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AFRO-NETS> RFI: Income generating or revolving funds (3)

RFI: Income generating or revolving funds (3)

Revolving drug funds for rural health facilities.

Before starting the fund please consider the issues. In Kenya almost 
all the rural health facilities have their revolving drug funds. Six 
major issues usually arise:

1. Accountability by the community. Proper management and accounting 
procedures should ensure that community funds are not misused by clinic
staff or community members.

2. Ensuring that drugs are available to those who cannot pay. Community 
should be able to identify those who are entitled to free or subsidised 

3. Community participation - Ensure the community participates not just 
influential people.

4. Quality control and supply pipeline. In Kenya, with liberalisation 
we have problems with imported drugs of dubious quality, we try and en-
sure that the health facilities buy drugs which are registered with the 
Board and are in the Essential Drug List. The supply pipeline also 
needs to be established for bulk procurements. Discounts are given to 
the facilities.

5. Monitor drug use. Drug sell generate money and prescribers tend to 
resort to poly-pharmacy. It is critical to educate the health workers 
on rational drug use before starting the programme. We had a problem 
when certain communities in consultation with the clinic staff decided 
to buy branded iron syrup preparations which were five times the price 
of ferrous sulphate tablets.

6. Full cost recovery or partial cost recovery. The decision must be 
made about this. If the aim is full cost recovery then provision must 
be made for those who cannot afford. If it is partial cost recovery, 
who will meet the deficit? Consider community insurance schemes.

Dr S K Sharif
Provincial Medical Officer
Coast Province
Mombasa, Kenya

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