COUNTRY PROPOSAL PRESENTATIONS
CAMBODIA PROPOSAL PRESENTATION
I. Rationale for Continuing Project
・ Project still in pilot phase
・ Long-term financing solutions must be found
II. Overall Objectives
・ Make essential drugs available at all facilities nationwide, and ensure their proper use
・ In selected areas, implement and evaluate sustainable supply systems in pilot facilities
III. Main Strategies
・ Advocate high national budget allocation for essential drugs
・ Monitor donor pledges to cover the financing gap to the year 2000
・ Improve efficiency of public supply
・ Develop private sector role
・ Decentralize supply functions
・ Improve basic skills of district teams
・ Promote hospital management committees
・ Train prescribers
・ Improve public awareness
・ Test alternative financing/RDF schemes at hospital centers and referral hospitals
・ Emphasize monitoring and supervision
IV. Main Activities 1998
・ Implement pilot financing schemes
・ Improve efficiency of drug supply
・ Improve drug use
・ Increase public awareness
・ Improve planning and monitoring
〜 Provincial, district monitoring/supervision teams
〜 Central team, health financing task force, essential drugs teams
〜 Most indicators already developed
Wider impact
Main constraints
Time frame
Sustainability- not a vertical project
LAOS PROPOSAL PRESENTATION UNICEF
Based on the January 1997 proposal submitted to The Nippon Foundation, entitled Strengthening of Community Health through Community Drug Revolving Funds, UNICEF Vientiane received US$70,000 on 23 June 1997. Because these funds arrived with only six months left in which to use the money, this is a request to extend the time to use these funds through 1998. The remaining balance of funds to date is US$50,650. The plan of action for 1998 is as follows:
Objectives
1. Continue to strengthen cost recovery systems−e.g. reporting, replenishment, and documentation of the operation of the community-based revolving drug fund system−in the 391 target villages participating in the project
2. Provide training in management and malaria prevention for twenty-five provincial health officers, sixty-eight district health officers and 782 village health workers to improve their ability to prescribe drugs in the right dosages; educate villagers in the use of treated nets and mosbars
Activities
1. Upgrade course for 270 village health workers and 135 village heads in order to strengthen technical skills needed for self-monitoring in the communities for sustainability of the system; this course will be for villages undertaking expansion of revolving drug funds
2. Upgrade courses for twenty-five provincial health officers and sixty-eight district health officers in revolving drug fund management and integrated primary health care (PHC) management, better coordination and cooperation within and among five provinces and seventeen district
3. Conduct study visits to better managed districts and provinces in the country for 170 village health workers and sixty-eight district health officers to learn about systems for managing revolving drug funds
4. The Central Ministry of Health and the Lao Women's Union will monitor and follow up on the above training two to three times a year per province; provincial health officers will monitor two to three times a year per district; district health officers will monitor at least twice a year in each village
5. Conduct internal project evaluation and workshop to draw out experiences in community-based revolving drug fund systems that show integration with primary health care and women's development
6. Strengthen management skills in RDFs in integration with other primary health care activities
BUDGET
| |
Activities |
Funding USD |
| 1. |
Upgrade courses for village health volunteers in 135 villages |
10,000 |
| 2. |
Upgrade courses for 150 provincial and district hea;th officers |
8,000 |
| 3. |
Provide training supplies;training materoal developmant |
4,000 |
| 4. |
Study visits for 170 village health voluntees and 68 district health officers |
4,000 |
| 5. |
Training,follow-up,and monitoring activities |
5,000 |
| 6. |
Evaluation workshop |
4,000 |
| 7. |
Provision of transportation |
5,650 |
| 8. |
Technical consulation |
10,000 |
| Total |
50,650 |
MONGOLIA PROPOSAL PRESENTATION
I. Reason for Continuation
The main aim of the project, which is the revitalization of rural health services through community participation in health care service with available and affordable drugs and the improvement of the health status of the population empowered with knowledge and healthy behavior, has not been fully reached.
The minister of health and social welfare has announced the government's commitment to establishing revolving drug funds in all sums in the country.
