Peru
I. Background
Although Peru has recognized the idea and practicality of “essential drugs” since 1959, early attempts to initiate any sort of substantive program based on the concept failed due to the dearth of budget resources. In 1991, the Peru-UNICEF Cooperation Programme started the Revitalization of Peripheral Health Services Project (PROPESEP), meant to help revive the health sector and improve the state of maternal/child health. PROPESEP encouraged joint community and public sector management of a package of essential drugs in 341 units of Peru's three health sub-regions, to the benefit of approximately 500,000 people.
PROPESEP had important results. Essential drug consumption rose, as did the size of the intangible fund and the use of services. The Ministry of Health, through the Department of Medicines, Supplies and Drugs (DEGEMID), was encouraged to take these achievements as the basis for a national essential drugs policy, implemented via the Co-Managed Community Pharmacies Programme (PACFORM).
II. Objectives
□Strengthen operation of 360 first-level health centers in the Sub-regions of East Lima, Chavin and La Libertad through PACFORM
□National implementation of PACFORM in 4000 first-level health services of the Ministry of Health
III. Main Achievements
□Essential drugs and funds totaling nearly US＄3.2 million have been transferred.
□The supply of low cost essential drugs has been extended to the entire state network of first level health units.
□1,300 Local Pharmacy Management Committees have been created
□32 sub-regional medicine distribution centers have been opened.
□Essential drugs have been delivered to all health centers and posts nationwide.
□3,500 health agents and technicians in charge of pharmacies have been trained in the rational use of medicines and in revolving fund administration.
IV. Main Limitations
□The logistics system of the health sub-regions is weak, particularly in planning, purchasing, information, supervision and control of inventories, and medicine distribution, which contributes to the danger of drug shortages.
□Community participation is not yet adequate. The mechanisms ensuring adequate community representation and involvement in management must be improved.
□The intangible fund administration procedure is not yet adequately developed.
□Considerable irrational prescription persists, necessitating further efforts toward establishing the rational use of medicine and to the training of prescribers.
□Health center staffs are reluctant to accept community participation in implementation.
□Current legislation in Peru does not allow for the development of local management systems (for local drug funds).
□Ways to maintain revolving drug funds in the extremely poor Andean and Amazon Jungle communities must be found.
V. Issues to be Discussed and Decided
□Insertion of the Essential Drugs Programmes into health sector reforms
□Strengthening of drug supplies to local sub-regional systems
□Development of production and marketing of essential drugs by private companies
□Local funding and capital systems in poor communities
□Community participation and other alternatives for cssential drugs revolving fund administration
□Rational drug prescription
□Local supervision and auditing systems for management of own funds
□Problems associated with national extension of program, i.e. loss of technical quality and logistical difficulties in implementation
VI. Future Plans
□Strengthen national implementation of PACFORM
□Strengthen PACFORM coordination with Ministry of Health investment programs and projects
□Strengthen PACFORM implementation in seven priority health sub-regions
Specific Activities
□Strengthen local essential drug stocks, including the participation of corresponding institutions
□Implement computerized system for registering sales, drug stocks and purchases
□Reinforce training of staff responsible for prescriptions in rational use
□Reinforce management training of staff in charge of sub-regional deposits
□Strengthen community participation as instrumcnt of social control for proper administration of revolving funds, and increase use of services offered by health centers
□Improve community education in rational drug use
□Campaign to inform public of existence of low cost, quality essential drugs at health centers, thereby promoting their use
