○ Ensure year-round supply of essential drugs at sub-health posts (SHPs), health posts (HPs) and public health centers (PHCs) by establishing community cost sharing schemes through community involvement in financing and management of health facilities

○ Promote community participation in management of health services

○ Standardize prescription patterns

○ Improve quality of care at SHPs, HPs and PHCs through use of standard treatment schedule and community management

○ Set up self-sustaining community drug funds

○ Ensure continuous availability of drugs by replacing in a gradual manner dependence on government supply with community cost-sharing system

○ Establish and operate effective drug replenishment system

○ Encourage, initiate and sustain community and health facility co-management, with movement toward independent community management and control of drug funds

○ Increase capacity of health workers to work collaboratively with community

○ Coordinate continuous, on-the-job training of health workers in the public and private sectors in promotion of rational drug use

○ Implement community health education activities to reduce self-medication and prevent misuse of drugs

○ A policy for the Community Drug Programme to introduce the user fee system at the health facility level has been developed and adopted by the government. The government has approved immediate implementation in three districts for fiscal year 1996-97.

○ Two years of operational research was completed in 1996 July in the Nuwakot district, location of the CDP pilot project. The findings were as follows:

- The community accepted the concept of cost sharing for essential drugs.

- Community members actively participated in the CDP.

- By having year-round availability of drugs, health facilities became self-sustaining.

○ The Nepal Drug Financing Study was completed by UNICEF and USAID/RPM. It recommends that communities have ownership of locally generated funds raised through the introduction of user fees.

○ A Joint Implementation Unit for CDP was established in 1996 May to follow-up on day to day activities and to execute the program at the district level. The unit is under the direct guidance of the Director General of Health Services and is located in the Department of Health Services. Members include full-time representatives from various divisions of DHS, MOH, the Ministry of Local Development and UNICEF.

○ District and VDC level orientation and training materials have been revised by the Joint Implementation Unit. A new training package which includes IEC materials has been developed.

○ The standard treatment schedule for health facilities has been revised by the Department of Drug Administration and approved by MOH. It will be used in training PHC workers to promote the rational use of drugs.

○ Central and district level Plans of Action have been prepared for immediate implementation of CDP activities in the selected three districts.

○ District Level Activities:

- District Drug Management Committees (DDMCs) and CDP Task Forces have been formed and oriented in the three new program districts.

- DDMC members, representatives of local NGOs, INGOs and line agencies, political leaders and journalists have been oriented in the CDP concept.

- VDC chairpersons and secretaries have been oriented in the CDP concept.

- Preparations for health staff training, scheduled for 1996 October/November, have been completed.

○ Unfilled staff positions

○ Frequent transfer of trained staff

○ Delays in supplying drugs from district to peripheral health facilities

○ Lack of supervision and monitoring

○ Lack of seriousness and commitment by health staff at periphery

○ Lack of timely support from authorities concerned

○ Lack of transportation facilities

○ Government policy changes due to political changes; frequent management changes

○ Sudden changes in priorities due to unexpected events, e.g. epidemic of communicable diseases

○ Unmotivated health staff members