E-drug: Decentralising pharmaceutical services (cont)
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Dear Wilbert and e-druggers:
First of all I think is necessary to be clear about a point.
Decentralization is always not a health sector initiative, but a global
government decision. In other words is a democratization, human
rights, and social participation discussion, and not a health,
pharmaceutical or
administrative discussion.
It means that our position usually is not if we agree or not about it. In
reality I think we need to prevent the most frequent risks, and take
care of the predictable problems.
Standardization of a restrictive list of essential drugs, and
enforcement of the regional control authorities is probably an
essential need.
If the country has a national supply system, there are a lot of
success decentralization experiences in Latin America. In the other
hand, there are also a lot of "disasters". Most of them goes on the
way of build a commercial relation between institutions or regions,
and the national office. And of course every institution have the
funds for drugs and the decision about what, how much and to whom buy.
Colombia, a well calificated country in the recent "world health
report" of WHO, has a decentralized system, where every hospital is a
social public enterprise with his own budget. There is a national
formulary and is widely used by doctors. But in the past 5 years, we
developed a regional hospital association model in hospital
cooperatives, that combines scale economies
with a very efficient management. Maybe is an interesting experience
with success results.
I'm sure we need to follow up the health sector reforms and its
impact in drugs. Decentralization is a core issue. But usually the
question is when,
how and in which way, and not yes or no. I believe.
Good Luck
Dr Francisco Rossi
"Francisco Rossi" <francisco_rossi@hotmail.com>
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