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
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
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
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