How to Develop and Implement a National Drug Policy (Second Edition): Part II: Key components of a national drug policy: 7. Supply systems: 7.1 Public or private? Or mixed?

How to Develop and Implement a National Drug Policy (Second Edition)
(2001; 96 pages) [French] [Spanish]

Table of Contents

Contributors
Abbreviations and acronyms
Preface
Part I: How to develop and implement a national drug policy
	1. Introduction
		1.1 Essential drugs are not used to their full potential
		1.2 What is a national drug policy?
		1.3 Key components of a national drug policy
	2. The national drug policy process
		2.1 Overview of the national drug policy process
		2.2 Formulating a national drug policy
		2.3 Implementing a national drug policy
		2.4 Monitoring and evaluation
	3. Legislation
		3.1 Importance of legislation and regulations
		3.2 Framework for drug legislation
		3.3 Developing drug legislation and regulations
Part II: Key components of a national drug policy
	4. Selection of essential drugs
		4.1 Essential drugs
		4.2 Old problems and new challenges
		4.3 Strategies for the selection of essential drugs
		4.4 Traditional and herbal medicines
	5. Affordability
		5.1 Challenges
		5.2 Strategies to increase affordability
	6. Drug financing
		6.1 Challenges
		6.2 Drug financing options
	7. Supply systems
		7.1 Public or private? Or mixed?
		7.2 Drug procurement
		7.3 Local manufacture
		7.4 Distribution strategies
		7.5 Drug supply in emergency situations
	8. Drug regulation
		8.1 Need for drug regulation and quality assurance
		8.2 Basic requirements for drug regulation
		8.3 Core elements of drug regulation
		8.4 Stepwise approach to drug registration
		8.5 Quality
		8.6 Safety
		8.7 Efficacy
		8.8 Information and drug promotion
		8.9 Information exchange with WHO and with other agencies
	9. Rational use of drugs
		9.1 Why is it important to promote rational use?
		9.2 Challenges
		9.3 Planning for activities to promote rational use of drugs
		9.4 Core strategies to improve drug use
		9.5 Educational strategies
		9.6 Managerial strategies to promote rational drug use
		9.7 Regulatory strategies to promote rational drug use
		9.8 Promoting rational drug use in the private sector
	10. Research
		10.1 Introduction
		10.2 Strategies to promote research
	11. Human resources development
		11.1 Introduction
		11.2 Strategies for human resource development
	12. Monitoring and evaluation
		12.1 Monitoring and evaluation are part of a national drug policy
References
Selected WHO publications and documents of related interest
Back cover

7.1 Public or private? Or mixed?

Who has responsibility for the supply system, and how it should be structured, are important choices with many political and economic ramifications. It is very important that the drug policy defines the future supply system and the role of the government. There are several options, and which one is chosen will depend on existing structures, the balance between public and private sectors, and other factors.

In some countries problems with the central medical stores and the public supply system have been overcome by contracting some of the work out to private operators while maintaining a centralized structure. For example, the transport of drugs can often be left to the private sector. In other countries different structures are used. An autonomous or semi-autonomous agency is set up to serve as a supply agency not directly managed by the government. The objective of such a system is to combine the efficiency of the private sector with the public health approach and the economies of scale that can be achieved in a centralized system.

Further options include direct delivery systems or primary distributor systems. In a direct delivery system drug prices are established by tender, but drugs are supplied directly to facilities. A primary distributor system is one in which contracts are negotiated with a single prime vendor who supplies and distributes directly to districts or major facilities.⁸

A well-coordinated supply system will ensure that public funds available for drug purchases are used effectively to maximize access, to obtain good value for money and to avoid waste. This will increase confidence in health services and promote attendance by patients. There needs to be good coordination between these central elements of the supply system. Failures at any point of the drug supply system can lead to shortages or to waste. Both the health and the economic consequences can be serious.

The choice of policy on the future drug supply system touches upon many vested interests and discussions on this subject tend to be heated and long. However, it is important for the government to consider all options very carefully and to take an informed decision on long-term policy before embarking on new activities (sometimes with donor funds), such as setting up regional stores.