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[e-drug] Medicines financing in Sudan (4)

E-DRUG: Medicines financing in Sudan (4)
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I agree with Bonnie in the sense that if the government -- any
government -- takes a policy decision to reduce the price of medicines
to patients, then that is within their rights to do so. I would
certainly like to read the study referenced in the original e-mail
indicating that only 6 percent of RDF users cannot afford procurement
costs plus the 38 (cumulative?) mark - up. That figure seems low. But,
as indicated, perhaps they are covered by health insurance, ensuring
affordability. 

The issue, as pointed out, will come in the mechanics of reimbursement
to the budget centers providing the reduced fee. If these budget centers
must continue to pay procurement costs plus marks ups, then sell to
patients at the 50 percent reduced rate, then, decapitalization will
occur from the bottom up very quickly. Government must make sure that
not only a budget line is approved quickly, but that those funds are
routinely transferred to the affected budget centers which would  be
paying more for the drugs than what they are selling them for. This
issue has come up in numerous countries operating RDFs (or cash and
carry systems). Many public sector health services offer exemptions from
drug charges for the elderly, under 5s, antenatal, etc..However, it is
often a cumbersome, slow procedure for the central level MoH operations
to reimburse districts and medicine outlets which go quickly into debt
without timely recapitalization when up to 80 percent of their patients
are exempt from payment.  

Regards,

Raja

Raja Rao, Senior Technical Advisor
USAID | DELIVER PROJECT
John Snow, Inc.
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Arlington, VA  22209-3100
tel:  (401) 293 - 0388 office
tel:  (703) 915 - 1382 mobile
Skype:  raja_rao1 
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