----------------------------------------------
E-DRUG Bulk Purchase Schemes & Pooled Usage
It seems that I may have started a monster! Thank you to all people who
have responded to me directly.
As Richard has pointed out, pooled usage is one model for a BPS. In
theory it is an admirable concept and can indeed be successful. It
certainly increases negotiating power when the individual drug
quantities required are small. Anything which encourages collaboration
and networking produces (hopefully) the desired target benefits plus
some other unexpected good outcomes e.g. information sharing.
Controlling drug standards and quality through a pooled system is easier
and more successful, than through individual purchase by small countries
which do not have a system of drug registration.
There are some practical challenges: There must be existing
infrastructure capacity which can accurately predict requirements (at
least 6 -12 months ahead). As acquisition time can be as much as six
months after placement of the pooled order, the procurement and
distribution must be efficiently managed and monitored or active life of
the drug will be compromised by the time that it reaches operational
level.
Coordination of finances can be complex. Legislation in small countries
usually precludes payment before goods have arrived, so participation in
schemes which require up-front payment can be impossible. In a shared
pooled procurement system (as distinct to an NGO purchasing for a number
of countries) a decision needs to be taken on how the risk in relation
to currency fluctuations will be shared. If the country suffers from
poor governance this can produce other financial problems.
Once a pooled system has been set up it does produce other options for
collaboration. Information sharing of course is one option, but another
is to share the drugs themselves when this is necessary. Electronic
communication can mean instant drug sharing possibility, provided that
transport exists. This "sharing" seems to work OK when the drugs are
given e.g. to a bus driver for within-country sharing, but small
packages even though clearly marked "urgent medicines" can easily be
left behind (for various reasons)when the transport is by air or sea.
The answer here may be the development of good personal contacts.
My view is that for too long the focus has been on procurement or
acquisition of drugs as an isolated factor. All sectors and sub-sectors
are linked and there is no point in merely making drugs available if
they are the "wrong" drugs or if they are then used in a manner which
compromises optimal patient outcomes. I consider that rational drug use
must be linked to drug availability, and that systems which
compartmentalise (in an attempt to over simplify) the overall
therapeutic process are doomed to sub-optimal outcomes or potential
failure.
But perhaps others can prove me wrong..............
Regards,
Murray
Murray Bailey
Pharmaceutical Development Consultant
Sydney, NSW, Australia
Tel/Fax: 61 2 9310 3365
Mobile: 61 414 310 338
Email: bailey_m@bigpond.com
[Moderators Comment Murray please could you summarize the responses you have
received. Richard Laing]
--
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'.