The concept

During the first years of the PHC programme, each newly trained VHV was expected to manage a 500 Bahts-worth stock of household drugs supplied to him or her by the MoPH. The drugs were expected to be used in the basic curative care provided by the VHV to their neighbours, The stock was expected to revolve: the VHV had to charge his/her clients and use the money to replenish the drug stock. However, this expectation was unrealistic: the stock was depleted rapidly, because the villagers did not want to pay. Their perception was that the drugs should be given to the villagers for free as they were distributed by the government.

In an attempt to keep the initial stock of drugs revolving, a village drug fund idea was developed. It started from a small pilot project in a northern province and became an important MoPH policy in 1980. Since then, VDFs have been set up nationwide in conjunction with the VHV/VHC training project. The coverage of the VDF rose from about 10% to almost 80% of all villages within eleven years, from 1982-1992 inclusive. As of 1991, 35,819 VDFs were reported to have been set up throughout the country²¹.

The VDF was originally intended to solve the problem of drug depletion, but once it became the MoPH policy, its purpose was expanded. The MoPH envisioned that the VDF would make available essential, good quality and cheap drugs to the villagers, enhance the VHVs' work performance, encourage community participation, raise funds for other community development activities and contribute to the protection of consumers’ rights.²²

The most important activity of the VDF was the day-to-day provision of essential drugs to the community. Sixty three items of drugs, mostly common or household drugs, were officially allowed to be available at the VDF²³. All of them were produced by the Government Pharmaceutical Organization (GPO) and supplied to the VDFs through the government health services structure, especially the district hospitals, district health offices and tambon health centers. The VDF was encouraged to stock only these drugs. No other commercial medicines were allowed to be sold at the VDF. The MoPH supplied a VDF with an initial stock of 700-1,000 Bahts value²⁴; after that the VDF procured the drugs from two sources: the health facilities or drugstores.

The relationship between the promotion of the VDF and the concept of rational drug use promotion, was not elaborated systematically. Still, the VDF may, in principle, help in enhancing the rational use of drugs by consumers through making essential drugs available to villagers who live in a context where there is a shortage of (essential) drugs, and where information is lacking²⁵. Given the reality of the drug situation in Thailand, such a concept is irrelevant and out of context, as all drugs, both essential and inessential, are widely available.

The VDF and the VHV/VHC

The villages with a VHV and VHCs were expected by the MoPH to set up a VDF. The VHV and VHCs were given the responsibility to start the activity, with the support of the tambon health officials. They were expected to prepare the entire community by disseminating to all community members and leaders information about the VDF and its advantages. Because villagers’ participation in the VDF was an important requirement, the VHV and VHCs were also responsible for assessing the villagers' willingness to take a share in the VDF.

The VDF was expected to be managed by an executive committee appointed by the whole community and comprised of village leaders, the VHV and VHCs. The latter were supposed to play active roles in the day-to-day sale of drugs. The executive committee was expected to be involved in procurement of new drugs, stock checking, routine accounting and auditing. Households would take part in the fund by taking shares mostly ranging from five to 20 Bahts per share. The VDF was supposed to have an accounting audit by the end of each year of operation. It was suggested that the profit from drug sales be divided into three to four parts, The first part was for paying back the shareholders; the second, had to be added to the capital; the third, had to be added to the village development fund, if any, or to be used for other village development activities; and the last part was to be used for social welfare for the poor, i.e. for giving drugs to them for free²⁶. However, as the profit margin from drug sales was extremely small, in particular for a VDF selling only MoPH supplied drugs, these expectations were hardly realized.

In reality, the operation of the VDF varied widely. Daily drug sale activity differed greatly among VDFs in terms of sale volume and form of operation. Many VDFs were transformed to be groceries or multi-purpose cooperative stores, where drug sale was only a part of the operation. Many others maintained their operation as single VDFs, with a small sales volume and considerable management difficulty. The administrative structure proposed by the MoPH was extremely rarely practiced. About half of the total VDFs were run by an individual person, mostly the VHV or VHC²⁷.

VDF retention

Based on routine reporting data, the MoPH claimed that in 1992 still about 78% of the national total 42,119 of VDFs were functioning²⁸. Compared to our mailed questionnaire and field-visit data, the MOPH rate for VDF retention is likely an overestimate. The average retention rate based on data from the mailed questionnaires is 42.3%, (The Chiangrai rate of 70% is an obvious outliner). The field-visit retention rates based on the census of VDFs in two sample districts in selected provinces are slightly different from the provincial rates. However, the two districts’ average retention rate of 43% comes very close to the average provincial rate²⁹ (Table 2).

Table 2: Percentage of VDF retention in sample provinces

Source: Mailed survey and field-visit (Phase I).