Dr. Takusei Umenai

　

　　The Second International Meeting on Essential Drugs and Community Health Systems differed significantly from the first one in that the conference was limited to participating countries in the Asian region. It focused on progress made in project implementation, including accomplishment of the recommendations made during the first conference. Emphasis was also placed on the identification of critical aspects of RDF projects by country working groups, and their development of draft plans of action that would be incorporated into annual plans of action on their return home. Another significant issue that was explored was the sustainability of progress made so far: the conference expressed recognition that if RDFs are to increasingly become the engines for stimulating the development of health care delivery systems and eventually strengthen the primary health care framework in host countries, a long-term view to supporting the process started will be required.

　　Cambodia, for example, in preparation for the launching of its RDFs and before the request for seed stock was submitted, began with the development of policies and guidelines for the management and operation of RDFs, for the local use of locally generated resources and funds, and for rational prescription. In preparation, it established an effective replenishment system, and began rehabilitation of health facilities in areas selected for RDF implementation. This approach was developed as a result of the experiences shared during the first conference: in other countries where RDFs were launched without adequate preparation in the areas mentioned above, it lead to the RDFs quite rapidly decapitalizing due to poor support and ineffective replenishment systems.

　　The other example was Vietnam, where the experience from first phase implementation of the project made it apparent that the guidelines for co-management of RDFs and for financial and inventory management needed to be reviewed and modified to include more detailed inputs from community and district levels. The roles of RDF/health committees and of provincial and district health administrations needed to be redefined, especially with regard to the supervision and monitoring of RDFs; this was made painfully clear when the resources of the RDF project committee at the central level were stretched far beyond capacity in efforts to regularly monitor RDF performance. The selection of focus areas by the Vietnam country group--namely a review of management, financial and accounting frameworks of RDF operations as the main activity for the forthcoming year--is testimony to the usefulness of such conferences in providing opportunities and in serving as pivots from which to review the past, to explore and analyze past experiences in the present with others involved in similar situations, and to plan for the future.

　　The stage has now been set for the scaling up from pilot projects to the national level in some countries and the systematization of pilot projects in others. Commodity and financial support from the Nippon Foundation provided additional resources, allowing countries such as Vietnam and Cambodia to plan the transition, in phases, from pilot to national program. Accordingly, the management of projects is also moving from management for small pilot projects to management styles more appropriate for mainstream national programs, as in the case of Vietnam. In countries such as Laos, Cambodia, Mongolia and Myanmar, the RDF projects are poised to move from pilot projects to national programs, while in others such as Nepal, they are still in the pilot stages.

　　As seen in Vietnam, and to some extent in other countries such as Myanmar and Cambodia, there has been significant development in health sectors as a result of revolving drug funds. Collaboration between project countries and outside support not only needs to be continued, but should become more technically focused and targeted to achieve the overall aim of the Essential Drugs Project, which is to improve access to affordable, acceptable quality essential drugs for vulnerable and disadvantaged populations and to strengthen primary health care. It is hoped that donors and other agencies realize the importance of the long-term view in this capacity-building initiative, and that participating countries continue to maximize the resources they receive and maintain the level of commitment they have so impressively demonstrated.