Drug Revolving Fund Scheme | Advantages And Its Challenges
Drug Revolving Fund Scheme: The primary objective of every pharmacist is to ensure that drugs are available for the public at all times, right dosage form, at sufficient quantity and at the right cost. This is a summary of what a drug revolving fund does.
Nonetheless, the idea of the Drug Revolving Fund (DRF) scheme was born at the Bamako initiative in Mali by the African health ministers in 1987. 1 The objective of the initiative is to increase access to primary health care by raising the effectiveness, efficiency, financial viability and equity of health services.
The Bamako initiative is to ensure that growing countries such as the sub- Saharan African countries have a steady supply of drugs known as the “Essential Drug Lists”. This program is sponsorship by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and the United Kingdom Departments for International Development (DFID).
What is Drug Revolving Fund (DRF) Scheme
A drug revolving fund scheme is a very effective scheme for ensuring uninterrupted drug supply in a health care delivery system. In an RDF scheme, a sum of money (contributed by government, donors or the community) is used to purchase an initial stock of essential and commonly used medicines to be sold ideally at a price sufficient to replace the stock of medicines and ensures a continuous supply.
The primary objective of RDF is to maximize accessibility to drugs and also to maximize profit especially for pharmacists in the community practice. Hence, the drug revolving fund should not be limited to secondary health care facilities but is to be effective in all levels of practice to ensure the continuous flow and availability of affordable drugs.
Therefore, for effective management of provision, storage and dispensing of drugs, the pharmacist in any area of practice should have an idea of what this scheme entails.
Rationale for the Drug Revolving Fund Scheme
Essential medicines are a critical component of effective, preventive and curative care. Many people residing in the rural areas most times have no access to quality healthcare services and drugs. Therefore, the Drug revolving fund is a policy to help generate a seed capital from the Government, through the community or Non Governmental Organizations to make sure these essential drugs are available at all times and a cheap rate.
Therefore, the DRF scheme is a way to improve the pharmaceutical services in these areas. In other words, patients get frustrated whenever they are told “out of stock” in the hospital or healthcare facility. This is a real negative impression to the pharmacy profession and the health sector in general.
Furthermore, patients attach a greater value to drugs prescribed to them by a doctor and dispensed to them in the same clinic by the pharmacist. They usually have the conviction that they are actually receiving the right drugs at the right place. Hence, DRF can help solve the problem of non adherence and also curb the probability of a patient getting a counterfeit drug and substandard drugs from patent medicine stores.
In summary, the Drug revolving fund scheme can solve a great lot of problems which may be patient-related, Facility based or as a result of getting the wrong or substandard drug from the wrong source.
Advantages of the DRF scheme
- DRF Encourages rational use of medicines and resources
- It Provides a platform to improving healthcare services available to patients
- The scheme helps to Boost the confidence of health care providers
- Drugs are affordable and available at all times for the poor masses
- There is improvement in the patient confidence in the healthcare service system
- Drug revolving fund enables the community to be part of funding and policy making processes about their drug needs.
- RDF is one of the ways to achieve the goals and objectives of the National Drug Policy
Who needs the Drug Revolving Fund Scheme?
The DRF scheme was specially designe for the hospitals and other governmental organizations. However, the knowledge of this scheme can serve a great deal in determining how the community pharmacists should provide these drugs for the community to maximize profit and still help patients save cost.
To this effect, community pharmacists are to be considerate to maintain a good supply chain management skills that will always make sure that the essential drugs are always available at all times in their facilities.
Therefore, the goal of the scheme should be the priority. Hence, both the private sector and the public sector have to enact the scheme as a way to help patients achieve their drug needs. However, the difference in having the DRF scheme run in a private sector is that the pharmacist in charge maybe bias in deciding the drugs to consider as essential drugs because of personal interests and jurisdiction.
Why RDF schemes fail
The DRF scheme is a complex structure and involves all the steps in the supply chain management system which may include; drug selection, procurement, distribution, storage, logistics e.t.c. Therefore, any breach or irregularity in this system can cause the scheme to fail. For example, during drug selection, cheaper but effective drugs are considered over any other drug that may have a therapeutic equivalency. As such, it is always better to consider drugs based on generics rather than brands.
Some other noteworthy reasons why the DRF scheme fails includes;
As said earlier, the DRF scheme is a system and is holistic. There is need for proper management of the processes, the human resources as well as the financial resources to keep the system up and running. In that case, Proper training of staffs is essential for an effective and continuous success of the scheme.
The facility where a drug revolving scheme is carried out contributes a lot to its success. Therefore, proper measure should be in place to make sure that there are enough resources for the running of the scheme. Most facilities lack the human resources or train staffs that is enough to carry out all the needful.
In addition, lack of equipment pose a great threat to the success of the scheme. Some of the equipment includes Storage facilities, transportation, good warehousing etc.
Misappropriation of funds
In Drug revolving scheme, the money in circulation is usually the seed capital or the initial deposit from the community or government. Therefore, when the funds generated during the selling of drugs are not properly used due to carelessness or embezzlement, the system becomes handicap and may fail to thrive.
The goal of the scheme is to make sure that profits from sales of the drug is put back into the system. Hence, when deciding the selling prices of drugs, it is also important to add money for logistics and other expense for the maintenance of the facilities such as staff salaries.
Lack of community interest in the scheme
It is ideal to make some members of the community part of the policy makers when trying to initiate a drug revolving fund scheme. The delegates from the community stands the chance to educate others on the reasons to embrace the scheme. This will help build trust between the community and health care providers.
In other words, when there is lack of trust between the community and the DRF facility, the scheme will fail because it is the community that will buy the drugs.
Purchasing drugs at exorbitant prices
One of the major setback in running a DRF successfully is the ability to get a trustworthy drug supplier. Most supplies either sell drugs at outrageous prices or supplies substandard drugs. When drugs are purchase at exorbitant prices it becomes expensive for the patients and will be a turn off to patients and also against the goal of the DRF which is to make drugs available at cheap prices.
In attempt to address this issue, the Nigerian government under the Federal Ministry of Health supervision established a Central Medical Store at Oshodi to annul the constraint.
Centralization of account
A DRF is likely to survive in an environment where there is a substantial level of decentralization, and where facilities have autonomy to manage their own finances. In other words, it is best to allow facilities to retain their internally generated revenue (IGR).
Policies that allows IGR to stay in a centralize accounts are easily siphoned or mismanaged.
The Drug revolving fund scheme is a policy that is solely built to help sustain the National drug policy and ensure that the poor communities or countries have a full assess to cheap drugs at all times. In that regard, the WHO help some African countries to draw out the ‘Essential Drug Lists” which are drugs that must be available for the community consumption at all times.
However, there are factors that may affect the successful running of the DRF system which will need the attention of the stakeholders and the community interest.
Do Read More: Pharmacovigilance – How To Report An Adverse Drug Event
Therefore, drug revolving fund should be everybody’s business if we all wants to stop the incidence of “out of stock” or “drug shortages” in our health facilities – All hands must be on deck if we have to achieve this goal.