I. The community participation process (see Appendix) ensuring active participation should be made an integral part of the project framework, leaving the details regarding methods, approaches and modalities to those implementing within the local cultural context.

II. Community participation should not be limited to compliance to program activities or the mere provision of resources, but should also include the community, through its representatives and organizations, in decision-making at various levels, such as during the needs assessment, community mobilization, program planning, implementation and evaluation stages of the project. Inclusion of this component in the project proposal should be the responsibility of the government and donors should include funds for such a component.

III. The project proposal should include a component to develop the capacity of the community, which should include specific activities for training of community members involved in the RDF/PHC committees, as well as appropriate indicators jointly developed with the community to measure participation and the progress of the RDF from a community perspective.

IV. Community mobilization takes time and resources, and this should be recognized and accommodated in the planning for the project. Adequate time and funds linked to specific activities should be included as part of the project proposal. Progress in this area should be frequently measured and made part of the ongoing monitoring of the project and of periodic evaluations.

I. Continued and continuous political will
　The already existing political will must be reviewed periodically in order to ensure the maintenance and sustainability of equitable access and use of primary health care services. Clear statements should be made on the choice of essential drugs and the constitution of RDFs. The national budget allocation for essential drugs must be well-defined, clearly specified and increased.

II. Normative role of the central level
　The aim of RDFs is not to use drugs as a regular commodity in and of itself, but to contribute to the delivery of appropriate preventive and curative health services. As this is a guiding principle, it is therefore the central level's responsibility to elaborate guidelines, procedures and regulations, as well as to set up mechanisms to scale up successful pilot projects in a phased manner to the national level. The revenues generated by RDFs may be utilized for related health activities only after the viability of RDFs is fully established.

III. Community ownership and empowerment
　Clear delegation to the community is crucial. The community's participation and its responsibility for the management of the funds collected should be endorsed at the policy level, entitling communities to manage RDF revenues for improving basic health services.

IV. Support of technical groups
　Intersectoral task forces and support groups at central and intermediate levels must be established to ensure:

* standardization of the operation of RDFs;

* timely and effective monitoring and supervision;

* prompt dissemination of information.

V. Regular and continuous training of both health workers and communities
　The supplying of drugs and technical and managerial training must go together. This process must involve both providers and users (partnership in health care).

VI. Monitoring by regulatory authorities
　The role of government structures (e.g. drug administration) in inspecting, controlling and monitoring drugs and their prescription, sale and usage must be enhanced.

VII. Review of drug selection and guides for priority diseases
　A regular review of the drug selection process, keeping in mind the use of traditional medicines and the standard treatment guidelines for priority diseases, should be made mandatory to ensure proper diagnosis and treatment, thereby contributing to better quality health care services.

VIII. Workload problem of multi-faceted health workers
　The workload of health workers as “multi-managers” should be examined in terms of their working functions and procedures. A task analysis exercise should be carried out to define functions and determine priority tasks and support requirements, so that a balance that would accommodate their multiple roles can be found.

IX. Need for operational research
　It is vital that findings from operational research be fed back into the system. Clear mechanisms ensuring that this happens should be included as part of the program/project. Operational research should be conducted to study such topics as:

* community perception of RDFs and community acceptance of health services;

* family/household expenditures on health;

* performance of health workers with regard to technical and managerial aspects of RDFs (including the monitoring of prescriptions and the use of essential drugs).

I. Governments should develop long-term plans for the operation of essential drug supply systems, which should include traditional medicine as appropriate.

II. Training in logistics should be improved at all levels. This training should be initially funded by donors, but gradually incorporated into government budgets.

III. Governments should review health allocations in the budget, and in general allocation for drug supplies should be increased. Donor funds should be directed to the support of ongoing health care reform.

IV. National plans for strengthening rational generic prescribing should be developed to improve use of drugs and decrease costs.

V. Assistance is required to augment capacity, improve procurement practices and, in certain countries, raise standards for local production of essential drugs as this is important for sustainability. The exact modalities of this collaboration should be determined at the national level.

I. Using the RDF structure as the starting point and in order to revitalize the management system for basic health services, guidelines, short-, medium- and long-term plans, policies, and procedures for RDFs should be clearly formulated with the participation of actors involved at each level. This would facilitate donor participation.

II. Utilize competency-based training methodology, a problem-solving approach, and participatory methods to develop the training component of project plans. Integrate the training of health workers and community organizations from a policy and implementation perspective.

III. The provision of basic health services and the management capability of health workers should be improved with training that focuses on cooperation with communities as active partners rather than simply as recipients.

IV. An RDF program should be prepared with a detailed calendar of activities. The process and progress must be closely monitored during actual implementation, ensuring adherence to the sequence of activities agreed upon.

V. Clear and simple indicators for monitoring the progress and impact of RDFs at the community level should be developed. These indicators must be easily understood by the local communities, feasible for implementation on a regular basis, and useful for guiding the program on a long-term basis. Such indicators should be prepared in close consultation with beneficiaries, such as the local communities, NGOs, and health workers.

VI. While monitoring the impact of RDFs at the community level, gender, literacy, urban/rural populations, and other such issues should be considered in order to ensure equity.

VII. The project proposal should include clear activities requiring participation of the community in the local planning process during the needs assessment, community mobilization, and program planning stages.

VIII. To strengthen and reinforce the management capacity of the Ministry of Health and community organizations involved in the delivery of health care and management of RDFs, it is recommended that countries prepare overall national plans with short-, medium-, and long-term components so that donors can configure their participation within the framework of these plans.

IX. Country-specific policies and guidelines involving the creation of community revolving drug funds should include decentralization of authority to utilize locally generated funds at the local level.

X. Sustainability measures, such as budget provisions, human resource allocation, provision of supplies, community participation, management frameworks, and relevance to local contexts, should be built into any project proposal, ensuring adequate commitment on the part of all parties concerned (governments, assisting agencies, and the communities themselves).