日本財団図書館（電子図書館）　First International Meeting on Essential Drugs and Community Health systems

Guatemala

I. Background

　　UNICEF's Urban Basic Services Programme (UBSP) currently operates in the country's metropolitan areas. The Integrated Health Programme (PIS), a component of the UBSP, was initiated nine years ago with the main participation of poor women, who formed an important community organization, the Effort and Prosperity Foundation (FUNDAESPRO). These activities are carried out in collaboration with the Health Ministry through its local health districts as well as with national and international NGOs.

　　The PIS, seeking to integrate its actions and to attain sustainability, began to develop models of community pharmacies, totally managed by FUNDAESPRO. Its successes prompted the request for further funding from The Nippon Foundation in order to allow the expansion of these activities to the rest of the country as the Essential and Generic Drugs programme under UNICEF's Bamako Initiative. It is hoped that the Essential and Generic Drugs Programme will be fully implemented in five years to meet the health needs of the estimated six million Guatemalans now living in extreme poverty.

II. Objectives

□Find and apply a formula that will make medicines of good quality and low cost available to those populations most in need

□Provide training/education in such areas as health promotion and the appropriate use of medicines

□Improve and extend distribution mechanisms of essential and generic medicines, eventually to even the most isolated communities.

□Stimulate self help in the area of health at the community level

□Create mechanism for the Program to be self-financing and for the efficient management of resources received from the state and other organizations

□Provide financial and technical support in the operation and consolidation of enterprises operating within the Program

□Promote investigation, development and the use of natural medicines

III. Mechanisms to be Used

□Establish training centers or study formulas that will allow better usage of existing training centers

□Create a Distributor of Essential and Generic Medicines, as well as a chain of popular pharmacies throughout the country that would be in charge of selling and distributing such medicines

□Integrate existing distribution and sales centers of essential and generic medicines into the Essential and Generic Drugs Programme through the supply mechanism

□Establish the Essential and Generic Medicines Fund (FOMES), which would be a trust acting as the financial branch of the whole program

□Stimulate domestic production of essential and generic medicines included in the national list of medicines that are of low cost and adequate quality

□Negotiate with other countries and international organizations to obtain at optimal conditions the medicines on the essential drugs list

□Organize community groups

□Create and maintain information system about use, prices, properties, new formulas and other information related to essential and generic drugs, natural medicines and traditional practices in health care

□Establish follow-up and evaluation system of the Essential and Generic Medicines Programme to measure compliance with the objectives for which it was created

III. Achievements Against Specific Goals to Date

　(see Table,p.78)

Table.Achievements Against Specific Goals to Date (Guatemala)
Goals	Achievements
1.Implement 50 community pharmacies in three-year period	1.Seven community pharmacies have veen established with FUNDAESPRO.Three other pharmacies have been put into place with other community organizations,and these will serve as models to be used towards network enhancement.
2.Train 150 women health promoters to administrate community pharmacies	2.In coordination with the Ministry of Health,the School of Pharmacy and the Technical Training Institute,36 women have been trained in management and administration.A course,Management and Administration of Community Pharmacies,was designed for health promoters and is currently in the process of being validated.
3.Systemize experiences of community pharmacies	3.Systemization has been initiated and is currently in its final stage.
4.Create central drugstore that will adequately provide pharmacies with qualified and affordable basic medical supplies	4.A national program,known as "Reaching All the People,"has been initiated.Encompassing.such areas as health education,epidemiological research and the use of traditional medicines,it is more expansive and ambitious than the original idea of a simple supply depot for medicines.