Honduras
I. Background
The administration and financing of a network of health units and the promotion of the sale of essential drugs through community drug funds (CDFs) began in 1991. Based on the framework developed under the Bamako Initiative, this project aimed to validate the strategy of broadening primary health care services through community participation. At the start, 50 CDFs were set up in rural areas located in various municipalities. To date, responsibility for organization, training and monitoring of the CDFs belongs to five NGOs that receive technical and financial support from UNICEF. Although the Ministry of Health endorses these activities, it has not actively participated in implementation.
Within a very short time, it became apparent that this project was effective in improving access to medicines, thereby raising demand from communities for the establishment of more CDFs. Between 1992-1994, 225 CDFs were implemented in five of the country, benefiting a population of approximately 200,000 people.
II. Key Objectives
□Promote and strengthen community organization and the self-administration of health services
□Improve access of the general population to primary health services
□Improve access of the poor to essential drugs of good quality and low cost
□Reduce the practice of self-administration of drugs and improve general knowledge of the proper use of medicines
□Promote use of natural medicines when possible
III. Achievements Against Objectives to Data
□225 CDFs have been installed, each with its own administrative committees comprised of four community-elected members. 90% of the CDFs are located in hard-to-access rural areas and 10% in the marginal zones of the capital city.
□10% of the administrative committees observe general maternal health activities in coordination with community midwives.
□Two community Houses for the Attention to Deliveries have been established.
□85% of the CDFs administer their own re-supply of medicines.
□300 CDF venders have been trained to: diagnose, treat and prescribe drugs for basic health ailments; properly handle and store the 20 drugs at their disposal; identify health problems requiring attention at a higher level and make the appropriate referral.
□CDFs have been officially recognized by the Ministry of Health as important components of the national strategy to improve general access to medicines. A technical-normative unit has been created to assume responsibility for the coordination of CDF development.
□The project has succeeded in involving municipal corporations, the Ministry of Health (at the local regional and area levels) and nine NGOs.
□The World Food Programme and the European Union participated in the financing of CDF expansion into areas where they are currently implementing development projects.
□30 nurses in Sanitary Regions 2 and 5 have been trained, particularly in regard to their roles as project promoters, coordinators and monitors.
□Some CDFs sell natural medicines that are widely used.
In some communities, the growth and success of CDFs has prompted the establishment of low cost food shops modeled after the administrative systems of CDFs.
IV. Problems and Constraints Experienced
□Insufficient conceptual development. Communities perceived CDFs as services provided by NGOs and were thus reluctant to take over. This problem has been almost completely overcome.
□Community organizational debility. Most communities have been beneficiaries of projects run by paternalistic organizations, resulting in a lack of confidence in their own abilities. This problem will be gradually resolved as they receive better training and see the results of their efforts.
□Insufficient initial political support (from MOH authorities) and the early absence of a higher level technical-normative entity (other than NGOs) to coordinate projects and normalize implementation. This problem is in the process of resolution as the MOH now officially recognizes CDFs as an important component of government health care strategy and a coordinating entity at the central level has been identified.
□Present re-supply system of CDFs discourages sustainability. This is a major problem that arises out of rising product and transportation costs. A proposal is currently being considered for the creation of a national drug fund (“The National Drug House”), which would be an autonomous organism that guarantees permanent, opportune, low cost and high quality drug supplies to CDFs.
□Poorly developed information system. The capacity to process data generated by CDFs so that the findings can be applied at local management levels is limited. Such data is anyway incompatible with the information systems used by the network of health services, and there is no central mechanism of consolidation to allow aggregate analysis. It is expected that this problem will be resolved with the establishment of the technical-normative entity described above.
V. Issues That Need Discussion and Resolution
□Regulations and normatization of community drug funds
□Sustainability of CDFs
□Definition of roles of various actors involved: the community, the Ministry of Health, NGOs, the National Drug Fund, and other international organizations
□Development of the CDF, incorporating other primary health care services, until it constitutes a community health service which is self-administered by the community and linked to the institutional network of services
Future Plans
□Creation and operationalization of a national drug fund
□Implementation of regulations and the normatization of CDFs by the technical-normative entity established by the MOH
□Expansion of the coverage of CDFs
□Expansion of the range of activities currently covered by CDFs, i.e. into reproductive health and acute respiratory illnesses
□Improvement of technical and managerial abilities of CDF administrators
□Development of a system of supervision, monitoring and evaluation to be based in the communities, and the results projected to higher levels
