الفهرس 
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Abstract
Introduction:Various studies conducted in developed as well as in developing countries during past few years regarding the safe and effective use of drugs show that irrational drug use is a global phenomenon and only few prescriptions justify rational use of drugs. The aim of work:to measure the performance of PHC centers and unites regarding the use of drugs in Mansoura district in Egypt. Research Plan: Using the WHO/INRUD core and complementary drug use indicators for public health facilities and a structured questionnaire for private pharmacies. It was descriptive cross-sectional study with analytic component included randomly selected 10 rural and 5 urban health facilities providing outpatient health services. 30 encounters were conducted in each facility.Also it included randomly selected 10 urban and 10 rural pharmacies using a data collection form about the source of drug prescription and the drug groups dispensed by these pharmacies for two weeks. Also, interviewing 100 urban and 100 rural individuals who attended these pharmacies to buy drugs without prescription using a questionnaire. Results:the number of prescribed drugs was 2 ± 1.2per encounter, drugs prescribed by generic name was 51.93% of all drugs prescribed, antibiotic injectables and were prescribed in 40.89% and 46.67of encounters respectively.the average consultation time was 12.3 ± 4.9minutes per encounter, the average dispensing time was 32.2 ± 14.9seconds, drugs actually dispensed represented 68.48% of drugs prescribed, drugs adequately labeled were 57.6% of drugs dispensed and the patients who knew the dosage of dispensed drugs correctly represented 52.4%the patients treated without drugs represented 14.7%, patients reported satisfaction with the overall care they received were 46% of all attending patients, and facilities with access to impartial drug information represented 2.2% the average drug cost was 19.67 ± 2.92 EGP per encounter, Antibiotics and injectable drug forms represented 51.9% and 68.5% of the total drug costs.As regard private pharmacies the most common prescribers were physicians (41.5%) followed by pharmacists (26.2%) and there was a statistically significant difference between urban and rural areas.The most common reason reported by individuals attending private pharmacies to buy drugs without prescriptions and didn’t seek medical advice was that medical consultation was expensive (25.5%) and that medical services were inaccessible (16.5%). Conclusion:the results were in general apparently far from the optimal levels likePolypharmacy, brand prescribing, over-prescribing of antibiotics and injectable drug forms, relatively short consultation and dispensing times, inadequacy of patients’ knowledge about prescribed medicines, unavailability of reliable drug information and high cost of drug treatment While it is observed in private pharmacies that the physician prescriptions were below half of all prescriptions and the reasons that compelled the patient to buy drugs without prescription is the relative economic and geographic inaccessibility to many of them.That is why this study recommended that the higher governmental authorities which are represented mainly by the Ministry of health and population in Egypt should perform routine training programs for prescribers and dispensers about drug use activities and preparing a national policy for drug use regulating the pharmacist’s role in health care activities.while at physicians and pharmacists’ level, they should be motivated to improve their personal knowledge, attitudes and skills of drug prescription and dispensing practices, as well as the commitment to updated guidelines and drug information and participating in report preparation about drug use indicators, encourage them to find innovative solutions. Finally, future studies should look at the outcomes of these observations and intervention plans for continuous performance improvement at a larger scale and wider scope not applied in this study.