・ Distributed guidelines to provinces, provincial hospitals and implementing partners

・ National RDF guidelines for hospitals reviewed by RDF Committee

・ Held working session in Louang Prabang (training center) on review of guidelines

・ Made corrections of national RDF guidelines for hospitals and health centers

・ Drafted national guidelines for RDF Committee (on supervision, evaluation, training)

・ Draft of guidelines on the role of provincial/district pharmacy in RDFs

・ Commenced planning of training activities

・ Started writing training modules

・ Not yet performed

・ Not yet performed in RDF program, but completed in programs of implementing partners (Savannakhet)

・ Not yet performed in RDF program but completed in programs of implementing partners (UNICEF, Sante sud)

・ Not yet performed in RDF program but completed in programs of implementing partners (SRC, UNICEF)

・ Setting up of a secretariat and practical organization of the program

・ Started database of RDF statistics for monitoring and evaluation

・ Preliminary training in Bokeo (five districts)

・ Evaluation of RDFs and cost recovery system in Paksan Provincial Hospital

・ Now redefining National RDF Program (objectives, planning, tasks, resources)

・ Redefining overall budget and proposal following Nippon Fundation visit

・ RDF established in 51% of public health facilities

・ RDF established in 7% of villages

・ Big differences between RDFs

・ Some RDFs are like private pharmacies while others concentrate on improvement in quality of care

・ RDFs with fixed objectives, training sessions, and guidelines usually do better

・ Lack of training

・ Lack of supervision and evaluation

・ Lack of objectives

・ Reporting principles included in national guidelines

- Monthly report of the management committee with financial data's on RDF

- Supervision every three months

　

・ In practice

- Monthly reports are not yet ofter sent to upper level but remain in public health facilities

- Annual reports summarize RDF financial performances

・ Pricing principles are included in the national guidelines. Prices are maximum 125% of purchasing price (allowing 10% for inflation, 10% for RDF administrative costs and 5% for transport)

・ Principles are, in practice, followed by the majority of RDFs

・ Essential Drugs List for Lao PDR reviewed on 7 April 1997 (1218/FDD): 261 items

・ Selection of direct delivery system (centralization of needs, contracts with suppliers, decentralization of orders, based on local manufacture) for the national procurement of drugs assisted by SIDA

・ Assistance from WHO/STC from March to September 1997 for start of RDF program

・ Drug supply assistance from SIDA for 1998 to 1999 period

・ Agreement on the General Policy on Cost Recovery & RDFs reached on 30 September 1997

・ Second version of National Guidelines on RDFs for hospitals, health centers

・ Writing of guidelines on supervision, reporting and evaluation for RDFs (WHO/STC)

・ National RDF program should start from training of central trainers, to provincial RDF committees, to provincial hospitals, and so on

・ NGO and IO (e.g. SRC, MSF, EED, UNICEF) assistance programs "in situ"

・ Not yet performed on an official basis

・ On experimental basis with NGOs working through in situ training

・ 1995-96 7.5% (source: Report of IV National Conference on Health, 08/97)

・ 1.633% of national budget allocation for the purchase of drugs (+/- 3$/pers/h), which is 12.23% of health budget

・ 0.212% of national budget allocation for medical equipment, which is 1.59% of health budget

・ Of course it is increasing because all the provided drugs are for sale

・ Exemption is very limited

・ The Lao government yearly provides funds for purchasing drugs to each province according to its population7 size; provided drugs are included in RDF system

・ Uncertainty regarding possible financing of National RDF Program

・ MOH-led changes in RDFs

・ Incentives for VHWs in community RDFs

・ Rising inflation

・ Lack of training and supervision

・ Unclear position of Nippon Foundation and unclear request from MOH

・ Ongoing structural review at MOH

・ Community RDFs generate little income

・ Uncertainty regarding need to pay 20% reimbursement to treasury

・ No clear official position for the payment of civil servants who pay for drugs through insurance (they pay themselves then ask for reimbursement, or hospitals pay first and are then reimbursed by MSW)

・ No clear official position on who should pay, who not and who should decide it

・ Ongoing structural review at MOH

・ WHO budget for local costs in six month periods

・ Engaged WHO for six month short-term consultation on RDFs

・ Decided to review National RDF Committee and attach it to FDD Department

・ Draft of guidelines on supervision, reporting, training on RDFs

・ Second version of RDF guidelines for hospitals and RDFs

・ Review of National RDF Program

・ Decision making around RDFs should be easier because RDFs have been attached to one department

・ National Health Conference has urged the MOH to take practical approach regarding the implementation of Decree 52/PM on treatment payment (e.g. who should be exempted, treasury reimbursement, civil servants)

・ Two visits from the Nippon Foundation resulting in one positive assessment from a consultant

・ Extension of community RDF program from LWU/UNICEF in the field

1. To train theams of trainers at national, provincial and district levels on revolving drugs fund guidelines and training methods

2. To train all staff people in working posts related to the revolving drug fund management system and VHWs

3. To train staff at provincial and district pharmacies in order to enable RDFs to run successfully in provinces and communities

4. To implement, monitor and evaluate revolving drug funds in targeted areas according to the General Policy on Cost Recovery and RDFs and to the National Guidelines on RDFs

5. To have a unit at the MOH gather information, collect data, and serve as a communication point with implementing partners

・ Monthly management committee and report

・ Supervision by upper level every three months for public health facilities, on the spot for villages

・ Evaluation of public health facilities every six months

・ Continue LWU/UNICEF project in community RDFs

・ NGOs acting as implementing partners: follow the General Policy on RDFs and main principles of RDFs; use guidelines as a base for implementing RDFs: assist RDF committees in training, supervision, evaluation; take care of financial costs related to RDFs in areas where RDFs are working; and propose technical improvements

・ UNICEF working as a ゛super" NGO in public health facilities with RDFs in collaboration with RDF committees

・ Nine central trainers responsible for training, supervision, evaluation

・ Decision making on RDF policy and main principles

・ Technical assistance to RDF committees could be needed for at least the first year of program

・ Costs involved depend on financing agency rates