Download Mandisa Hela-Parallel Track - Management Sciences for Health

Pharmaceutical
Supply in a
Decentralised
Environment
* The South African
Experience
POLICY & LEGAL FRAMEWORK
§ National Drug Policy (NDP)
Health objectives
Economic objectives
National Development Objectives
§ National EDL & Standard Treatment Guidelines
§ Norms and Standards
§ Medicines & Related Substances & Pharmacy Acts
§ Public Finance Management Act
THE STRUCTURE
National
District Municipalities
Metros
Sub-District
PHC Package (CHC, Clinics)
Provinces
Central Hospitals
Tertiary Hospitals
Regional Hospitals.
District Hospitals
FISCAL FEDERALISM
§ Vertical division between national and
provincial and local spheres of government
§ Equitable share for each province through a
formula
§ Provincial legislature allocates departmental
share
§ Health department allocates a bloc grant to
districts, referral hospitals
§ Additional grant for academic hospitals,
tertiary and regional referral hospitals –
conditional grants
PROCUREMENT
§ National pooled procurement for all 9 provinces
(NDP)
§ “Clients” purchase through provincial warehouses
managed wholly by government or private/public
partnerships or hybrid
§ Warehouse funded through a Trading Account or
budget allocation
§ Debits clients at cost plus levy (4,5%-10,25%)
§ Computerised inventory management systems or
manual systems
PROCUREMENT FLOW
Forecasting
Provincial
Depots
National
COMED
OSTB
Contracts
POs
Suppliers
Pull
Hospitals
PHC Clinics
Metros
DDVs
MONITORING & EVALUATION
§
§
§
§
§
§
Procurement Indicators
Distribution indicators
Inventory management indicators
Financial management indicators
Supplier evaluation indicators
Periodic cross sectional surveys
WHAT HAS WORKED
§ WHO INDICATORS compared with baseline
§ Compliance with EDL at PHC 90% vs 65%
§ Cold chain temperature monitoring 75% vs
25%
§ Injection use 5% vs11%
§ Availability of basket of drugs 82%
§ Patient satisfaction 81%
WHAT HAS NOT WORKED
§ Inventory management – survey 50%
match of stock records with physical
§ SOPs implementation
§ Prescribing by generic name
§ Financial management
§ Down Referral Systems
§ Inequities not fully addressed
LESSONS
§ Interventions must be tailor-made for each
situation
§ Supervision is key at operational level
§ Adequate human resources with the
appropriate skills and the right attitude
§ Fiscal federalism has inherent challenges
WHAT WOULD WE DO
DIFFERENTLY
§ Alignment of policies and legislation
with resources
§ Pay attention to system linkages at all
levels to facilitate monitoring &
evaluation
§ Ensure processes and controls fit the
environment
WHAT WOULD WE DO
DIFFERENTLY Cont.
§ Strengthen management to close the gaps
§ Outsourcing is not a panacea for weak
management
§ Interventions must be tailor-made for each
situation
§ Pay more attention to poorly resourced areas
§ Expenditure variance between public and
private sector
The ultimate measure of a man is not
where he stands in moments of
comfort,
but where he stands at times of
challenge and controversy.
Martin Luther King, Jr