Transcript WHY DID UNIT DOSE DISPENSING HARD TO BE

DECENTRALIZATION AS A
CHALLENGE TO IMPROVE THE DRUG
MANAGEMENT; AN EXPERIENCE
FROM SLEMAN DISTRICT,
YOGYAKARTA, INDONESIA
SUNARTONO
HEAD OF SLEMAN DISTRICT
HEALTH OFFICE, INDONESIA
1
ABSTRACT
Problem statement: Pharmaceutical has importance role in health service, so it must be given big attention by
stakeholders to ensure availability, accessibility and affordability, especially in health centers. Before year 2001
the drug management in Indonesia was more centralized, thus, the district has a smaller authority. Since
January 1st, 2001 the decentralization was started as a national policy with 11 obligated authorities at district
including health, meaning that the drug management as a part of health has become responsibilities of the
district. Some of the district failed to maintain it which is characterized by: reducing pharmaceutical funding,
increasing non generic name and irrational use at health centers. Actually, decentralization is an opportunity to
improve the selection, procurement, distribution and use of drug at the district level. Therefore, the question is:
“How the health district management can use to good advantage this opportunity?”
Design: This abstract describe serial activities have been conducted in Sleman district, Yogyakarta, Indonesia,
as a consequence to the decentralization policy. To evaluate the success of the activities, several indicators are
presented, i.e. local regulation, finance, pharmaceutical with generic name, efficiency of money, availability,
stock out of drug, percentage of antibiotic use, percentage of injection use, and number of drug per
prescription. The period of data collection is 1999 to 2003
Result: Since 2002 Sleman district has reduced 33 to 24 health centers and recruited doctor it self for health
center. Among district level policy others are practicing rationale drug use as one of the selective criteria of the
new doctors in the district, no procurement at HC level, providing better incentive for doctors practicing in
health center, and bioequivalence as a requirement for drug procurement. Drug management have succeeded
in keeping local funding of drug about 60% and increasing per year with the mean 17.78%, although in 2003
reduced slightly (about 2.84%). The routine budget of pharmacy is also increased from 19 to 89 millions or 4.5
times. More than 96% pharmaceuticals being purchased are with generic name, and the efficiency of using
money for purchasing drugs increased from 0.17 to 16.13%. The availability of pharmaceuticals can be
maintained at the safety level that is 1.72 times of consumption level with the highest stocked out 5.1% (8 from
157 items in 4 months) in 2003. Furthermore, it can keep performance of the rational use on drug with
indicators: reduced percentage of antibiotic use from 49.5 to 13.23%, reduced percentage of antibiotic use
(less than 5 days) from 100 to 24.7%, maintained percentage of injection from 2.63 to 0.8%. Number of drug
per prescription is maintained at 2.75-3.
Conclusion: Decentralization is a chance for district health management to increase the quality of health
services through improving the drug management efficiency. However, these effort need comprehensive
approach involving all stakeholders and strong political support from the district authority.
BACKGROUND
 Pharmaceutical has importance role in health
service, so it must be given a big attention
 Decentralization in Indonesia was started on
January 1st, 2001 meaning that the drug
management as a part of health care
management has become responsibilities of the
district.
 Some of district have failed to maintain the drug
management which are characterized by:
 reducing pharmaceutical funding,
 increasing non generic name, and
 irrational use of medicines in health centers.
OBJECTIVE
 To evaluate the success of
the Sleman District Health
Managers to maintain the
drug management during the
process of decentralization in
Indonesia.
METHODS




Design: a case study
Location: Sleman District, Yogyakarta, Indonesia.
Period of data collection: 1999 – 2003,
Qualitative data: recruitment process of new
doctor, drug procurement process, capacity
building process, budget negotiation for drug,
political will from local authority, etc.
 Quantitative indicators:
Budget allocation for drugs, efficiency of funding,
availability, drug stock-outs, percentage of
antibiotic use, percentage of injection use, drugs
prescribed with generic name, and average
number of drug per prescription.
TIMELINE
Decentralization Process
Advocacy to
local authority
Capacity for political will
building and budgeting
Year 1999
2000
New system New system
of recruitment for drug
new doctor procurement
2001
2002
2003
QUALITATIVE FINDINGS
 Reducing the number of health centers: 33 to 24
 Continuous training; Clinical Performance
Development Management System for nurse and
midwife, Monitoring-Training-Planning approach,
regular supervision and feedback on drug use and
management
 Implementation of local government policies and
regulations:
 Rational drug use principles as a requirement in
new doctor recruitment,
 No drug procurement at health center level
 Better incentive for prescribers in health centers
 Bioequivalence data as a requirement for drug
procurement
BUDGET FOR PHARMACEUTICALS
Millions
Pharmaceutical budget
3,000
1999
2,500
2000
2001
2,000
2002
2003
1,500
1,000
500
0
Central govt.
Province govt
Health insurance
Budget of district
Others
TOTAL
GENERIC PRESCRIPTION,
ANTIBIOTICS, INJECTIONS
%
100
90
80
70
60
50
40
30
20
10
0
1999
2000
% generic name
2001
% AB < 5 days
2002
% AB
2003
% Injection
EFFECIENCY OF FUNDING IN
DRUG PROCUREMENT
20%
15%
10%
5%
0%
1999
2000
2001
2002
2003
DRUG AVAILABILITY AND
CONSUMPTION (Rp)
Millions Rp
8,000
Availability
Consumption
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
1999
2000
2001
2002
2003
IMPLICATION DRUG MANAGEMENT ON
DECENTRALIZATION PROCCESS
 Centralization
Diagnose
Treat
Follow up
Evaluation
 Decentralization
-Organization
-Finance
-Human resource
-Equipment
(qualitative & quantitative)
-Capacity building
-Commitment building from the staffs
-Advocacy to the local decision makers
•Improving the drug management:
-Selection
-Distribution
-Procurement
-Use of drug
-Sustainability of finance resource
-Availability of drugs
-Efficiency on procurement
-Rationality on use of drug
CONCLUSION
 Decentralization is a chance for district health
management to increase the quality of health
services through improving the drug management
efficiency.
 The district health management needs
comprehensive approaches involving all
stakeholders, and strong political support from the
district authority.
 The main management support to comprehensive
approach includes organizational, educational, and
financial supports