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The effect of an educational intervention
on the drug purchasing practices of
local government officials in a
decentralized setting
Isidro C Sia M.D., Ph.D.*, Cristina E. Torres, Ph.D.†,
Noel R. Juban, M.D., M.S.‡
* Department of Pharmacology, College of Medicine, University of the Philippines Manila
† Department of Social Sciences and Philosophy, College of Arts and Sciences,
University of the Philippines Manila
‡ Department of Clinical Epidemiology, College of Medicine,
University of the Philippines, Manila
Background
The advent of decentralization has given greater
responsibility to local leaders for decision-making &
resource allocation. Devolution in the Philippines involved
the transfer of responsibility & resources from the national
to the local government units (LGUs) who now have to
deal with the burden of apportioning scant resources for
multiple local programs. It is widely perceived that funds
available for health and drugs after devolution has been
substantially reduced. Given the limited resources &
urgent need for provision of other basic social services it
becomes important that municipalities efficiently purchase
appropriate & sufficient drugs to address the health
requirements of the people.
Objectives
The aim of this study is to improve the drug purchasing practices of local
officials using an educational intervention focusing on the principles of
rational drug use. We hypothesize that the intervention will increase
health budgets for drug purchases and bring about a corresponding
increase in the purchase of essential drugs.
Methods
Subjects & Setting: Ten municipalities/cities were chosen at random
from the provinces of Laguna (intervention) & Batangas (control).
Potential participants were recruited my mail and included the mayor or
representative, mayor’s executive staff including the local planning &
development officer, budget officer, accountant, municipal/city health
officer & staff, barangay officials.
Intervention
The intervention was pre-tested & included two components:
1. Interactive discussion (IGD) addressing purchasing procedures at
the municipal level, including budgeting guidelines and procedures,
purchasing procedures and actual practices being followed in each
community.
2. Short lecture-discussion, distribution of materials and IGD
addressing legislation and guidelines for drug use and purchasing.
Topics were; national drug purchase guidelines; Executive Order
49; Generics Act of 1988 (Republic Act 6675); Philippine National
Drug Formulary (PNDF); essential drugs for rural health units;
principles of drug supply management; rational drug use principles;
drug use guidelines for common illnesses; & drug use
guidelines for community health workers, pharmacies & home use.
The intervention was conducted 10 times, in each intervention
municipality or city, & coincided with regular executive meetings.
Each session lasted between 1.5 & two hours.
Results
Table 1. Number and Class of Participating
Local Government Units
Intervention
Province
1 City
9 Municipalities
1 - 1st Class
2 - 4th Class
6 - 5th Class
Control
Province
1 City
9 Municipalities
2 - 1st Class
1 - 2nd Class
1 - 4th Class
5 - 5th Class
Municipa
lity
Class
Total Budget
2000
Amount
(000,000
Php)
Laguna (Intervention)
San
Pablo
City
375.3
79.7
Rank
Health Budget
2000
Amount
(000,000
Php)
1
Rank
1
18.5
5
Sta. Cruz
Pagsanja
n
1
4
25.4
Pila
4
28.3
7
% Health to Total
Budget
2000
Rank
Amount
(000,000
Php)
9.3
9
11.64
13
1.6
10
8.51
2.3
9
10.46
0.87
19
5.58
Liliw
5
22.1
12
Mabitac
Magdalen
a
5
15.6
18
5
20
Majayjay
5
19.7
15
1.3
17
8.86
Pakil
5
16.2
17
1.3
17
7.73
Victoria
Average
5
22.7
11
0.4
20
1.75
62.5
10.9
3.947
11.95
7.706
11.5
1.7
Rank
3
13
2.67
1
9
0.41
10
5
14
7
8.5
0.2
0.1
0.2
15
18
14
12
0.3
12
8
20
10.9
% Drug to Health
Budget
2000
Rank
Amount
(000,000
Php)
2
2.14
9.09
2.2
14
2000
Amount
(000,000
Php)
17
4.94
2
Drug Budget
0.15
0.3
0.3
0.677
17
10
11
10.9
11.52
14
28.32
5
24.64
6
8.32
17
4.45
20
22.95
8
17.63
10
11.87
13
23.95
7
75.58
1
22.923
10.1
Municipa
lity
Class
Total Budget
Health Budget
2000
Amount
(000,000
Php)
Rank
2000
Amount
(000,000
Php)
Rank
% Health to Total
Budget
2000
Rank
Amount
(000,000
Php)
Drug Budget
2000
Amount
(000,000
Php)
Rank
1.5
3
4
7
% Drug to Health
Budget
2000
Rank
Amount
(000,000
Php)
Batangas (Control)
Tanauan
City
91.9
4
4.7
4
5.12
Bauan
Sto.Toma
s
1
108
3
4.2
5
3.91
1
210.4
4.9
3
2.33
Lemery
2
45.7
6
3.5
6
7.63
3.2
7
11.7
2
Taal
4
27.6
8
Alitagtag
5
14.3
19.5
1.4
14.5
9.8
Laurel
5
17.8
16
1.4
14.5
7.74
Talisay
5
23
10
1.3
17
5.63
San Luis
Sn
Nicolas
Average
5
20.2
13
2.5
8
12.24
1.7
11.5
12.25
2.88
9.05
7.835
19.5
5
14.3
57.32
10.1
16
18
19
1.5
0.5
11
4
6
9
15
1
2
1
0.5
0.22
0.1
0.1
0.48
5
6
13
19
20
8
16
0.16
10.1
0.606
10.1
31.88
3
35.55
2
10.15
15
28.65
4
15.51
12
15.71
11
7.26
19
7.74
18
19.21
9
9.15
16
18.081
10.9
Table 2. Average Baseline Total, Health and Drug
Budgets and Ranks per Group
Intervention
Control
P – value*
Total Budget
62.5
57.3
0.7623
Rank
10.9
10.1
3.95
2.88
11.95
9.05
7.71
7.84
Rank
10.9
10.1
Drug Budget
0.68
0.61
Rank
10.9
10.1
22.92
18.08
10.1
10.9
Averages
Health Budget
Rank
Health over Total
Drug over Health
Rank
* Mann- Whitney Rank Test at alpha = .05
0.2720
0.8798
0.7043
0.7624
Table 3. Comparison of health and drug budgets
pre- and post-intervention
Averages
Intervention
Control
P-value
Health Budget
2000
2001
% change
67.21
81.4
14.19
64.24
72.23
8.05
0.6501
Drug Budget
2000
2001
% change
12.31
11.30
- 1.02
11.14
14.29
3.15
0.4497
Drug to Health
2000
2001
% change
22.92
14.49
- 8.43
18.08
19.50
1.51
0.1736
Table 4. Comparison of purchase of essential and nonessential drugs pre- and post-intervention
Intervention
Control
P-value
Essential
2000
2001
% change
Non-Essential
2000
2001
% change
88.58
91.99
4.26
82.52
84.21
2.89
0.5453
11.42
8.01
- 11.75
17.48
15.80
9.47
0.5453
Conclusions
1. One time intervention may not be sufficient to
bring change.
2. There seems to be a greater impact among LGUs
with less resources than the rich LGUs..
3. There was noted increase in the health budget
and per capita health expenditure in the
intervention LGUs.
4. There was a decrease in the purchase of nonessential drugs in the intervention LGUs compared
with the control LGUs..
Recommendations
1. Reinforcements may be done in educating the heads
Of LGUs regarding rational drug purchasing and use.
2. Involvement of the village leaders should be encouraged
since they have to work with lesser budgets and are the
most in contact with the people.
3. In depth analysis of the processes done by the different
LGUs to identify which systems works for whom.