ABSTRACT
This paper presents a comprehensive evaluation of a country where a revolving drug fund (RDF) has lasted for fifteen years and serves more than three million patients annually; with more than SDG 2.8 million (Sudanese Pound) (US$11.1 million) annual turn over. Regardless of the fact that the supply of medicines and improvement in public health facilities utilization are among the main objectives of user fees policy; there is little information on the effect of RDF on accessibility of essential medicines and its impact on the utilization of public health services where RDF schemes have been introduced. We measured the percentage of prescribed medicines dispensed to patients in selected health facilities (both RDF and non-RDF); the availability of essential medicines in a twelve month period in order to determine whether the cost of the medicines is a barrier to utilization of public health services with RDF scheme in Khartoum State (KS). Structured interviews with users (186); personal observations; and archival as well as statistical records were used to capture data of interest relevant to the study objective. The average availability rate of key items was greater (93) in the RDF facilities compared to 86in non-RDF facilities. RDF records also showed that the availability of medicines in the RDF health facilities ranged from 95 to 100in the twelve months period studied. Data from the household survey; demonstrated that over a third (36) of respondents did not consult public health facilities when a member of a household was ill two weeks prior to the date of interview. Of note; only 9of them said that this was because of unavailability of medicines. This study suggests that the RDF scheme adopted by KS made essential medicines available at its health facilities and increased health services utilization compared to those without RDF scheme. Therefore; sustained availability of low cost medicines near where people live that benefit previously disadvantaged poor population; particularly the vulnerable rural groups is achievable through RDF
Subject(s)
Fees and Charges , Pharmaceutical Preparations/supply & distribution , Primary Health Care , SudanABSTRACT
Objective: The study was carried out to evaluate short term effects of one to one educational intervention approach; conducted with 40 drug sellers in order to improve the private sector's practices; compliance and performance in using the national treatment guidelines for malaria and other common childhood (diarrhoea; acute respiratory tract infection-ARI) illnesses in Kibaha district-Tanzania. Methods: The training took place one month after baseline data collection. Data collection was undertaken eight months after training and the effects of training was evaluated. The 40 drug stores were divided into 20 intervention and 20 control facilities. Trained nurses were used as clients who posed as caretakers of sick under-five children needing medication. The drug dispensers/sellers knowledge of anti-malarials and other drugs and their dispensing practices was assessed. Results: The intervention seemed to have had a significant impact on knowledge pattern for prescribing and dispensing practices of drug stores for some common childhood illnesses but not in other control drug stores/shops. About 90 (n = 18) of shops prescribed to clients; the approved first-line anti-malarial drug for uncomplicated malaria (sulfadoxine-pyrimethamine); as compared to only 55 (n = 11) of the control shops. Conclusion: Changing the private sectors' knowledge; behaviour and practices/performance may be a slow and difficult process. The intervention approach applied in this study seems to be feasible at district-level. This strategy can be applied in all districts of Tanzania with the aim of achieving significant improvements in knowledge; behaviour; compliance; improving performance and practices of drug sellers in drug stores/shops. However; other alternative strategies are needed to influence drug sellers'/dispensers' compliance and performance. Thus; the overall impact on performance and practices in these facilities will remain at moderate level for quite sometime unless national policies; other programs and stakeholders are involved actively