisable n°8.5 pair

50

Recall from basic unit:

Protective glove, non sterile, disposable. (100 units x 10)

1,000

Sterilization test tape (for autoclave). roll

2

Chloramine, tabs or powder kg

2.5

Thermometer (oral/rectal) dual Celsius / Fahrenheit.unit

10

Spare bulb for otoscope. Unit

2

Batteries R6 alkaline AA size (for otoscope).unit

6

Recall from basic unit:

Thermometer (oral/rectal) Celsius /Fahrenheit.(6 units x 10)

60

Ballpen, blue or black (10 units x 10)

100

Exercise book A4.(4 units x 10)

40

Health card + plastic sachet. (500 units x 10)

5,000

Small plastic bagfor drugs. (2,000 units x 10)

20,000

Notepad A6 (10 units x 10)

100

Urine collecting bag with valve, 2000 ml. unit

10

Finger stall 2 fingers, disposable. Unit

300

Suture, synthetic absorbable, braided, size DEC.2 (000) with cutting needle curved 3/8, 20 mm triangular unit

24

Suture, synthetic absorbable, braided, size DEC.3 (00) with cutting needle curved 3/8, 30 mm triangular unit

36

Surgical blade (surgical knives) n°22 for handle n°4. unit

50

Razor blade.unit

100

Tongue depressor (wooden), disposable unit

100

Gauze roll 90 m x 0.90 m roll

3

Gauze compress 10 x 10 cm, 12 ply, sterile unit

1,000

Recall from basic unit:

Absorbent cotton wool.(1 kg x 10)

10

Adhesive tape 2.5 cm x 5 m.(30 rolls x 10)

300

Bar of soap (100-200 g/bar). (10 bars x 10)

100

Elastic bandage (crepe) 7.5 cm x 10 m. (20 units x 10)

200

Gauze bandage 7.5 cm x 10 m (100 rolls x 10)

1,000

Gauze compress 10 x 10 cm, 12 ply, nonsterile. (500 units x 10)

5,000

Equipment

Clinical stethoscope, dual cup. unit

2

Obstetrical stethoscope (metal).unit

1

Sphygmomanometer (adult). unit

1

Razor non disposable. unit

2

Scale for adult. unit

1

Scale hanging 25 kg x 100 g (Salter type) + 3 trousers. unit

3

Tape measure. unit

5

Drum for compresses, h: 15 cm, D 14 cm.unit

2

Recall from basic unit:

Drum for compresses, approx. h :15 cm, D 14 cm.(2 units x 10)

20

Otoscope + disposable set of patric speculums. unit

1

Tourniquet. Unit

2

Dressing tray, stainless steel, approx. 30 x 15 x 3 cm unit

1

Kidney dish, stainless steel, approx. 26 x 14 cm.unit

1

Scissors straight/blunt, 12-14 cm. unit

2

Forceps Kocher no teeth, 12-14 cm. Unit

2

Recall from basic unit:

Kidney dish, stainless steel, approx. 26 x 14 cm. (1 unit x 10)

10

Gallipot, stainless steel, 100 ml. (1 unit x 10)

10

Dressing tray, stainless steel, approx. 30 x 15 x 3 cm (1 unit x 10)

10

Scissors straight/blunt, 12-14 cm. (2 units x 10)

20

Forceps Kocher, no teeth, 12-14 cm.(2 units x 10)

20

Abcess/suture set (7 instruments + box).unit

2

Dressing set (3 instruments + box). Unit

5

Recall from basic unit:

Dressing set (3 instruments + box). (2 units x 10)

20

Pressure sterilizer, 7.5 litres (type: Prestige 7506, double rack, ref. UNIPAC 01.571.00) unit

1

Additional rack Public Health Care 2ml/5ml, ref.Prestige 7531 unit

2

Pressure sterilizer, 20-40 litres with basket (type UNIPAC 01.560.00).unit

1

Kerosene stove, single burner (t,vpe UNIPAC 01.700.00).unit

2

Water filter with candles, 10-20 litres (type UNIPAC 56.199.02).unit

3

Nail brush, plastic, autoclavable.unit

2

Recall from basic unit:

Plastic bottle, 1 litre. (3 units x 10)

30

Syringe Luer, disposable, 10 ml (1 unit x 10)

10

Plastic bottle, 125 ml. (1 unit x 10)

10

Nail brush, plastic autoclavable.(2 units x 10)

20

Bucket, plastic, approx. 20 litres. (1 unit x 10)

10

Foldable jerrycan, 20 litres.(1 unit x 10)

10

Portable weight / height chart (UNICEF/SCF) (UNIPAC 01.455.70) unit

1

Clinical guidelines - diagnostic and treatment manual.

