PATHS Final programme report: "Togetherness in Health" the Enugu ...

and the core DRF models used in other PATHSstates were adapted to fit the Enugu context.Prior to the introduction of the DRF considerablepreparatory work was undertaken including:“There was always out of stock syndromeand laxity on the part of staff, or you comeand you don’t see patients and you have nodrugs to give them”.• Determining an essential drug listThe Officer-in-Charge at Ozalla PHC facility,• Selection of participating facilitiesAni Stella, describes the situation before the• Ensuring facility preparedness for a DRF (e.g.initiation of the DRF programme•safe and secure drug storage areas)Removal of all expired drugs from the•facilities and their destructionRemoval of all “private” stocks of drugs• Up-to-date stocktake of the remaining drugs• Quantification exercise to determine the volume of drugs required by each facility• Submission to the Health Commodities Programme of information on drug requirements• Design and implementation of the financial management system to underpin the DRF to ensurethat decapitalisation did not occur• Training of four DRF teams responsible for the implementation of the scheme (these comprisedeight accountants and eight pharmacists, four from each of the private and public sectors)• Preparation of CMS, including provision of additional finance staffAt the end of the first quarter of 2006 DRF implementation began using a two-phased approach:• Capacity building of facility staff on DRF procedures• Mobilisation of facility catchment communitiesInitial difficulties encountered included:• Capacity of staff to manage the DRF and associated FMS• Provision of off-site rather than on-site training, which reduced the impact• Poor quantification resulting in an over-supply of drugs• Large volume of paperwork• Challenging replenishment logistics• Slow lodgement of DRF funds• Outmoded CMS systemsOver time and with ongoing supportive supervision most of these challenges dissipated and facilitiesbegan to implement the scheme effectively. Replenishments were frequent and no stock-outs ordecapitalisation had been recorded by early 2008.As of early 2008 the DRF was managed entirely by SMoH staff and had been introduced into 100facilities - both public and private, primary and secondary care. Other positive developments includethe fact that several private sector facilities were starting to replenish their stocks at the CentralMedical Stores rather than use private suppliers. Nevertheless, frequent and robust monitoringwill be essential if the scheme is to continue to succeed, but given the logistics and expense, thiswill be challenging to achieve. Ensuring that adequate funds are included in the health budget formonitoring activities will be essential. A further challenge is that with the implementation of a free38 PATHS Final Programme Report