During the week of 14th to 18th September, within the framework of an exchange visit organised by EUROsociAL, the European cooperation programme with Latin America for social cohesion, a delegation from Colombia and El Salvador visited health institutions in Spain and Denmark in order to learn about the legal frameworks and mechanisms used to implement policies on Rational Medicine Use (RMU). In Spain, the group visited the Spanish Agency for Medications and Healthcare Products and the Regional Ministry of Health of the Community of Madrid. In Denmark, it met with the Nordic Cochrane Centre, the Institute for Rational Pharmacotherapy, Ministry of Health, Statens Serum Institut, and the Medicines Committee of the Capital Region (Copenhagen), among others.

The visit enabled them to learn about RMU policies, which range from guidelines at the national level to implementation of these guidelines in an administrative region like the Community of Madrid or the Capital Regional in Copenhagen, which is important as Colombia has a decentralised healthcare system divided into departments.

The group was also able to interact with individuals responsible for preparing independent information on medicines (Pharmacotherapy Information Bulletin of Navarre and the Nordic Cochrane Centre). This is of great importance for ensuring that a state has reliable information when taking decisions regarding the therapies to be promoted or covered by the national healthcare system, free from conflicts of interest or undue influence by the parties selling a medicine.

In Colombia between 1995 and 2005, expenditure on medicines went from 10% to 20% of the healthcare budget; and according to the current Minister of Health, Alejandro Gaviria, “between 2005 and 2010 the dosages consumed of certain high-cost medicines increased by over 600%, and their average value by 847%”. This trend justifies the Ministry's prioritisation of the RMU policy, as it will contribute to the sustainability of the healthcare system and the coverage provided to the population. It also reduces dilemmas when choosing treatments that could be inappropriate, costly, and involve inequitable access to medicines. Currently, Colombia is progressing in its RMU policy with the support of EUROsociAL through a pilot programme on blood pressure medications to transform inappropriate prescribing practices, and this will be evaluated with a view to scaling it to the national level.

In El Salvador, the priority being placed on pharmaceutical policy comes at the initiative of citizens, who promoted the 2012 Medicines Act. The law created a National Directorate of Medicines and establishes the importance of promoting rational use policies. In early September, the first meeting was held of the National Rational Medicine Use Committee, made up of various stakeholders in the national healthcare system who participated in the visit (including representatives of the Ministry, National Directorate of Medicines, Social Security [ISSS], and the teaching profession [ISBM]). This committee has the task of creating the National RMU Plan (November 2015) and of implementing educational strategies targeting physicians and patients.

The visit to Spain and Denmark enabled both countries to gain in-depth knowledge of some of the RMU policies being implemented in Europe which can serve as inputs for the process the two countries are initiating.