1

Guide clinique et thpeutique.

1

Guia clinica y terapica

1

Annex 1

Basic unit: treatment guidelines

These treatment guidelines are intended to give simple guidelines for the training of primary health care workers using the basic unit. In the dosage guidelines, five age groups have been distinguished. When dosage is shown as 1 tab. x 2, one tablet should be taken in the morning and one before bedtime. When dosage is shown as 2 tab. x 3, two tablets should be taken in the morning, two should be taken in the middle of the day and two before bedtime.

The treatment guidelines contain the following diagnosis/symptom groups:

· Anemia
· Pain
· Diarrhoea: see detailed diagnosis and treatment schedules in Annex 2 a-c.
· Fever
· Respiratory tract infections: see detailed diagnosis and treatment schedules in Annex 3.
· Measles
· Eye
· Skin conditions
· Urinary tract infections
· Sexually transmitted disease
· Preventive care in pregnancy
· Worms


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Annex 2

Evaluation and treatment of diarrhoea

Annex 2a

Assessment of diarrhoea patients for dehydration


FIGURE

Annex 2b

Treatment plan A to treat diarrhoea at home

Use this plan to teach the mother to:

· Continue to treat at home her child's current episode of diarrhoea.
· Give early treatment for future episodes of diarrhoea.

Explain the three rules for treating diarrhoea at home

1. GIVE THE CHILD MORE FLUIDS THAN USUAL TO PREVENT DEHYDRATION:

· Use a recommended home fluid, such as a cereal gruel. If this is not possible, give plain water.
· Use ORS solution for children described in the box overleaf.
· Give as much of these fluids as the child will take. Use the amounts shown below for ORS as a guide.
· Continue giving these fluids until the diarrhoea stops.

2. GIVE THE CHILD PLENTY OF FOOD TO PREVENT UNDERNUTRITION:

· Continue to breast-feed frequently.
· If the child is not breast-fed, give the usual milk. If the child is less than 6 months old and not yet taking solid food, dilute milk of formula with an equal amount of water for 2 days.
· If the child is 6 months or older, or already taking solid food:

- Also give cereal or another starchy food mixed, if possible, with pulses, vegetables, and meat of fish. Add 1 or 2 teaspoonfuls of vegetable oil to each serving.
- Give fresh fruit juice or mashed banana to provide potassium.
- Give freshly prepared foods. Cook and mash or grind food well.
- Encourage the child to eat: offer food at least 6 times a day.
- Give the same foods after diarrhoea stops, and give an extra meal each day for two weeks.

3. TAKE THE CHILD TO THE HEALTH WORKER IF THE CHILD DOES NOT GET BETTER IN 3 DAYS OR DEVELOPS ANY OF THE FOLLOWING:

· Many watery stools
· Repeated vomiting
· Marked thirst
· Eating or drinking poorly
· Fever
· Blood in the stool

Children should be given ORS solutions at home, if:

· They have been on Treatment Plan B or C.
· They cannot return to the health worker if the diarrhoea gets worse.
· It is national policy to give ORS to all children who see a health worker for diarrhoea.

IF THE CHILD WILL BE GIVEN ORS SOLUTION AT HOME, SHOW THE MOTHER HOW MUCH ORS TO GIVE AFTER EACH LOOSE STOOL AND GIVE HER ENOUGH PACKETS FOR 2 DAYS


FIGURE

· Describe and show the amount to be given after each stool using a local measure.

Show the mother how to mix ORS.
Show her how to give ORS:

· Give a teaspoonful every 1-2 minutes for a child under 2 years.
· Give frequent sips from a cup for an older child.
· If the child vomits, wait 10 minutes. Then give the solution more slowly (for example, a spoonful every 2-3 minutes).
· If diarrhoea continues after the ORS packets are used up, tell the mother to give other fluids as described in the first rule above or return for more ORS.

