E-drug: Bamako Initiative (cont'd)
---------------------------------------------
Dear Michel and other e-druggers,
I am sure that the next-weeks-conference in Bamako will show the
enormous difference between west and east/southern Africa
concerning experiences with cost-sharing / user fees and local drug
revolving funds. In many west-African countries, such as Mali,
Burkina, Ghana, Guinee Conakry, experiences with community
financing and local drug revolving funds have been quite positive over
the last 5-10 years. Since essential drugs have been introduced at
large scale (thus becoming an affordable and adequate alternative for
the far more expensive french commercial brand name 'specialites'
that still dominated the market during the 80s), prices for essential
drugs came down enormously (in Segou, a baseline survey on the
average cost of prescriptions in 1989 showed that patients paid on
average 5 times less after the introduction of essential drugs provided
by international sources such as IDA) and utilisation rates of public
health services rose significantly. As selling prices usually include the
real cost price and a realistic mark-up for drugs management costs,
many of these local revolving funds have proved to be financially
sustainable (hi sceptics.. I am sorry, but it is true!). Furthermore, many
local communities have been actively involved in financing issues at
the health centre level. It is unfortunate that these positive
experiences have been insufficiently documented in english literature
and are thus greatly unknown to the 'anglophones'...
To the contrary, experiences with user fees and financial drugs
management in east / southern African countries have been much less
positive. The most important explanatory factor here is that donors
have been financing essential drugs for decades (Malawi, Tanzania, ..)
and patients never paid (or - if they did - a token fee..) for their
prescriptions in public health institutions. In the mean time, I dare to
say that the public vertical 'push' supply systems have proven to be
rather inefficient and the availability of drugs in the public health
facilities has often be suboptimal. The role of local communities in
improving drug supplies has been insignificant. Now that donors will
not automatically continue to pour money in these unsustainable
top-down management systems, the way how to finance and organise
future drugs supply has become a very important question that
deserves all attention ...
I hope that the BI conference allows the participants from
west-African countries to tell their story to their 'confreres' in the east
and southern parts. But let's not be naive... I sincerely hope as well
that the conference will then continue to address the enormous
problems arising in the same west-African countries related to the
liberalisation of drug markets and decentralisation of control: illegal
self-medication, lack of inspection of local markets, illegal (essential)
drug selling, etc. Successful management of local drug funds is not
the same as appropriate use of these drugs... Any solutions,
participants from eastern and / or southern Africa?
Rene Dubbeldam.
ETC/Crystal, Leusden, Netherlands
e-mail: DubSlob@compuserve.com
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.