Impact of a cost sharing drug supply scheme on the quality of service in public health facilities

Abstract

Insufficient drug availability undermines primary health care in Nepal. This study investigated the impact of cost-sharing drug schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged, on the quality of service provided. A cross-sectional survey was conducted & WHO indicators used. It was found that the CSDS did improve drug availability and utilization rates. Further drug use was more rational in the CSDS in terms of prescribed drugs being dispensed and antibiotics being prescribed and dispensed in full course. In other respects the quality of care in CSDS was similar to non-CSDS facilities and was poor. Low staffing levels probably contributed to this. Of particular concern was the inadequate sterilization practices and sterile injection technique in most health facilities (CSDS & non-CSDS).