E-DRUG: Decentralising pharmaceutical services
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dear E-druggers,
South Africa is preparing to decentralize primary health care services from
the current 9 Provincial Health Authorities to 284 Local Authorities, which
range from very big urban "megacities" to understaffed, remote rural
districts.
A debate is looming whether, and if so, how pharmaceutical services should
be decentralised. Should Districts be given real money to procure essential
drugs for themselves (whereever the service is best) or should they be
given "virtual" paper money to obtain essential drugs from the existing
provincial warehouses?
What will happen with (chronic) patients needing expensive drugs: will they
risk being referred by districts to provincial hospitals so that they don't
eat into the PHC budget? Similarly, will (provincial) hospitals not be
tempted to downrefer "expensive" patients to districts, in order to save
costs?
Experiences in the past (e.g. Kenya's District Focus in 1985) had
disastrous consequences when drug budgets were decentralised without
building proper capacity in districts to handle budgets or procure
essential drugs efficiently.
Some districts finished their annual drug budget in a few months.
How do we build capacity in the districts to run pharmaceutical services
responsibly?
Any e-druggers who want to share their positive and/or negative
experiences?
Anybody who studied the impact of "health reform" programmes on
pharmaceutical services?
Is there any "Bamako Initiative" style projects that are still working at
district level?
Let's hear from the experts in the field....
regards
Wilbert Bannenberg
South African Drug Action Programme
Email: WilbertBannenberg@compuserve.com
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