Summary of Issues, Constraints and Problems from Country Reports and Presentations, Categorized According to Working Group Assignments
I. Community Participation (community mobilization, community education and PHC/RDF committees, etc.)
□Management capacity of health workers low
□Irregular supervision
□Weak information and financial management at community level
□Reluctance to accept community participation in program implementation
□Extreme poverty in poor and rural communities
□Inadequate local funding and capital development in poor communities
□Community participation in administration of RDFs
□Lack of experience in community based health services, cost sharing and RDF
□Harmonization with existing structures and networks
□Insufficient understanding of the concept of RDFs and its ownership by the community
□Meeting health service demand based on disease and socio-economic profile
□Matching services with community needs
□Weakness of community organizations because of culture of dependency
□Low attendance at health centers due to lack of awareness and lack of faith in system
□Patient responsibility for services received
□Poor local health care habits
□Incomplete implementation (e.g. national to community levels, prescriber to users)
□Acting on community willingness to pay for health care
□Irrational use of medicines, self administration of medicines
□Promote use of natural medicines
□Inadequate training
□Unmotivated basic health staff
□Diminishing resources (family incomes, capital) due to general economic situation
□Problems arising from regional differences (i.e. language, customs, living conditions, migratory habits) within each country
II. Drug Supply and Logistics (national drug policies, Essential Drug Lists, drug information systems, etc.)
□Discontinuity/difficulties in permanent supplies of essential drugs in local market for replenishment
□Integration of RDFs into health sector reform
□Strengthening drug supplies at the sub-regional levels
□Production and marketing of ED by private companies
□Logistical difficulties when scaling up/expansion to national level
□Shortage of drugs and stock outs at central and rural stores
□Weak management tools and information flows for project evaluation
□Present system of replenishment for RDFs subject to ever increasing drug costs because of forex reasons and no national drug fund
□Scope and nature of the health reform process to include RDFs and pharmaceuticals
□Legal reforms to require use of generic drugs
□Registration and control of imported drugs
□Problems related to transitional economies, changing political environment
□Scarcity of information sources (e.g. information centers, instructional manuals and guidebooks)
□Incomplete implementation (e.g. national to community levels, prescribers to users)
□Introduce community cost sharing scheme for replenishing essential drugs
□Prioritizing health care needs according to scarcity of resources
□Formulation of Essential Drugs Lists
□Improve distribution and logistics systems
□Inequity of health care system
□Problems arising from regional differences (i.e. language, customs, living conditions, migratory habits) within each country
III. Functioning and Operation of RDFs (guidelines and procedures for the RDFs, inventory management, accounting and financial management, rational prescribing, etc.)
□Management capacity of health workers low
□Irregular and poor supervision
□Weak information and financial management at community level
□Substantial irrational prescribing, incorrect usage
□Community participation in administration of RDFs
□Local supervision and auditing systems for management of individual funds
□Weak management tools and information flows for project evaluation
□Insufficient understanding of the concept of RDFs and its ownership by the community
□Standardization of the operation of the RDFs in the country
□Integration of the RDF with other PHC services
□Legal reforms to require use of generic drugs
□Introduce community cost sharing scheme for replenishing essential drugs
□Infrastructural problems (e.g. transportation, sanitation, storage)
□Scarcity of information sources (e.g. information centers, instructional manuals and guidebooks)
□Need for adequate monitoring, supervision and evaluation of project activities
□Inadequate training
□Strengthening coordination with donors
□Long-term sustainability of projects
IV. Stregthening Management Capacity of Health Teams at the Various Levels (supervision, monitoring, planning, implementation, coordination activities, and training to deliver quality health care)
□Managiment capacity of health workers low
□Irregular and poor supervision
□Knowledge and skills of health workers poor
□Poor planning and monitoring skills
□Poor quality of services
□Lack of legislation/policy that permits local managemnt of funds esp. RDF funds
□Integration of RDFs into health sector reform
□Local supervision and auditing systems for management of individual funds
□Loss of technical quality when scaling up
□Full time person for project implementation at provincial level
□Harmonization with existing structures and networks
□Weak management tools and information flows for project evaluation
□Lack of health economic management capacity and ability at provincial, district and community level
□Lack of methodological guidance in Bamako Initiative experiences
□Development of information network between participating countries to exchange project experiences (e.g. newsletters, regular meetings in participating countries, project site visits and staff exchanges)
□Development of common indicators to measure RDF/ Bamako Initiative activities and achievements
□Costing of basic package of rural health services
□Insufficient initial political support for RDFs from MOHs
□Lack of a drug and health information system
□Role definitions of the various actors (community, NGOs, MOH, National Drug Fund and international organizations) involved
□Integration of the RDF with other PHC services
□Scope and nature of the health reform process to include RDFs and pharmaceuticals
□Management policies (coordination and decentralization) in a health district
□Matching services with community needs
□Problems related to transitional economies, changing political environment
□Infrastructural problems (e.g. transportation, sanitation, storage)
□Incomplete implementation (e.g.national to community levels, prescriber to users)
□Prioritizing health care needs according to scarcity of resources
□State subsidies for poorest sectors of society
□Establishment of emergency care network
□Scarcity of information sources (e.g. information centers, instructional manuals and guidebooks)
□Improvement of administrative processes with respect to intangible funds
□Improve distribution and logistics systems
□Need for adequate monitoring, supervision and evaluation of project activities
□Inadequate training
□Unmotivated basic health staff
□Strengthening coordination with donors
□Inefficient management of funds, coordination of efforts, personnel, resource allocation, etc.
□Long-term sustainability of projects
□Problems arising from regional differences (i.e. language, customs, living conditions, migratory habits) within each country
