# \[e-drug\] Decentralising pharmaceutical services **URL:** \ **Category:** e-drug\ **Created:** [January 24, 2001, 8:56pm UTC](https://talk.edrugplus.org/t/e-drug-decentralising-pharmaceutical-services/10156 "2001-01-24T20:56:37Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![wilbertbannenberg](https://avatars.discourse-cdn.com/v4/letter/w/8e8cbc/32.png) [@wilbertbannenberg](https://talk.edrugplus.org/u/wilbertbannenberg)\ **Post date:** [January 24, 2001, 8:56pm UTC](https://talk.edrugplus.org/t/e-drug-decentralising-pharmaceutical-services/10156/1 "2001-01-24T20:56:37Z")
E-DRUG: Decentralising pharmaceutical services --------------------------------------------------- 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 -- 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'.