Transcript Poster presentation

PROVIDA’S IMPACT ON
IMPROVING ACCESS TO
AND USE OF ESSENTIAL
DRUGS IN POOR
COMMUNITIES IN PERU
JOSEFA CASTRO, PHARMACIST
JORGE SOLARI, PHYSICIAN
SERVICIO DE MEDICINAS
PRO-VIDA
Abstract
•
Problem Statement: The poor of Peru were confronted with high-cost medications, lack of supplies in
government health facilities, and the promotion of the irrational use of drugs by health care providers.
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Objectives: Increase access to essential drugs for poor communities, with their active participation.
Promote the rational drugs use (RDU) among communities, health professionals, and the general
public. Lower the costs of health care not only by lowering drug costs but also by lowering the cost of
drug treatments through their rational use. Set an example for government institutions to include RDU
as part of their health policies.
•
Intervention: A model was designed for grassroots pharmacies (GPs) in communities where
government services were not available. The model includes training a health promoter elected by the
community to be the head of the grassroots pharmacies and a professional health care adviser to the
grassroots pharmacies . An essential list of generic drugs was developed to be supplied to the
grassroots pharmacies at low cost (60% to 90% less than regular pharmacies). A methodology for
providing health education to uneducated adults was also developed. In 1985, Provida started
working as a nongovernmental organization based on this model.
•
Results: Provida’s model has been replicated by the Peruvian Health Ministry (PHM) and some other
Latin American countries. grassroots pharmacies are recognized by Peruvian law as providers of
pharmacy services of high quality. A 1996 study found 4,500 active grassroots pharmacies serving
2,600,000 community members. Medications had been provided to 1,200,000 people. The number of
grassroots pharmacies has decreased since the government applied Provida’s model and expanded
its health services. Around 10,000 health promoters and health professionals have been trained.
Provida’s team periodically conducts research studies on drug use. Provida’s supply system is 100%
auto-financed, while Provida’s administration as a whole is 85% auto-financed. For the past 17 years,
Provida has put out a quarterly magazine that is independent of the pharmaceutical industry and
contains reliable scientific information.
Background
• Servicio de Medicinas Pro-Vda,
Pro-Vida, was created in July, 1985 as a
non government organization by initiative of
pastoral agents following a catholic church
initiative to contribute to improving access to
essential drugs for Peruvian poor people.
• Pro-Vida promotes the rational drug use(RDU)
to different target audiences:
- Health care workers:health professionals
health promoters(HP), among others.
- MOH authorities and health official
- General public
Problems Addressed
• Poor people of Peru faced
– High-cost medications
– Under supply of drugs in
government health facilities
– Inadequate access to
essential drugs, especially in
rural areas
– Health care providers
prescribing and dispensing
irrationally.
Objectives
• Increase access to essential drugs for
poor urban and rural communities.
• Promote active participation of these
communities in health care.
• Promote rational drug use (RDU) among
communities, health professionals, and
the general public.
• Lower the cost of health care by
lowering the cost of drugs and drug
treatments through their rational use.
• Set an example for government
institutions to include RDU as part of their
health policies.
Intervention Model for
Grassroots Pharmacies
A model was designed for grassroots pharmacies in
communities where government services were not available.
It included:
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A methodology created by Provida: training conducted by
using educational techniques specially designed for
uneducated adults.
Training materials to support training activities.
Training a health promoter (HP)elected by the community to be
head of the grassroots pharmacies
Training a health care professional to give technical assistance
to the HP in charge of the grassroots pharmacies
A limited list of essential drugs to be managed by HP
A rational system for supplying essential-quality drugs to the
grassroots pharmacies at low cost (60% to 90% less than regular
pharmacies).
A revolving fund for drugs raised by the community by means of
loans from Provida as seed fund.
Since 2001, HP are also being trained on community epidemiology
to cover needs beyond grassroots pharmacies.
Methodology of the
Intervention Model
• Characteristics of Pro-Vida’s methodology are:
– To encourage active participation of the community
with representatives in the local board. The grassroots
pharmacies are a initiative of these local boards.
– To introduce a strong awareness of the benefits of an
RDU policy
– To provide accessible educational material to the
community in such a way that it be related to them
– Constant updating of the training of the health
promoters and the training material to fit the needs of
the community
– To extend the training and RDU education to
healthworkers from public services, MOH and NGOs.
• Thus, education efforts cover all levels from the
general public to health professionals and
policy makers.
Implications
• Provida’s model has been replicated by the Peruvian
Ministry of Health (PACFARM, a public supplying
program) and some other Latin American countries.
• Because of the good work that Grassroots pharmacies
have done and as well as Pro-Vida’s lobbying have
donne, they have been recognized by peruvian law as
providers of pharmaceutical services of high quality in
their communities (firsth level)
• In the Health Act (Law) promulgated in july 1997, the
Peruvian Ministry of Health has declared that:
Government health care providers must follow a RDU
policy.
Drug supply must be managed through a generic drug
list.
Community participation in health care should be
promoted
Results
• A 1996 study found:
– 4,500 active grassroots pharmacies serving
2,600,000 community members.
– medications had been provided to 1,200,000
people.
– around 10,000 health promoters and health
professionals have been trained.
• Pro-Vida’s team periodically conducts research
studies on drug use.
• Its supply system is 100% auto-financed, while
provida’s administration as a whole is 85% autofinanced.
• For the past 17 years, Provida has put out a
quarterly magazine that is independent of the
pharmaceutical industry containing reliable
scientific information about RDU.
Others Achievements
Beyond supplying low cost drugs to
community pharmacies, Provida :
• is now actively participating in the MOH
tenders
• has been able to reduce the price of
antileshmaniasic drugs drastically, thus,
bringing the cost of treatment down to
1/8th of the cost in 2003.
• has obtained a 5 fold price decrease for
antileishmania drugs
• has increased the number of treatments
obtained by supplying quality drugs at
lower price
• is contributing to improve efficiency of
government funding
Limitations
• Strong opposition from some laboratories and
drug suppliers to the RDU policy
• Lack of economic resources restricts the
promotion of RDU. It is not easy to finance a drug
bulletin that promote RDU.
• A weak legal system hinders the promotion of
generic drugs
• The register process of drug needs technical
improvement in order to strengthen RDU.
• Withdrawal of health promoters from grassroots
pharmacies due to personal economic needs.
CONCLUSIONS
Provida’s model has shown to
be successful in:
• improving use of drugs and
• lowering the price of essential
medicines for the poorest families
in Peru.
• By doing so, it is contributing to
increase access to proper
treatment.
Current and Future Work
• Continue to support communities in their efforts
to have access to rational health treatments.
Continue -and improve the logistics on -the
supply of drugs to the Ministry of Health for
treatments against:
- Leishmaniasis (since December, 2003)
- Malaria (since February, 2004)
- VIH (currently in supplier selection process)
 For tuberculosis (since February, 2004), joint
work with the MOH and some others NGOs on
prevention, education and organization of
patients, their needs and rights (Global Fund
Project ).