Annex 2 c

Treatment plan B to treat dehydration

APPROXIMATE AMOUNT OF ORS SOLUTION TO GIVE IN THE FIRST 4 HOURS


FIGURE

* Use the patient's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the patient's weight (in grams) times 0.075.

· If the child wants more ORS than shown, give more.
· Encourage the mother to continue breast-feeding.
· For infants under 6 months who are not breast-fed, also give 100-200 ml clean water during this period.

OBSERVE THE CHILD CAREFULLY AND HELP THE MOTHER GIVE ORS SOLUTION:

· Show her how much solution to give her child.
· Show her how to give it - a teaspoonful every 1-2 minutes for a child under 2 years, frequent sips from a cup for an older child.
· Check from time to time to see if there are problems.
· If the child vomits, wait 10 minutes and then continue giving ORS, but more slowly, for example, a spoonful every 2-3 minutes.
· If the child's eyelids become puffy, stop ORS and give plain water or breast milk. Give ORS according to Plan A when the puffiness is gone.

AFTER 4 HOURS, REASSESS THE CHILD USING THE ASSESSMENT CHART. THEN SELECT PLAN A, B OR C TO CONTINUE TREATMENT.

· If there are no signs of dehydration, shift to Plan A. When dehydration has been corrected, the child usually passes urine and may also be tired and fall asleep.
· If signs indicating some dehydration are still present, repeat Plan B, but start to offer food, milk and juice as described in Plan A.
· If signs indicating severe dehydration have appeared, shift to Plan C.

IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT PLAN B:

· Show her how much ORS to give to finish the 4 hour treatment at home.
· Give her enough ORS packets to complete rehydation, and for 2 more days as shown in Plan A.
· Show her how to prepare ORS solution.
· Explain to her the three rules in Plan A for treating her child at home:

- to give ORS or other fluids until diarrhoea stops;
- to feed the child;
- to bring the child back to the health worker, if necessary.

Annex 2d

Treatment plan C to treat severe dehydration quickly

Follow the arrows. If the answer is "yes", go across. If "no", go down.


FIGURE

Notes:

· If possible, observe the patient at least 6 hours after rehydration to be sure the mother can maintain hydration giving ORS solution by mouth.
· If the patient is above 2 years and there is cholera in your area, give an appropriate oral antibiotic after the patient is alert.

Annex 3

Management of the child with cough or difficult breathing

· Assess the child

Ask:

- How old is the child?
- Is the child coughing? For how long?
- Is the child able to drink? (for children age 2 months up to 5 years)
- Has the child stopped feeding well? (for children less than 2 months)
- Has the child had fever? For how long?
- Has the child had convulsions?

Look and listen (the child must be calm):

- Count the breaths in one minute.
- Look for chest indrawing.
- Look and listen for stridor.
- Look and listen for wheeze. Is it recurrent?
- See if the child is abnormally sleepy, or difficult to wake.
- Feel for fever, or low body temperature (or measure temperature).
- Look for severe undernutrition.

· Decide how to treat the child

- The child aged less than two months

see Annex 3a

- The child aged two months up to five years

- who is not wheezing

see Annex 3b

- who is wheezing

refer

- Treatment instructions

see Annex 3c

- Give an antibiotic

- Advise mother to give home care

- Treatment of fever

Annex 3a

The child aged less than two months


FIGURE

Annex 3b

The child aged two months to five years


FIGURE

Annex 3c

Treatment instructions

· Give an antibiotic

- Give first dose of antibiotic in clinic.
- Instruct mother on how to give the antibiotic for five days at home (or to return to clinic for daily procaine penicillin injection).


FIGURE

(1) Give oral antibiotic for five days at home only if referral is not feasible.
(2) If the child is less than 1 month old, give 1/2 pediatric tablet or 1.25 ml syrup twice daily. Avoid cotrimoxazole in infants less than one month of age who are premature or jaundiced.
(3) Not included in kit but if available can be used as an alternative to ampicillin.

Advise mother to give home care

· Feed the child.

- Feed the child during illness.
- Increase feeding after illness.
- Clear the nose if it interferes with feeding.

· Increase fluids.

- Offer the child extra to drink.
- Increase breastfeeding.

· Soothe the throat and relieve the cough with a safe remedy.
· More important: in the child classified as having "No pneumonia: cough or cold", watch for the following signs and return quickly if they occur:

- Breathing becomes difficult.
- Breathing becomes fast.
- Child is not able to drink.
- Child becomes sicker.

