- Austausch & Vernetzung
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Von Karin Wiedenmayer
Considering that pharmaceutical expenditures at public and private facilities in Africa typically make up to one third of total recurrent costs of a health care budget and can represent a large percentage at household level, good management of drug supply systems including promotion of rational drug use by qualified pharmaceutical manpower is imperative both economically and for good quality of health care.
The World Bank estimates that “because of widespread inefficiencies and waste, patients at public sector health facilities in Sub-Saharan Africa may effectively receiving the benefits of only $12 worth of quality drugs for each $100 of tax money spent for them.” (Better Health in Africa, 1994) This inefficiency and waste in the supply of drugs from budget allocation to consumer can be explained by inadequate buying practices, quantification problems, inefficient procurement and distribution, irrational prescribing and non-compliance by patients.
Because of inefficiencies, far more is being spent on pharmaceuticals than is necessary, erroneously reinforcing the view that the only answer to drug shortages is more money. However much can be achieved through more effective use of existing resources. Immense cost savings can be made by improving drug supply management systems.
The drug supply system is one of the very important components of the health care delivery system. An effective procurement and distribution process ensures the availability of the right drugs in the right quantities, at reasonable prices and at recognized standards of quality. High costs, frequent shortages, and donor dependence however are chronic problems of drug supply. There are many reasons for this: irrational and indiscriminate drug use, insufficient budgets and limited funding, but, first of all, inefficient drug supply management leading to duplication, waste, theft and spoilage.
Drugs and medical supplies can save lives and improve health, and they promote trust and participation in health services. Drugs are costly and different from other consumer products. In addition, substantive improvements in the supply and use are possible. Logistics - the science of procuring, maintaining and transporting supplies - is crucial: It involves delivering large amounts of supplies on schedule to many people located in various places. Considering the chain of events that occur for a drug from manufacture to end-user, it is clear that at every point along the way decisions can and have to be made involving all kinds of considerations:
Better management of drug supply can lead to better use of resources and allow significant savings. Government policy makers, essential drugs program managers, NGOs, donors and others should be made aware of the importance to strengthen pharmaceutical management capacity.
Literature: MSH/WHO, Managing Drug Supply, Kumarian Press, USA, 1997. Training for drug supply management is provided by MSH/IDA, Amsterdam, and at the Gordon University, Aberdeen, UK.