Since November 1994, the project has been implemented in forty-one townships, with a cost recovery rate of around 20%. Project expansion to twenty-five more townships began in September 1996.

　

Specific Objective		Achievement
1. Establish clear policy guidelines on drug pricing		Decentralized the pricing of drugs
2. Define exemption policy and establish exemption criteria		Supervisory committees for health development funds set up exemption mechanisms in all project townships. Exemptions applicable to: - families designated as indigent by supervisory committees - homeless people - orphans - cases of medical emergency - members of religious orders
3. Establish transparent and accountable financial systems		Financial guidelines laid out and dispersed to townships by finance section of the Department of Health
4. Operationalize effective drug replenishment systems		Formed central level drug replenishment committee; issued call for tenders from approved drug manufacturers
5. Increase coverage and utilization of services		Increased coverage and utilization of services, observable in increasing trends
6. Rationalize use of staff time for delivery of basic health services		Rationalized use of staff time
7. Ensure that basic health workers apply essential drugs concepts		Conducted series of training courses
8. Ensure active community involvement in cost sharing schemes, particularly in planning decision making and resource management		Improving community involvement in cost sharing scheme, but involvement still weak in terms of planning, decision making and resource management; held series of advocacy meetings for community leaders and treasurers
9. Train and equip midwives and volunteers on management of local endemic diseases affecting children under five		Trained midwives supplied them with essential drugs; planned training for volunteers
10. Build capacity in area of health economics within the Ministry of Health		Held workshop on cost, resource use and financing of health services
11. Develop plan for building national capacity to produce essential drugs		Will invite consultant to survey local capacity for drug production

　

Problem		Action
1. Financial management still weak among some basic health staff		Conducted workshop on cost resource use and financing which was attended by trainers; translated financial management modules to be published for use in training sessions
2. Regularity in submitting reports and returns still weak in some townships		Instructed township medical officers to submit monthly reports by telegram or telephone at month end (see flow chart)
3. Some basic health staff still prescribing irrationally		Instructed TMOs to conduct monthly continuing education sessions on standard treatment schedules; planned flow charts on diagnosis and treatment of common health problems
4. Community awareness of principles and practice of the community cost sharing scheme still needs strengthening		Approached and trained community leaders and treasurers in skills for imparting knowledge of RDFs
5. Low utilization patterns in terms of percentage of population covered		Developed posters, pamphlets and folders for distribution to communities and basic health services
6. Township medical officers still reluctant to practice exemptions		Informed health care providers that the CHMF dose not deny the poor health care
7. Drug replenishment mechanisms operational, but local importers still unable to supply full list of essential drugs		CMSD now searching for local suppliers able to provide complete list
8. Affordability to consumers still an issue		Localized pricing of drugs; developed guidelines to exempt unaffordable items
9. Latest consignment of drugs experienced problems in terms of prices (unit prices higher than UNIPAC prices) and packing sizes (did not conform to specifications of order)		Reported to The Nippon Foundation
10. Basic health staff involved in community cost sharing still need incentives		Planned cash incentives; may create external study tours in collaboration with The Nippon Foundation