Transcript Accessibility of essential drugs in remote areas in

Accessibility of Essential Drugs in Remote Areas of Laos
Sivong SENGALOUNDETH, Bounnao PHACHOMPHONH, Sivixay XAYASAN
Khamveuy THAMMAKHANH, Vongchanh PHANOUVONG
Facilitated by Chanthakhath PAPHASSARANG & Lamphone SYHAKHANG
Supervised and Assisted by Ass. Dr.Rolf Wahlstrom, Dr Bo Erickson,
Ass. Dr.Cecilia Stålsby, Mrs Solveig Freudental, Prof. Goran Tomson
Problem Statement: To improve the situation of low access to essential drugs for
combatting common diseases in remote areas of Laos, revolving drug funds at the village
level (VRDFs) have been established since the early 1990s, but poor functioning has
recently been reported.
Objectives: To assess the accessibility of essential drugs in remote areas in two provinces
of Laos, and to explore the views on the performance and sustainability of VRDFs among
the VRDF committees and community members.
Design: Cross-sectional using quantitative and qualitative methods.
Setting and Study Population: A total of 400 household heads were randomly selected
from twenty villages in four districts of Khammouane and Champasak provinces. Twenty
village health volunteers (VHVs), who administer the VRDFs, were interviewed, and six
group discussions were conducted with community members and VRDF committees.
Outcome Measures: Percent of selected tracer essential drugs. A checklist, including the
existence of a VRDF committee, number of meetings, guidelines for VHVs, report
system, monitoring, auditing, the use of benefits from drug sales, etc., was used to assess
the performance of VRDFs. The perceptions of people regarding the issues of VRDF
sustainability were also explored.
Results: The availability of 10 selected essential drugs in the villages was low, with an
average availability of 35% in Khammouane district and 38% in Champasak. Of those
available, 41% and 37% were expired, and about 44% and 25% were incorrectly labeled,
respectively. For three out of four villages, the availability of essential drugs was higher in
a village where a private pharmacy existed than in villages with only a VRDF. No regular
meetings were held among VRDF committee members. There was a lack of necessary
guidelines and equipment for VHVs. The report and feedback system was not available.
No regular monitoring, auditing, or supervision of VRDFs by the district level was
performed. Only a few training sessions were provided to VHVs. Treatment seeking at
VRDFs was low among the villagers, mainly due to the lack of essential drugs at VRDFs,
the inadequate experience of VHVs, and the existence of other health providers.
Conclusions: There is a need to improve the quality of VRDF services by establishing a
comprehensive management system for VRDFs to strengthen the knowledge of VHVs,
improve drug procurement and monitoring, and ensure availability and accessibility of
good quality drugs for people living in remote areas, as well as to ensure sustainability of
VRDFs.
Background and rationale:
• Since Alma Ata in 1978, “Health for All” goal
not reached
• Widening gap between poor and rich, and
between urban and remote areas.
• Access to Essential Drugs(ED) to combat
common diseases in remote areas still a burden
in Lao PDR.
• Few revolving drug fund (RDF) in some remote
areas but generally unsustainable.
• Challenge to meet government policy to alleviate
poverty in 2020:
– A need to make ED accessible in remote areas,
thus expending the RDF.
• Lack of information on how to improve access of
ED in remote areas and how to make RDF
functioning and sustainable.
General Objective:
• To assess the accessibility of E.D
of the population in remote areas.
• To explore the performance and
mechanism of sustainability of
RDFs.
• To give information to the MoH
for further planning and
intervention.
Specific Objectives:
• To assess the availability of ED
based on the existing ED list.
• To describe where people can
get ED, what they know about
drug use.
• To assess the perceived quality
and price of ED.
• To assess and explore the
performance and sustainability
of the RDFs.
Methods
• Both quantitative and
qualitative methods were used
• Study type: Cross-sectional
• Study sample:
KM CHP
–
–
–
–
Sample size of households
Village Health Volunteers
Pharmacies/drugsellers
Group discussions
200
200
10
10
2
2
3
3
(5-10 pers.)
Data Collection
• 20 RDF drug kits were
surveyed.
• 4 Private pharmacies (2 in CPS,
2 in KM) were surveyed.
• 400 hh were interviewed
• 6 group discussions were made:
2 maleS, 2 femaleS, 2 RDF
Committees.
• 2 RDF Committees were
interviewed
Results
1. Availability of EDs
KM CPS
1 10 ED avail
%
35
%
38
2 Registered
2.5
25
3 Expired & unknown
42
38
4 correct packaging
64
75
5 Correct label
44
25
2. Health seeking behaviour
KM
CPS
N=304 N=369
%
%
11
11
1
Provincial hosp
2
3
District hosp
Health Centre
10
17
6
0.8
4
5
6
7
8
Village RDF
TM
Private pharmacy
Private clinic
Unlicensed
Practitioner
23
1
11
10
3
34
1
23
1
18
3. Reasons for not going to
RDF
KM
CPS
N=233 N= 242
%
%
1 Drug are not available at
RDF
2 No drugs as needed
5
46
25
1
3 Using private providers
18
13
4 Not cured at RDF
13
3
5 Serious illness
7
4
6 No injection at RDF
5
4
7 Poor service at RDF
4
2
8 Drugs at RDF expensive
4
3
9 VHV not available at
RDF
3
8
4. Prices of drugs in Kips
1 USD = 10400 Kip
KM
CPS
1 Ferrous
sulfate
60
(10-200)
60
(30-80)
2 Ampicilline
250
(250-250)
178
(50-500)
181
(125-200)
175
(100-250)
370
(300-500)
l 76
(25-250)
1.500
257
(200-500)
52
(35-100)
1437
(1000-1500)
3 Chloroquine
4 Cotrimoxazol
5 Paracetamo
6 ORS
Main findings
• Low availability of ED at village level
with high number of unregistered drugs,
expired drugs and poor labeling drugs
• Drug prices in KM were more expensive
than in CHS
• Inadequate comprehensive management
system e.g.organization,poor drug
supply system, qualified VHVs, no
guidelines, poor incentive system for
VHV and RDF committee
• 23% to 34% utilized village RDF in KM
& CHS
• Performance and sustainability of RDFs
are challenging issues
Recommendations
• Appropriate regulation and guideline of
RDF management system should be
developed.
• Regular monitoring from District Health
Officer to RDF should be performed
• The functioning of RDF management
committee should be improved.
• Training on RDF management and drug
use should be provided to VHVs.
• An appropriate incentive system should
be developed for VHVs and RDFs
management committee.
• Indicators for regular monitoring system
should be developed.