Improving access to antidotes and antivenoms, Thailand

• Published in: Bulletin of the World Health Organization 2018-12, Vol.96 (12), p.853-857
• Main Authors: Suchonwanich, Netnapis, Wananukul, Winai
• Format: Article
• Language: English
• Subjects: Access; Antidotes; Antivenins; Antivenom; Case management; Centralization; Consultation; Costs; Drugs; Finance; Government Programs; Health; Health care industry; Health care management; Health care policy; Health insurance; Health Services Accessibility; Historical account; Hospitals; Information systems; Internet; Lessons from the Field; Management; Medical personnel; Medical treatment; National health insurance; National security; Patients; Poisoning; Poisons; Procurement management; Purchasing; Security; Stocks; Thailand; Training; Urgency; Wastage
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.18.217075

Historically in Thailand, access to poison antidotes was limited and antivenom stock management was inefficient. In 2010, the country established a national antidote programme, which created national and subnational antidote stocks, managed their distribution and trained health-care providers on clinical management and antidote use. In 2013, the programme incorporated antivenoms to improve stock management and avoid wastage due to stock expiry. Before the programme, health-care providers consulted poison centres on clinical management of poisoning and some antidotes were not available. Individual hospitals stocked antivenoms, which often expired before use. Today, the National Health Security Office finances and manages the centralized procurement of antidotes and antivenoms and all Thai patients have a right to antidotes regardless of health insurance. National and subnational stock levels are determined based on demand, treatment urgency and cost. A web-based system, which incorporates geographical information, was introduced for requesting antidotes and antivenoms. Poison centres provide training, 24-hour consultation services and outcome monitoring. Antidotes and antivenoms are now readily available and used correctly and clinical management has improved. Moreover, better stock and distribution control has helped avoid antivenom wastage and reduced antivenom costs, from US$ 2.23 million United States dollars (US$) to US$ 1.2 million. The programme's success depended on strong and sustained policy support, adequate funding, improved operational capacity, training for health-care professionals and the provision of 24-hour online consultation services. A web-based centralized procurement and distribution ensured these essential medicines were available, minimized costs, reduced waste and saved lives.