| Current Status |
Key Constraints |
Priority Areas for Action |
| Cambodia |
|
|
| The necessary framework (policies and guidelines, replenishment mechanism, preparedness of community and health teams) for RDF implementation is in place in selected areas. |
→ Guidelines for use of locally generated funds not yet approved
→ Widespread self-medication
→ Rehabilitation of health centers not proceeding as planned
→ Government funds still not reaching periphery |
→ Development and establishment of RDF pricing mechanism
→ Integration of community financing into overall supervisory and monitoring system of MOH |
| Laos |
|
|
| Currently 391 village communities have community health workers and operational, community-level RDFs. The MOH has finalized and budgeted a plan to set up RDFs at eight of nine provincial, ten district, and ten pilot community health centers. The estimated budget for commodities and training will amount to US$561,350. The government has committed to increasing the drug budget to eight percent within five years. |
→ UNICEF and MOH differ in priorities, with UNICEF actively supporting CHW-based RDFs, MOH promoting RDF implementation at government health facilities down to community level
→ Pricing mechanism needs further consolidation
→ Drugs still distributed free-of-charge in some provinces
→ High inflation eroding buying power of revolved funds |
→ Because of national government's exemption policy, need to develop guidelines and procedures for policy implementation and prevent decapitalization of RDFs especially at health facility levels
→ Overall supervision needs strengthening, and RDF supervision at community and facility levels needs to be integrated into overall supervision |
| Mongolia |
|
|
| Pilot activities in selected sums have had mixed results, but there is sufficient indication that the project will be scaled up to twelve sums in the UNICEF districts. Health insurance currently covers 95% of the population, but due to recent government changes, it has not been able to reimburse hospitals which has resulted in significant outstanding dues. The rate of cost recovery is currently at 73.9%. |
→ Local management is weak despite extensive decentralization
→ Drug procurement and distribution still centralized
→ Links with health insurance system still needs further development
→ Accounting and financial management capacity needs further strengthening |
→ Explore legal issues surrounding RDFs and develop plan to define legal status of RDFs
→ Further develop and strengthen financial and accounting frameworks for operating RDFs based on pilot experience |
| Myanmar |
|
|
| Township level RDFs are all revolving. At the community level, results are mixed. An effective consumption mechanism is in place and communities are compensating RDfs for drugs used for treatment of indigents. Financial guidelines are being implemented. Coverage and utilization are increasing, and staff time is being rationalized |
→ Community participation is still weak in regard to supervision, oversight, and in local decision making about the use of generated funds
→ Drug procurement process still very centralized
→ Financial management capability at the health team level still weak
→ Considerable irrational drug use
→ Very limited decentralization |
→ Increase buying power of revolved funds and develop medium- and long-term investment plan to increase supply of essential drugs by government and donors
→ Develop plan to accelerate decentralization within MOH, starting with drug procurement and management at township level
→ Develop management capabilities of health teams at peripheral levels |
| Nepal |
|
|
| The initial phase of the CDP is being implemented in three districts, and the project proposal for the second phase is being finalized for submission to the Nippon Foundation by 1 December 1996. Collaboration between various donors involved in strengthening the Logistics Management Division (LMD) is being improved. |
→ Tendency to develop projects in response to perceived requirements of available and possibly available funds instead of developing system for MOH and CDP in response to actual needs
→ Very weak coordination and implementation capability at central and provincial levels MOH relies excessively on NGOs and other donors to deliver basic health services |
→ Develop replenishment mechanism to support community drug funds consistent with effort to strengthen LMD and in accordance with recommendations of recent UNICEF and MSH study on drug financing in Nepal
→ Develop within LMD guidelines and procedures a transparent accounting and financial management accounting system for community drug funds |
| Vietnam |
|
|
| The majority of RDFs are revolving. Training for the next phase is being carried out. Thirty TOTs have been carried out. Guidelines for RDF operations at the commune level are being revised. Training on rational drug use is underway with 2,400 staff already trained. The operation of RDFs is bringing about an integration of various health committees. Community mobilization and health education activities are being carried out or initiated at the commune level. The project is poised to move to the next stage on receipt of the next batch of drugs from the Nippon Foundation. |
→ Guidelines for RDF operations and for communication between communities and the CHC need to be reviewed and revised
→ Impact of training on rational drug use needs to be assessed
→ Integration of health care delivery and of various PHC activities needs to be accelerated |
→ Review financial management and accounting frameworks for RDF operations
→ Develop plan for accelerating training on rational drug use and community health education |