II. Medium-Term Objectives
・ Meet the immediate essential drug needs of children and women in Mongolia
・ Revitalize the health system through community participation in health care and through the operation of revolving drug funds
・ Integrate project activities with poverty alleviation to ensure the equity and accessibility of health services
・ Execute expansion of revolving drug funds to include funds for health development with already developed training materials
・ Improve quality of care at local level through standardization of treatment
・ Develop health financing methodology
III. Project Objectives for 1998
・ Strengthen community participation in RDF operations, decision making, implementation, and planning of health care services at local level
・ Enhance RDF management capacity at local level
・ Strengthen supervisory and monitoring mechanism at all levels from the central level down to the grass roots level
・ Establish information and reporting system
・ Ensure sustainability of RDFs already established
・ Improve prescribing practices and community awareness on rational use of drugs and improve community knowledge of preventive care
IV. Strategies
・ Train local leaders, health managers, and community members in health care and drug management, and in health service financing
・ Develop indicators to monitor project activities
・ Conduct surveys
・ Develop national policy on health education and integrate it with project
V. Project Plan for 1998
PROJECT PLAN FOR 1998
| Activities |
Cost (US$) |
| 1. |
In sums with newly established RDFs, TOT and training for local leaders, health managers, health volunteers, and community members on RDF operation, community participation, cost sharing, supervision and monitoring, preventive care, rational use of drugs, drug and health care management |
80,000 |
| 2. |
Establish supervisory and regular monitoring mechanism at all levels |
|
| 3. |
Conduct advocacy meeting for decision makers (government officials, local leaders, NGOs, mass media) |
25,000 |
| 4. |
Develop information and training materials (newspaper, posters, TV and radio segments, booklets, training video, etc.) |
30,000 |
| 5. |
Establish information and reporting system for RDFs in selected aimags |
3,000 |
| 6. |
Develop indicators for operation of RDFs, community participation, and quality of care followed by TOT in 6 selected aimags |
18,000 |
| 7. |
Conduct survey of impact of project activities on health status of communities |
10,000 |
| 8. |
With local authorities, conduct supervisory and monitoring visits from the central level to all project sites |
10,000 |
| 9. |
Develop health financing methodology (consultant services, guidelines development, etc.) |
10,000 |
| 10. |
Collect, print, and distribute data and information from the RDF experiences of different sums |
12,000 |
| 11. |
Expand RDFs to other 100 sums |
|
| |
TOTAL |
198,000 |
MYANMAR PROPOSAL PRESENTATION
Main Aim
To ensure that people can obtain essential drugs at all times at affordable prices, and that the drugs reaching patients are safe, effective, of good quality and rationally prescribed
Short-Term Objectives for the Next Program/Fiscal Year
1. To make good quality essential drugs available at minimum and affordable prices and in sufficient quantities at all levels of health care facilities in (175) townships
2. To improve the diagnostic, prescribing, dispensing, financial management and communication skills of health workers
3. To decentralize overall management of CCS to different levels of health facilities and improve community participation and ownership
4. To accelerate process of producing essential drugs in the country and strengthen partnership with the private sector
5. To integrate with other projects and strengthen the primary health care concept
6. To lobby policy makers to fully support CCS
Medium-Term Objectives
For 1998, 1999, 2000, objectives are same as for short-term, subject to the following modifications:
1. To cover at least 80% of townships (261)
2. To produce essential drugs in the country; to cooperate with the private sector to provide ED needed at different levels of health facilities
3. To have national law and regulations for ED and CCS
4. To strengthen primary health care
5. See page 56
Strategies
1. Introduce CCS at all levels to cover at least 80% of townships with primary health approach
2. Improve availability of essential drugs
3. Improve drug procurement, storage and distribution system
4. Decentralize CCS process
5. Increase community participation and ownership
6. Improve quality of health services
7. Advocate political commitment
Indicators
| Availability |
〜 Stock-out period |
| |
〜 Amount of drugs |
| Affordability |
〜 Utilization rate |
| |
〜 Exemption rate |
| |
〜 Inflation |
| |
〜 Drug pricing |
| Drug safety, effectiveness, acceptability |
〜 Marketing survey |
| |
〜 Prescription patter |
| |
〜 Amount of drugs prescribed |
| |
〜 Percentage of generic name drugs on all prescriptions |
| |
〜 Percentage of drugs on national list of essential drugs |
| Community ownership |
〜 Number of RDFs managed by communities |
| |
〜 Number of community/health staff meetings |
| Political commitment |
〜 Community Cost Sharing Law |
| |
〜 Number of CCS townships |
| |
〜 Production of essential drugs |
Plan for Monitoring Strategies and Activities
・ Evaluation in 1998 and mid-term review (MTR)
・ Develop indicators based on activities and evaluation results
Resources/Funding/Justification
・ In all areas (limited external support at the moment)
・ Nippon Foundation as key donor and other donors to sustain project
・ Project going in right direction, having achieved at least 50% of its objectives, but still in transitional period on its way up to a sustainable orbit
Potential Impact
Will be the leading project that, like a train, will pull other projects toward year 2000 goals
Main Constraints
・ Clear political commitment from the top to the grass roots level
・ Financial support
・ Local production of ED
・ Community ownership weak
・ Minimum package of PHC needs to be clarified
Time Frame
・ One fisical year for evaluation and modification of CCS process
・ Three years to reach mid-term in line with National Health Program
Project Sustainability
・ National CCS Law
・ Community-managed RDFs/CCS
・ Donor support to reach sustainable orbit
・ Local production of essential drugs
Other Comments
・ Work as team on CCS with other countries
・ Work hand-in-hand and develop more cooperation with donors
Final Goal
・ To reduce morbidity and mortality
− Male and female (MMR)
− Children (especially<5)
VIETNAM PROPOSAL PRESENTATION
1. Main Aim
・ Availability of drugs
・ Quality/quantity of health services
・ Socialization of health activities
2. Objectives for 1998
・ Continue and strengthen the project in seventeen provinces
・ Analyze deeply the project evaluation results of 1997
・ Expand project into five to ten other provinces
・ Increase monitoring and supervision
3. Strategies
・ Disadvantaged and poor areas
・ Commune level (CHC)
・ Socialization
・ Management, monitoring and supervision network
4. Key Activities
・ Needs assessment
・ Drug supply
・ Essential drugs (quality, price, rational and safe use)
・ Training in technical and management skills
・ Socialization
・ Monitoring and supervision
5. Measurements
・ Basic indicators
・ Monitoring and supervision data
・ Surveys (HHS, health facilities, leaders)
6. Monitoring
・ Provincial and district monitoring teams
・ Materials, guidelines, checklists
・ Training in monitoring and supervisory skills
・ Field work (routine activities)
7. Resources
| Type of Resource |
Supplier |
| Manpower |
MOH |
| Materials,equipment |
Donors,MOH |
| Training |
Donors |
| Supervision |
MOH,donors |
| Decentralization |
MOH |
| Policy development |
MOH,government |
| Pharmaceutical sector |
MOH,government |
| Technical assistance |
Donors |
8. Estimated Cost
| Activity |
Cost(US$) |
| Drugs and equipment for ten provinces to cover population of approximately 8 milion |
2,000,000 |
| Training |
300,000 |
| Supervision |
100,000 |
| Total |
2,400,000 |
