Dr Lucky S. Slamet, Indonesia
During the past 20 years, the Indonesian government has applied national strategies to the drugs sector to ensure the availability and accessibility of drugs. A national drug policy was established in 1983 and has been used since as a guideline for pharmaceutical development. This policy is now being updated to take account of recent developments. The concept of national essential drugs was adopted in 1980, with the aim of ensuring the cost-effective use of drugs. The list is revised every 3-4 years.
A third strategy is a generic drug policy, which aims to ensure accessibility of essential drugs, especially for the lowest-income population. All public sector health facilities are obliged to procure essential drugs in the form of generic products.
A fourth strategy was the establishment of a quality assurance system for premarket and postmarket control. All drug manufacturers and distributors are required to obtain a licence and comply with GMP, and all drugs must be registered prior to marketing. Drug inspection and quality control laboratories have been established throughout the country.
A fifth strategy was the development of a programme on rational use of drugs, which seeks to ensure proper prescribing, dispensing and use of drugs.
An early warning system has been developed to monitor the trends in the percentage of districts with drug stocks below the minimum level. The availability of key essential drugs in public health centres is considered satisfactory, at between 81% and 94%. Generic products are also well represented in pharmacies, ranging from 90% to 94%.
In terms of the percentage of essential drugs prescribed, health centres showed the best prescribing practices while the private sector used fewer essential drugs. This might reflect the pattern of prescription of private physicians.
The generic drug policy has had an indirect impact on the pharmaceutical market, where the market share of generics reached 12.8% in 2001. The policy has to be supported by a sustainable supply of products of assured quality and a good distribution mechanism.
To promote the rational use of drugs, easy access to objective information on drug efficacy, safety and quality has been provided for health professionals, as well as the community. The information includes treatment guidelines, a formulary, bulletins and journals. A hotline for consumer complaints about drugs and food has been set up so that consumers can request information directly.
In conclusion, the implementation of the essential drugs concept and the generic drug policy, through integrated drug planning at the district level, pooling procurement, direct distribution to districts, and intensive monitoring of availability and quality, have been the key factors in maintaining access to drugs for the public in Indonesia. However, more efforts are needed to maintain the availability and accessibility of affordable drugs.