Background Medicine and medical commodities constitute essential and important inputs to health service delivery in all health systems. Irrational use of medicines is a multi-dimensional issue and requires interventions at several levels including Health Systems, Organization, Doctors, Dispensers, Patients and Community and it still remains a challenge in health facilities (HF) all over the country, including those managed by the Swedish Committee for Afghanistan (SCA).

Purpose To identify the factors that influence prescribers’ behaviour and decision-making (Personal, Interpersonal, Workplace and Informational) while managing medicines and medical supplies.

To provide detailed information for improving the Rational Use of Medicine in SCA health facilities.

Materials and Methods Along with my teams I assessed 4 SCA projects through register books, stock cards, prescriptions, structured questioners and medical records. 28 were selected randomly from 123 HFs with a sampling interval of 5 (every 4th HF). This constituted 10 Comprehensive Health Centres, 9 Basic Health Centres, 5 Sub Centres, 2 District Hospitals and 2 Provincial Hospitals.

Results The average number of medicines per encounter was 2.1, ranging between 1.76 in Saripul and 2.49 in Wardak.

Prescription of antibiotics in health facilities visited averaged at 53.4%. It ranged from 48%.in Saripul and 60% in Samangan. In Wardak it was 56% and it was 49% in Laghman.

The average percentage of injectables prescribed was 7.8 percent. Laghman prescribed 10%, Saripul 6.22%, Samangan 8% and Wardak 7%.

Conclusions Irrational use of medicines is a complex issue and calls for multi-dimensional interventions.

RUM training for professional staff and health education and awareness programmes for people who are living in rural areas as well as distribution of standard treatment guidelines will play a significant role in promoting the rational use of medicine.

No conflict of interest.