How to Develop and Implement a National Drug Policy (Second Edition): Part II: Key components of a national drug policy: 7. Supply systems: 7.4 Distribution strategies

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

7.4 Distribution strategies

Public sector

Whether or not a public sector supply system operates with cost-recovery, decentralized drug budgets, “cash-and-carry” or other systems, it should be well designed and given sufficient human and financial resources to be run properly. The performance of the distribution system defines whether or not patients will receive the essential drugs they need.

As mentioned above, the best systems are probably based on a combination of public and private management. For example, the transport of drugs and supplies can often be done better by private transport companies. In all cases, distribution and storage should be monitored to ensure the quality of drugs at all levels of the distribution network.

Availability of essential drugs in rural areas depends heavily on the distribution system within the districts. In several countries, such as Kenya, Uganda and the United Republic of Tanzania, monthly ration kits have been used. However, they are inflexible and involve higher direct costs. They can also lead to surpluses and shortages of some drugs. If the necessary managerial and administrative structures are in place this “push” system should be changed into a “pull” system on the basis of lists of essential drugs and supplies for rural facilities. A simple requisition system includes the use of a maximum stock at the rural facility (usually set at three months’ consumption) towards which monthly orders are placed by rural staff.

Private sector

In most countries the majority of the population is serviced by private-sector drug supply systems, which include private wholesalers, distributors, pharmacists and informal drug sellers. Although growing in most countries, in developing countries the private sector is still concentrated mainly in urban areas and usually fails to serve rural areas fully. When developing a national drug policy it is important to take this sector into account, since it can play a role in maximizing access to health care.

Motivating the private sector to cover less profitable areas of the country may need a system of incentives, such as government subsidies, public or “people’s” pharmacies, or franchising. Another approach to increasing access through the private sector is by a programme of training in prescribing for drug sellers (see under rational use). This may require legal changes.