E-drug: Community Pharmacies in Burundi (cont'd)
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In response to the request of Trish Araru (Health Co-ordinator, Save
the Children, Burundi)I would like to share the following information.
a. The Britain Nepal Medical Trust (BNMT) is implementing drug
schemes in the government health institutions of 5 remote hill districts
in Nepal. These schemes are managed by the Local Health Support
committees (LHSC) and the health institution. The Chair person of the
Local Village Development Committee (VDC) is the Chair person of the
LHSC. The person in charge (a paramedical prescriber) of the health
institution is Member Secretary of the LHSC. Other members of the
committee are: Headmaster of the most senior school of the VDC,
Ward Chair of the VDC, Female Community Health Volunteer, one
social worker. If needed the LHSC can also include the representatives
of the local political parties. This committee manages the drug fund,
procures drugs from the BNMT district offices and transport drugs
from district office to the local health institutions. The LHSC also
decides the fee to be paid by patients. Every year the LHSC can revise
the rate. In the first year, patients pay 40% of the cost of dispensed
drugs (based on single item fee). BNMT staff and the district health
staff of the government support in capacity development and technical
matters including monitoring. Before the implementation of the drug
scheme at the health care facility level, the local people should decide
(through a mass-meeting) whether to implement the programme at
their health institution or not. This meeting, however, requires a good
facilitation.
b. The drug retailers take part in the mass-meeting. They have not
shown any opposition to any drug schemes implemented at the
government health institutions. There are two reasons: (i) the
community pharmacies cannot go against the decisions of the local
communities and (ii) only essential drugs (drugs from restricted list
identified by the government for a particular level of health institution)
are supplied to the health institutions. Besides when drugs are
continuously available prescribers stay at health institutions and
patients flow to the particular health institution is also increased. The
local retailers can get chance to sell some drugs not dispensed at the
health institutions. However, the programme has a built in provision of
advocacy and education on rational drug use.
The BNMT drug schemes aim to improve quality of care and
sustainability on drug supply at government health institutions. The
BNMT programme has supported drug scheme activities even at the
district hospitals (not less than 15,000 patients per year per hospital)
with medical doctors. There are 5-7 private pharmacies near these
hospitals. Sometimes during informal discussions, they blame our staff
that the government has started selling drugs. Our programme does
not directly criticise the private sector prescribing and dispensing. The
staff facilitate them to understand the importance of drug schemes in
our local/ national context.
Therefore, the existence of community pharmacies has not adversely
affected for the implementation of essential drug programme and
cost-sharing drug schemes at health institutions.
Shiba Karkee
Co-ordinator
BNMT Drug Schemes Programme
Biratnagar, Nepal
e-mail: dspbnmt@mos.com.np
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