Transcript Oral Presentation 1

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, College of Arts and Sciences,
University of the Philippines Manila
‡ Department of Clinical Epidemiology, College of Medicine,
University of the Philippines Manila
Background
 Devolution in the Philippines
 change in decision-making
 transfer of responsibility & resources
from the national to the local government
units (LGUs)
 the burden of apportioning scant
resources for multiple local programs.
 need for municipalities to efficiently
purchase appropriate & sufficient drugs
to address the health requirements of the
people.
Levels of Government
and Decision-Making Authority
 National Level
DOH*
 Regional Level
DOH
--------------------------------------------- Provincial
LGU**
 City/ Municipal
LGU
 Village (Barangay)
LGU
 *Department of Health
 ** Local Government Unit
Objective
• 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
 Design: Non-randomized pre-post comparison
 Setting: Ten municipalities/cities were chosen
at random from the provinces of Laguna (intervention) &
Batangas (control).
 Subjects: Participants for each municipalities were:
 the mayor or representative
 mayor’s executive staff:





local planning & development officer
budget officer
accountant
municipal/city health officer and staff
Village/ Barangay officials.
Intervention

The intervention was pre-tested & included
two components:
1. Interactive discussion (IGD)
- purchasing procedures at the municipal level
- budgeting guidelines and procedures
- purchasing procedures actual practices being
followed in each community
2. Short lecture-discussion
 National drug purchase guidelines
Executive Order 49
Generics Act of 1988 (Republic Act 6675)
Philippine National Drug Formulary (PNDF)


Principles of drug supply management
Rational drug use principles and drug use guidelines
for common illnesses
Outcome Measures and Analysis
 Outcome measures







Total Municipal or City Budget
Health Budget
Health Over Total Budget
Drug Budget
Drug over Health Budget
Essential Drug Expenditure
Non- Essential Drug Expenditure
 Statistical Analysis
 Descriptive statistics
 Mann- Whitney Test at alpha = 0.05
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
Table 1A. Baseline Budget Data for the Intervention Group
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
% Health to Total
Budget
2000
Rank
Amount
(000,000
Php)
9.3
Sta. Cruz
Pagsanja
n
1
4
25.4
Pila
4
28.3
7
2.2
10
8.51
Liliw
5
22.1
12
2.3
9
10.46
Mabitac
Magdalen
a
5
15.6
18
0.87
19
5.58
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
9
11.64
13
1.6
14
11.5
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
1.7
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
Table 1B. Baseline Budget Data for the Control Group
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
Taal
4
27.6
8
3.2
7
11.7
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
2
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 Test , alpha = 0.05
0.2720
0.8798
0.7043
0.7624
Table 3. Comparison of health and drug per capita
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
Mann – Whitney Test , alpha = 0.05
Table 4. Comparison of purchase of essential and
non-essential 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
Mann – Whitney Test , alpha = 0.05
Conclusions

One time intervention may not be sufficient to
bring change.

There was noted increase in the health
budget and per capita health expenditure in
the intervention LGUs.

There was a decrease in the purchase of
non- essential drugs in the intervention LGUs
compared with the control LGUs..
Recommendations

Reinforcements may be done in
educating the heads of LGUs regarding
rational drug purchasing and use.

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.

In depth analysis of the processes done
by the different LGUs to identify which
systems works for whom.
Good Day !