Drug Supply Systems in Developing and Transitional Countries

1
Drug Supply Systems in Developing and
Transitional Countries

• Richard Laing
• BUSPH

2
Drug Supply Systems -Public and Private Systems

• Selection
• Procurement
• Distribution
• Use
• Legislation Regulation
• Financing

3
The Essential Drugs Target
National list of essential drugs
Registered drugs
All the drugs in the world
Levels of use
S
S
CHW
dispensary
Health centre
Supplementary specialist drugs
Hospital
Referral hospital
Private sector
4
Selection Agents

• Regulatory Agency responsible for registering
  drugs to be in the country
• EDP responsible for defining Essential Drugs
• DTC responsible for defining hospital formularies
  or drug lists

5
Definition of essential drugs

• Essential drugs are those drugs that satisfy the
  health care needs of the majority of the
  population, at a price they and the community can
  afford they should therefore be available at all
  times and in adequate amounts, and in appropriate
  dosage forms.
• WHO Expert Committee on Essential Drugs, December
  1999)

6
Procurement

• Public sector Tenders, Central stores, hospitals
  procure directly, Kits in some countries
• Private sector
• -Not for profit - Mission Organizations
• For Profit - MNCs and local either manufacturers
  or agents
• International

7
Distribution

• Public sector
• Push Kits Vaccines
• Pull Regional and district stores
• Transport Public or Private
• Private sector
• Private wholesalers Distributors
• Pharmacies
• Drug stores
• OTC and Drug Peddlers

8
Rational Use

• Varied situations in different countries
• Doctors, pharmacists, drug sellers all prescribe
• Quality of dispensing a big problem
• Prescribing in private and mission sector often
  financially motivated

9
Financing - Multiple source

• Public Sector
• Public Health Diseases eg TB vaccines usually
  free
• Other diseases subsidized or free usuallybut
  sometimes Cash and Carry Availability a problem
• Private Sector
• Mission Full cost recovery
• Private for Profit Full cost full profit

10
MaliHousehold spending-1986
health costs in Mali. Health Policy and planning
1990, 5(2)126-138
11
Legislation regulation

• Drug Regulatory Agencies of differing competency
  and areas of responsibility
• Stages
• Notification
• Recognition
• Local registration
• Full Registration with quality testing
• May regulate product, facilities or people

12
Conclusion

• Many differences, many similarities
• What should happen and what does happen often
  very different
• Understanding positive experiences from other
  countries often serve as the basis for future
  developments!