APPENDIX 4: GUIDELINES AND FORMAT FOR REPORTS ON RDF PROJECTS SUPPORTED BY THE NIPPON FOUNDATION
The primary aim of these guidelines and the suggested format is to assist MOH/NGOs and UNICEF in reporting on the core elements of their individual RDF projects, including related areas that have a bearing on project performance. These guidelines and format can also serve as a checklist of project components, usable as a means of monitoring progress. The forthcoming regional review, tentatively scheduled for October 1996, is a valuable opportunity for participating countries to develop their reports accordingly and in a consistent manner, so that comparison across countries is facilitated and broad view of the progress of the Essential Drugs Project as a whole is made possible. The usefulness of the guidelines and format themselves can be discussed and improved at the conference.
It is hoped that reports based on these guidelines and format will also help the Nippon Foundation and the University of Tokyo's Department of Health Policy & Planning (Graduate School of International Health) to follow-up on the recommendations made at the First Conference on Essential Drugs and Community Health Systems and review overall support. In addition to serving as a survey of the EDP at the end of each support cycle, these collective reports will also become a historical record of project implementation, providing the basis for future expansion and scaling-up.
Part I. Overview of the Project
A. List overall goals and objectives.
These should be derived from the original program proposal, Memorandum of Understanding, and any other documents developed by the MOH/NGO and UNICEF when the RDF project was established. Objectives from other projects that have a direct bearing on the RDF may be listed and referenced here as well.
B. List specific objectives (including planned activities) for the current reporting period.
These should be derived from the plan of action for the current reporting period.
C. List achievements against objective for the current reporting period.
Briefly describe what was achieved in terms of the objectives listed above. How do these achievements contribute to accomplishing the overall objectives of the RDF project (or other related projects).
Part II. General Status of the Project
How many RDFs were originally planned?
How many RDFs are functioning as scheduled?
How many RDFs are not functioning as scheduled? List key reasons why.
A. Operations of the RDFs
1. Are drugs sold, or distributed free of charge?
2. How many funds are revolving?
3. What has been the increase/decrease in capital and drug stock since the last reporting period?
4. Is the replenishment system working in terms of drug requisitioning, purchasing, receiving, inventory management and storage?
5. To what extent is the community involved in the operation and oversight of the RDF? Of the personnel involved in running RDFs, what percentage is composed of community members?
6. To what extent is supervision provided by MOH/NGO and UNICEF?
7. What financial records on RDF operations are being maintained? Is the following information kept on a monthly basis?
□ starting stock
□ monthly sales
□ monthly drug purchases
□ other monthly expenses
□ cash balance at the end of the month
□ cash in bank at the end of the month
□ stock value at the end of the month
□ total value of the RDF at the end of the month
□ increase/decrease of total value since the previous month
□ loss due to pilferage, damage or credit provided but not collected
8. How are these financial reports being used by the community, the health committee, the NGO/MOH and UNICEF?
9. How are drugs being priced at the local level and at higher levels? Give a price schedule, if possible.
10. Who are the prescribers and what can they prescribe?
11. What other reports are sent to the MOH/NGO and UNICEF about the operation of the RDFs?
B. Drugs from the Nippon Foundation
1. How is an order for seed stock developed? How is the selection of drugs accomplished?
2. What procedure is followed for requesting seed stock from the Nippon Foundation?
3. How long after an order is sent before drugs are received?
4. What criteria are used in how drugs are apportioned and allocated?
5. How are drugs distributed, where and in what quantities?
6. What kinds of reports are being kept of the distribution of Nippon Foundation drugs? Who receives these reports?
7. What have been the problems encountered in carrying out the following:
□ ordering seed stock, and receiving notification of their dispatch;
□ receiving notification of arrival of the seed stock, and clearing the delivery through port;
□ inspecting, receiving and making inventory of the seed stock.
What actions have been taken to address these problems?
C. National drug policy
1. When was the Drug Policy last reviewed?
2. When was the Essential Drug List last revised?
3. What are current guidelines or regulations that regulate the pharmaceutical sector?
When were these guidelines and regulations last reviewed?
4. What are the current guidelines and procedures for the financial management of the drug supply system?
5. What are the current guidelines and procedures for logistical management (procurement, storage, distribution and record keeping of drugs)?
6. What is the public sector's current budget for drug procurement? What is the amount of foreign exchange available?
7. Briefly describe any programs or projects currently under way to improve any aspect of the National Drug Policy framework, or the logistical and financial management of the public sector drug supply system. Have there been improvements in the regulatory mechanisms of the whole pharmaceutical sector? How has the RDF project been affected by these activities?
8. What are the current policies, guidelines and procedures for cost recovery, cost sharing and operations of RDFs? Do they include authorization to locally manage locally generated funds?
D. Management capabilities of district and provincial health services
1. What MOH programs are currently underway to strengthen the management capacity of health teams? How are these programs linked to the RDF project?
