Financial sustainability is vital to the success of any bulletin. Money is needed for:

• human resources: payment for administrative staff, writers and editors;
• material resources: references, equipment, rent, phone and electricity charges;
• printing and distribution of the bulletin.

Financial resources vary greatly from country to country and between different regions or centres within a country. Developing countries usually have severe budgetary constraints and sources of funding are usually limited. It is important to carefully manage finances right from the start. Decisions on the size, appearance and the extent of circulation of a bulletin should be based on a realistic assessment of the financial resources available. It is best to start modestly, at least initially, and then slowly expand as the bulletin gets established and more resources become available.

Much can be achieved with a limited budget if there is a strong commitment and motivation at both individual and organizational levels. As an example, the production cost of the Nepal Drug and Therapeutics Letter, described above, is very modest. Seven hundred copies of the bulletin, produced every two months, cost around US$10. This cost is borne by the university teaching hospital.

Sources of funding

There is no simple answer to the question of how to finance a bulletin. Some say that whenever possible bulletins should try to generate their own income through paid subscriptions. Having a lot of small sponsors can support a much stronger and more independent editorial base than one or more main sponsors (e.g. through a bulk subscription arrangement). Relying on the sponsorship of individual readers means relying on people who share the views of the editorial team. Bulletins that depend on subscriptions expect their readers to be interested enough to pay for their information, and subscription renewals are indeed a sign of readers’ interest.

Most doctors and pharmacists are used to receiving promotional information from industry free of charge. Some bulletins who do not try to change this established custom choose a system of controlled circulation in which all or most health professionals receive their copy of the bulletin free. This may be possible with financing from the Ministry of Health, a consumer organization, a sick fund, a professional association or a non-governmental organization. Charging for a bulletin may discourage or diminish its use, especially in developing countries. It is not unusual for a bulletin that depends on subscriptions to reach only 10 - 20% of professionals whereas a bulletin distributed free to health professionals may reach 80 - 95%. Broad distribution of a free bulletin has the advantage that it may reach the 'not-yet-converted'. Readership surveys should be carried out, however, in an attempt to know to what extent a bulletin is being read (see Chapter 12). Bulk subscribers (e.g. governments, health authorities) will also need to be assured that the bulletin is worth paying for.

The choice of financing will also depend on how you can obtain funding with the maximum guarantee of maintaining your editorial independence. No interest group should be allowed to influence the choice of topics or the contents of a bulletin. Before accepting any external funding, the bulletin’s editors need to assess if there are any implications for the independence of the bulletin. The following could be considered.

Government

In countries where national drug policies exist and are really implemented, it is very helpful for bulletins to try to be included and funded within the framework of such policies. Some bulletin editors might be as wary of government funding as of private industry. An important difference however is that the government normally represents the general public interest and does not promote the use of certain brand name drugs. By contrast, it might be in the interest of the government to reduce costs and therefore to promote use of the cheapest, but not necessarily the best, option. There are examples where drug bulletins published by government department have had ‘sensitive’ articles censored. A national government cannot be considered as one monolithic block, but as an umbrella for different sections, often with conflicting interests. Funding is best sought from a government department that is oriented towards public health and directly concerned with the aim of promoting rational drug use (for example, the department responsible for drug reimbursement or for the development of national health and drug policies); such a department is probably less likely to have conflicts of interest than, for example, the authorities in charge of industry development.

Institutions and non-governmental organizations

Depending on the local situation, funding for the bulletin could be secured from several other sources. These include local, national or international non-governmental organizations, universities, hospitals, professional organizations of doctors or pharmacists, health insurers, consumer organizations, donor agencies and charities.

The pharmaceutical industry

Pharmaceutical companies are never a good option to ask for funding. Sooner or later they will want to influence the contents of your bulletin. How will you write critically about a certain new drug if the company selling the drug is your main sponsor? Companies will often want a return on their investment, for instance by being named or by letting you print advertisements for their products. Concern about future funding can also lead to a less critical editorial policy or to silence on sensitive issues. A bulletin cannot be a member of ISDB if it receives funding from the pharmaceutical industry.