Regional pharmaceuticals management

The evaluation covered the period 1985-3/89. The project is on track. Suitable management and staff have been assembled for the Eastern Caribbean Drug Service (ECDS), and the ECDS has begun to implement a regional pooled tendering mechanism which has given all OECS countries (except Antigua and Barbuda, which has not yet participated in the scheme) access to lower unit prices for pharmaceuticals. Regionally, there is an aggregate cost reduction of about 44% for the pharmaceuticals most frequently purchased. This reduction has not led to actual savings, however, since the countries have used the funds to purchase more drugs in order to obviate supply shortfalls. Most countries seem to be reimbursing their drug procurement accounts at the Eastern Caribbean Central Bank in order to ensure prompt payments of suppliers, and all except one have regularly remitted the 15% administrative surcharge to the ECDS. It is projected that ECDS will capture approximately 63% of the total drug volume in its first year and in subsequent years reach the 74% level needed for long-term sustainability. However, support beyond the current PACD may be needed to reach this goal. The staff of the central medical stores (CMS"s) in individual countries have benefited from TA and training in drug supply procurement, storage, and distribution. Commodities provided by the project have also enhanced drug management: the delivery van procured for each country has expedited port clearance; the microcomputer provided each CMS has improved forecasting and stock management; and other equipment (shelving, refrigerators, etc.) has improved drug storage. In addition, participating countries have begun systematizing drug procurement by adopting the first regional drug formulary. On a negative note, several observed instances of expired drugs on warehouse shelves and of inaccurate recordkeeping indicate the need for further improvement in these areas. There are also indications that country-level health personnel outside the CSM"s do not clearly grasp ECDS"s role. The benefits associated with participation in the "buyers" alliance" and the importance of supporting ECDS by paying the administrative fee need to be communicated both to the top (Ministry of Health) and bottom (periphery health clinic) levels of the health care system. Private pharmacists have shown significant interest in the pooled tendering system. A careful study of this issue should be undertaken. Cost recovery is another important issue - while the need to recover some of the costs of public sector pharmaceuticals is widely recognized, this is not the domain of ECDS, which is essentially a procurement system and should not participate in policy dialogue at the country level. The major action recommendation is that ECDS assume full management responsibility for execution of the project.