2. How is RDF supervision integrated into the overall supervision framework of the MOH/NGO?
3. What criteria are used in supervision of RDFs, health teams and community committees?
4. What sort of reports are prepared and to whom are these reports submitted?
5. What sorts of action have been taken in response to findings of the supervisory trips at various levels?
6. What sorts of problems, if any, were encountered in carrying out and maintaining supervision of the RDFs?
E. National health budget
1. What is the current budget for the MOH in terms of % of GNP?
2. What proportion of the national budget is allotted to health?
3. What proportion of the national budget allotment is actually disbursed to the MOH?
4. How have these proportions changed from the previous year?
5. How is the MOH budget divided? What proportions go to primary health care services, and to drugs and medical supplies? How have these proportions changed from the previous year?
6. In real terms (dollar terms), the total amount of financing available for MOH activities has risen or declined by how much since the establishment of the RDFs? What are possible reasons for this?
7. Has the government been able to decrease financial support to health facility levels due to the successful operation of RDFs? If yes, by what factor?
F. Problems encountered
1. List the problems encountered. Attempt to broadly classify these problems in terms of how long these problems existed.
2. If unresolved, list factors and other reasons why these problems are resistant to resolution.
3. Describe any circumstances beyond the control of the MOH/NGO that have contributed to the problems.
4. List actions that have been taken to resolve the problems cited above.
5. What factors would have facilitated problem resolution?
6. Describe any efforts outside the project to address these problems.
What sort of support has UNICEF/NGO, the Nippon Foundation and the University of Tokyo provided?
G. Financial status
1. Include in the report a brief statement of the costs involved for each activity carried out in accordance with the action plan for the reporting period, and of the costs for budget line items.
2. Indicate what percentage of allocated funds were spent and why there was a over- or under- expenditure.
3. Describe any financial issues, problems or constraints encountered and what efforts were made to resolve them.
H. Future plans
1. List the objectives or activities scheduled for the next reporting period, the resources required, and time frames.
2. How will these activities be monitored and evaluated?
3. Describe how these activities and objectives will contribute to accomplishing the overall objectives of the project.
4. Identify what support will be required from UNICEF and MOH/NGO.
5. What sort of technical assistance will be required from the Nippon Foundation, the University of Tokyo or other sources?
6. What sort of costs will be involved during this reporting period.
Part III. Progress towards Achieving Recommendations Made at the First Conference
A. Community participation
1. Describe the extent to which community participation has been integrated into the overall project framework. How has the community been involved in terms of needs assessment community mobilization, and program planning, given constraints imposed by government and agency regulations, and by the processes of implementation and program monitoring/evaluation.
2. Describe the steps that have been taken to strengthen the capacity of the community in terms of training and developing locally employable indicators to measure performance and participation.
3. List the indicators that have been developed and how they are being used.
4. List steps that have been taken to facilitate resource allocation and increase time for community mobilization.
B. Operation of RDFs and RDF committees
1. Has there been any budget change towards ensuring a continuous supply of essential drugs?
2. Has progress been made in developing and disseminating guidelines, procedures and regulations for the operation of RDFs?
3. Have guidelines been developed for the scaling up of successful pilot projects in a phased manner to a national level?
4. In regard to locally generated funds, what actions or initiatives have been taken to encourage community ownership and empowerment?
5. Have RDF operations been standardized?
6. Is timely and effective monitoring and supervision being carried out?
7. How is the training of the health workers and the committees being carried out? How is it being synchronized with the supply of seed stock?
8. Has progress been made in regulating inspection, control and monitoring of drugs coming into the country?
9. What mechanisms are in place to review the selection of drugs?
10. What is the extent of the use of standard treatment guidelines where these have been developed and approved?
C. Drug supply and logistics
1. What steps has the government taken to develop long-term plans for the operation of the ED replenishment system?
2. What kind of logistics training has been provided to government and agency health staff? How is the training being evaluated?
3. What actions has the government taken to promote rational generic prescribing?
4. What steps have been taken to develop the pharmaceutical sector over the last reporting period?
D. Management capacity of health teams
1. How has the planning of health services activities at the district and community health facility level been linked to the operation of the RDFs in accordance to policies and procedures governing the operation of the RDFs?
2. How has the training of the health workers and community members been integrated and to what extent has the competency-based approach been used?
3. To what extent has the plan of action for the project been adhered to?
4. What local indicators have been identified for monitoring performance and impact of the RDFs in the communities?
5. How were these indicators selected and who was involved?
6. What steps have been taken to make sure that issues such as gender, literacy, and urban/rural population mix are considered in ensuring equity?
7. To what extent has the RDF project been a part of the national health development plan? Identify the linkages to that plan.
8. How have decentralization initiatives of the government/MOH affected the RDF project?
9. In planning , how has the issue of project sustainability (in terms of budget provisions, human resource allocations, provision of supplies, etc.) been included?
