Nepal
I. Background
In 1989, the first national level seminar on cost sharing schemers for drugs was held. It was decided that a Bamako-type strategy would be introduced on a national scale. This was delayed due to political upheavals and the subsequent restructuring of the Ministry of Health. In September of 1991, the government promulgated the new health policy which placed emphasis on the expansion of health facilities. The Community Drug Programme (CDP) was formally endorsed by the Ministry of Health (MOH) on August 19, 1994.
II. Objectives
The overall objective is to increase utilization and efficiency of health facilities to the point where their own financing, in combination with government contributions, can meet total financial needs, including the cost of essential drugs.
□Ensure year-round availability of essential drugs at sub-health posts, health posts and primary health centers by establishing community cost sharing schemes through community involvement in financing and management
□Promote community participation in the management of health services
□Standardize prescription patterns
□Improve the quality of health care at health posts, sub-health posts and primary health centers
III. Activities Carried Out
□Initiated development of training materials on scheme management, drug storage, drugs dispensing, and training of community members in December of 1994
□Conducted one-day orientation for senior MOH staff in December of 1994
□A three-day retreat with senior UNICEF staff held in February of 1995, where idea to involve the Ministry of Local Development (MOLD) evolved
□Program orientation in all five regions, with 200 participants from 75 districts, took place in March of 1995
□Formation of new steering committee in April of 1995, with Secretaries of MOH and MOLD as co-chairmen
□Donor's meeting held in May of 1995
□Orientation meeting of district health officers (DHOs), district public health officers (DPHOs) and district level community leaders from five districts held in August of 1995
□Community Drug Programme officer deputized in LMD
IV. Problems and Constraints
□Frequent changes in leadership occurring at various levels
□Inadequate management experience
□Training difficulties:
・ Lack of adequate staff in logistic division to manage central Drug Policy.
・ An historically established system of free service and drugs difficult to replace
・ Much needed frequent supervision and monitoring difficult to sustain
・ Effective coordination difficult to maintain at all times
V. Future Plans
□A study regarding drugs financing to be conducted in July through October of 1995
□Training materials to be revised and printed
□CDP field officer to be recruited
□Treatment guidelines and national essential drug list to be completely revised
□Training to be conducted in five districts
□Supervision, monitoring and evaluation to be strengthened
VI. Recommendations
□Examine existing drug scheme in terms of drug financing
□Slow down expansion plan
□Strengthen coordination with donors
□Revise treatment guidelines and national essential drug list
□Continue operational research in Nuwakot project area
