Community-based revolving drug funds - The way forward ?

Abstract

Lack of drugs due to insufficient government (HMGN) funds undermines primary health care in Nepal. In order to address this problem, a number of organizations have been operating local revolving drug funds. HMGN now plans a national drug re-supply
system, the Community Drug Programme (CDP), based upon community-controlled revolving drug funds. This paper looks at the experience of the various drug schemes operating in Nepal with a view to finding "lessons learnt" that can be used in the
planning process for the CDP. The paper incorporates a comparative study of the various drug schemes based upon data collected at health facilities and any involved organizations. Prescribing, quality of care, access, financial data, community involvement and sustainability were looked at and discussed. It was found that there was a trade-off between sustainability and quality of care. An example of a revolving drug fund is then worked through in steps showing the various issues that must be addressed. This example shows that provided HMGN continues to supply an annual drug indent (worth the same amount) and if village development committees provide a small subsidy (within the amounts recommended for health by HMGN) then patients need only pay a nominal user fee, no more than 50% of the wholesale cost of the drugs. This is considerably less than that recommended by the CDP and is advantageous in terms of patient access. Recommendations include that (1) item user fees, not more than 50% of the cost of the drugs, are charged, (2) the cost of drugs is shared between central government (HMGN), local communities (village
development committees) and individual patients, and (3) the establishment of district drug stores under the control of district health office and the district development committee be established.