A new initiative in drug financing within the context of health economics is proposed for the WHO essential drugs strategy. As part of this initiative, the WHO/SEARO Working Group on Drug Financing came into being. This Working Group will meet regularly in the next two to three years. Members will learn from each other about drug financing, both policy and implementation.

The objectives of the Working Group are:

• To promote the development and strengthening of effective drug financing systems.

• To facilitate and improve access to essential drugs at affordable prices for the entire population.

Country presentations on drug financing

Country papers from Indonesia, Myanmar, Nepal and Thailand were presented at the meeting. They have been abridged to focus on country specific issues. Even though drugs play an important role in primary health care (PHC) in the four countries, most of the drug financing in these countries comes from non-government sources; i.e. private households (Indonesia and Thailand) or donors plus private households (Nepal and Myanmar).

Countries provided the following information on user charges and cost-sharing for drugs:

Indonesia

User charges for medical services exist in hospitals, but drugs for PHC facilities are provided free of charge.

Myanmar

Several cost-sharing programmes jointly funded by the Government and external donors have been implemented during the past several years, and some have proved to be working well in improving the availability of drugs in PHC facilities. However, the programmes' viability in the long-run is still questionable since not all donations will continue. Therefore, Government, as well as alternative sources of funding, need to be developed for long-term development and sustainability.

Nepal

Several experimental programmes on cost-sharing have been implemented and some are more successful than others. An insurance programme (the United Missions to Nepal (UMN) scheme) showed the best performance in improving drug availability and accessibility.

Thailand

Thailand has the most complicated mix of health insurance among the four countries. Drug financing is from a mixture of private and public sources provided through various forms of insurance. User charges are common practice in health service provision (including drugs). In addition, several public assistance programmes for the underprivileged and the needy are also provided by Government allocation.

Korat Provincial field visit

There were three field visits: to Soongnern Community Hospital, Maa Kleur Kao Health Centre and to village drug funds (or drug cooperatives).