Community Drug program ( CDP) Its success and challenges versus with Free Health Care service

1. Community Drug program in Nepal, its
success and challenges and relation with
free health care service
Keshav Sah
Bsc.MIT
Institute Of Medicine,
Maharajgunj Medical Campus
Kathmandu,Nepal

2. Introduction and background
• Community Drug Programme is a major alternative health
financing mechanism and is based on community cooperation,
self reliance, and community control & management.
• The concept of community drug program(CDP) has been started
from African countries where they had been facing problems of
lack of medicines in health facilities due to massive cut down of
health aid.
• UNICEF recognized that people are willing to pay for medicine.
After having several discussions, UNICEF launched the scheme in
African countries and was found effective.
• A revolving fund was established to purchase drugs initially.
Then the money is reused to purchase medicine again.

3. CDP in Nepal
• Nepal , revolving drug fund scheme in the name of
community drug program has been started since FY 2053/54 ,
initially with support from UNICEF.
• GoN/MoHP has set CDP in Nepal Health Sector Program.
• In 2000 (2057) Nepal government approved “policy on drug
financing scheme” which was taken as the milestone for the
rational development of drug scheme activities in the country.
It was the basis for the operation of all drug scheme including
community drug program.
• Ministry of health and population(MoHP) declared on
December 15 , 2006 that health care would be free for all.

4. Why CDP?
• CDP drugs to be charged (User’s Fee) at cheaper rate in
compare to the local market.
• Identified socially & economically marginalized people to
be covered by exemption case management
• covering year round drug availability
• To meet total financial needs including the cost of
essential drugs.
• Irrational drug prescription practice
• Low utilization of preventive and promotive services
• Seasonal flow of patient
• Peoples apathy to health services

5. Objectives
The CDP has been developed to achieve the following
objectives:
• To ensure year around availability of essential drugs at
health facilities with full community participation.
• To improve the quality health services in all health
facilities.
• To ensure that the available essential drugs are of an
acceptable quality in accordance with the standards of
development of drug administration(DDA).
• To ensure that drugs are prescribed rationally and not
misused by the general population.
• To ensure effective and efficient community management
with the community maintaining responsibility and control
over the management.

6. CDP success in Nepal
• The CDP started eight years without any concrete rules
and regulations.(as per article published in 2005)
• According to the Ministry of Health, the governments
yearly supply of drugs to health organization's lasts three
to four months only. The programmed is a success and
the MoH is including the CDP for the first time in its
health policy to be announced soon so that the
Programme can be extended to other districts to end the
shortage of drugs.
• According to the MoH, there are 84 government
hospitals, 75 district public health offices, 188 primary
health Centre's, 697 health posts and 3,129 sub-health
posts.

7. • The government provides Rs 25,000, Rs 50,000 and Rs
75,000 worth of drugs yearly to primary health posts,
health posts and sub-health posts respectively which do
not last for more than four months.
• The MoH is also planning to identify the shortage of
drugs in some districts and necessary steps will be taken
to provide drugs in each district at the earliest.
• According to the amendment, a sector for the CDP will be
formed under the Ministry of Health. At present, the CDP
covers 30 districts and is planning to extend it to Dolakha,
Ramechhap, Bajhang and Makwanpur districts.

8. Problems associated with CDP
• When the CDP started in 3 districts during 1997-98 with
the help of UNICEF. At that time , there have been a
number of problems in implementation such as lack of
suitable manpower, both in the MOH and in local
communities and much debate over various aspects of the
CDP e.g. the fee level.
• Weak management of the exemption cases
• Some people were against the charging of the drugs at the
health facilities (then political conflict situation)
• Poor supervision/monitoring of the program initially (no
budget for the program)
• About CDP, misunderstood by some of the health-
workers and communities
• Misuse of CDP funds in some facilities

9. Public awareness & participation
• Advocacy
• Community education
• Community orientation
• Promotion through mass media

10. Major challenges, issues and
concerns
• Availability of adequate human resource
• Improve the quality of care
• Increase allocative efficiency
• Promote utilization of free care
• Reducing the stock-out of essential drugs at
peripheral level health facility
• Expanding the list of free essential drugs for
other non-communicable health problems ;
like mental health

11. Free health service versus Community Drug
Program
• Community drug program was introduced long before
the implementation of free health service program and
was regarded as a successful strategy to ensure year
round availability of drugs in health institutions. But, CDP
has been affected by the implementation of free health
service program in the district and there has been a huge
controversy on how to mobilize the fund raised through
CDP.
• On October 7,2007 the GoN decided essential health care
services universal free of charge at all health posts and
sub health posts and started since January 1 ,2008.

12. Free health services
• Government of Nepal had decided to provide national wide free
essential health services free of charge to all citizen at SHPs and
HPs level.
• Free health services covers registration fee, available health
services and essential drugs. The essential drugs will be
categorized into 22 items in SHP ,32 items in HP which is provided
to the people round the year.
• The new government has initiated important policies such as
providing free emergency and inpatient services to the poor
patients in District Hospitals and developed policy of posting
newly graduated doctors to the districts.
• And lastly, but the most important of all, Government of Nepal
has made political commitment for health of the people at the
highest level by declaring “Basic Health as Human Right” in the
Interim Constitution of Nepal 2063 (2007) for the first time in the
history of Nepal.

13. • From fiscal year 2063/64 (according to the decision of
cabinet 2063/08/29), in 25 bedded hospitals and PHCCs,
essential emergency services and indoor services and
from fiscal year 2064/65 in PHCCs and Hospitals of 35
districts, those services including OPD service are
provided free of cost to poor, helpless, disabled, elderly
and FCHVs.
• Similarly, from fiscal year 2064/65 (according to the
decision of cabinet 2064/06/21) from all the HPs and
SHPs, essential health care services are being provided to
all the citizens out of cost and this service was launched
from 2064/11/01.

14. Free health service program
All the HPs and SHPs of 75 districts
(To all the citizens)
25 bedded hospitals and PHCCs
(To very poor, helpless, disabled, elderly, FCHV)
40 districts
(Emergency and indoor)
35 districts
(Emergency, indoor and OPD)

15. • In the ongoing fiscal so far, a total of 1,265 people got free
treatment while 1,234 people had received free treatment
in the fiscal 2016-17. The number was just 995 in the
fiscal 2015-16. Of the total patients receiving free
treatment, 588 were cancer patients and 446 heart
patients.

16. Objectives
• Ensure right of poor and underprivileged people’s access to
the health services.
• Ensure accessibility of poor to reach the health services.
• Decrease morbidity and mortality in poor and underprivileged
groups.
• Ensure state responsibility in health
• Provide quality essential health care services effectively

17. Major challenges and concerns
• Providing free services in all the hospitals.
• Promote utilization of free care
• Maintain standard quality of care
• Reducing the stock- out of essential drugs at periphery level
health facility
• Expanding the list of free essential drugs for other non-
communicable health problems ; like mental health ,etc.

18. Thank you ǃǃǃ