# \[e-drug\] Decentralizing Pharmaceutical Services (cont) **URL:** \ **Category:** e-drug\ **Created:** [January 28, 2001, 5:14am UTC](https://talk.edrugplus.org/t/e-drug-decentralizing-pharmaceutical-services-cont/10185 "2001-01-28T05:14:58Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![Oliver\_Hazemba](https://avatars.discourse-cdn.com/v4/letter/o/d2c977/32.png) [@Oliver\_Hazemba](https://talk.edrugplus.org/u/Oliver_Hazemba)\ **Post date:** [January 28, 2001, 5:14am UTC](https://talk.edrugplus.org/t/e-drug-decentralizing-pharmaceutical-services-cont/10185/1 "2001-01-28T05:14:58Z")
E-drug: Decentralizing Pharmaceutical Services (cont) --------------------------------------------- Dear E-druggers, South Africa is about to enter into an interesting phase of health reforms where access to health services and real dynamics of the pharmaceutical services and the industry are at play. In Zambia, we decentralized the public health commodities budget (essential drugs, laboratory and other medical supplies) to district level. The budget allocation is based on per capita. The District Health Boards get paper budgets or "virtual" paper money. They order their essential drugs and medical supply requirements against their budget allocation from a given essential list. Any other item required outside the list would be obtained from other sources using cost sharing or recovery and emergency funds. The system has not worked quite well for various reasons. Some of these include: 1) Limited stocks at the central warehouse, 2) restocking that is resource based rather than need, 3) limited capacity to prioritize facility needs based on pharmacoeconomics and public health concepts. 4) There is limited competence to functionalize the concept. 5) Inappropriate procurement practices both at central and district levels; and many others. Lessons learnt from expenditure of emergency and cost recovery funds has been encouraging. Some of the mitigating factors are compelling some stakeholders to contemplate the possibility of decentralizing the funds to district level. However, the experiences are very limited and the amounts at hand are very little. In addition, Health Boards are not allowed to spend above given figures by the contractor (Central Health Board). In some cases institutions do under spend due to various reasons too. Drugs are expensive and if bought in little amounts do not have a visible impact on the health service delivery. Inadequate pharmacy outlets (if any) in the remote districts is another limiting factor, etc. Decentralization of money would put the staff at the mercy of the industry. Most of the institutions do not have pharmaceutically trained cadres. In addition, to be frank, it is common knowledge that civil servants are very much under paid in our country. They will not miss the window of opportunity to assist the industry to maximize the costs. The issue of incurring high costs by referring patients has been taken care of in Zambia. The system here demands that the referring institution must meet the costs incurred by the higher referral level. Hence, in some cases it is the patients who suffer most when the lower level is unwilling to incur any further costs from the referral hospitals. There are many lessons that could be learnt from the Zambia health reforms. For South Africa, I would recommend that before the system is introduced make sure there is a good program of district capacity building and ensure availability of pharmaceutically trained health personnel. These may assist to improve availability, access and equity of access to pharmaceuticals, particularly the remote and disadvantaged communities. Oliver Hazemba Lusaka, Zambia ohazemba@zamnet.zm -- 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'.