This child may have pneumonia

· Treat fever


FIGURE

Annex 4

Sample monthly activity report


FIGURE

Annex 5

Sample health card


FIGURE

Annex 6

Guidelines for suppliers

Quality

1. The quality of the drugs must comply with intemationally recognized pharmaco-poeial standards.
2. At the time of shipment the product shall have at least two thirds of its shelf life.
3. Tablets should preferably be divisible and carry characteristic symbols for easy identification.
4. Drugs should be procured only from those manufacturers able to produce documents meeting the regulations of the WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce.

Labelling

1. Labelling should be in English and preferably one other official language of WHO.
2. All labels should display at least the following information:

· International nonproprietary name (INN) of the active ingredient(s).
· Dosage form.
· Quantity of active ingredient(s) in the dosage form (e.g. tablet, ampoule) and the number of units per package.
· Batch number.
· Date of manufacture.
· Expiry date (in clear language, not in code).
· Pharmacopoeial standard (e.g. BP, USP.).
· Instructions for storage.
· Name and address of the manufacturer.
3. A printed label on each ampoule should contain the following:

· INN of the active ingredient(s).
· Quantity of the active ingredient.
· Batch number.
· Name of the manufacturer.
· Expiry date.
The full label should again appear on the collective package.
4. Directions for use, warnings and precautions may be given in leaflets (package inserts). However, such leaflets should be considered as a supplement to labelling and not as an alternative.
5. For articles requiring reconstitution prior to use (e.g. powders for injection) a suitable beyond-use time for the constituted product should be indicated.

Packaging

1. Tablets and capsules should be packed in sealed waterproof containers with replaceable lid, protecting the contents against light and humidity.
2. Liquids should be packed in unbreakable leak-proof bottles or containers.
3. Containers for all pharmaceutical preparations must conform to the latest edition of internationally recognized pharmacopoeial standards.
4. Ampoules must either have break-off necks, or sufficient files must be provided.
5. Each Basic Unit should be packed in one carton. The Supplementary Unit must be packed in cartons of max. 50 kg. The cartons should preferably have two handles attached. Drugs, renewable supplies, infusions and equipment should all be packed in separate cartons, with corresponding labels.
6. Each carton must be marked with a green label (the international colour code for medical supplies in emergency situations). The word "BASIC" must be printed on each green label for the basic unit.

Packing list

Each consignment must be accompanied by a list of contents, stating the number of cartons and the type and quantity of drugs and other supplies in each carton.

Annex 7
Useful addresses

World Health Organization, Avenue Appia, CH-1211 Geneva-27, Switzerland. Telephone 41.22.7912111; telex 27821; telefax 41.22.7910746

United Nations High Commissioner for Refugees, Palais des Nations, CH-1211 Geneva-10, Switzerland. Telephone 41.22.7398111; telex 27492; telefax (general) 41.22.7319546; telefax (supplies) 7310776

UNICEF (UNIPAC), Arhusgade 129, Freeport, DK 2100, Copenhagen, Denmark. Telephone 45.31.262444; telex 19813; telefax 45.31.269421

OXFAM, 274 Branbury Road, Oxford OX2 7DZ, United Kingdom. Telephone 44.865.56777; telex 83610; telefax 44.865.57612

Mcins Sans Frontis, 8 Rue Saint-Sabin, 75011 Paris, France. Telephone 33.1.40212929; telex 214360; telefax 33.1.48066868

International Committee of the Red Cross, 17 Avenue de la Paix, CH-1202 Geneva, Switzerland. Telephone 41.22.7346001; telex 22269; telefax 41.22.7332057

League of Red Cross and Red Crescent Societies, P.O.Box 372, CH-1211 Geneva-19, Switzerland. Telephone 41.22.7345580; telex 22555; telefax 41.22.7330395

Christian Medical Commission of the World Council of Churches, P.O.Box 66, CH-1211 Geneva-20, Switzerland. Telephone 41.22.7916111; telex 23423; telefax 41.22.791.03.61

London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. Telephone 44.1.6368636; telex 8953474; telefax 44.1.4365389

International Dispensary Association, P.O.Box 3098, 1003 AB Amsterdam, The Netherlands. Telephone 31.2903.3051; telex 13566; telefax 31.2903.1854