To facilitate this discussion, the group used a questionnaire (see Annex 4).

(a) Assessing the implementation of NDP

The participants assessed broadly the seven main components of a NDP (see Annex 5 and Annex 6), as it is assumed that if these components were functioning properly, the objectives would be achieved. For most countries, the structures/systems/mechanisms as measured by the structural indicators were in place. For example, in all the countries there is a drug regulatory authority whose mandate includes registration and inspection (ST4); in all countries except Chad and Viet Nam, drugs in the public sector are usually procured through competitive tender (ST24). However, the weakest components everywhere are the ones related to financing of drugs in the public sector and pricing of drugs in the private sector. For example, only in five countries was the public drug expenditure per capita more than US$ 1.00 per year for the last three years (ST20).

In most countries although structures are in place, implementation is not always working as expected. As stated by the Guinean team "it is easier to create structures than to make them work". In the same country for example 87% of the drugs prescribed in the public sector were on the essential drugs list, the same figures from the private sector and the black market were 28% and 39% respectively. Zimbabwe provided an opposite example: for the public sector procurement procedures, the process indicators were better than the structural indicators. Although not all the structures are in place, Zimbabwe obtains very good prices for drugs, due to the fact that there are a few very knowledgeable and motivated staff at the procurement level.

Through this assessment, the countries were able to identify areas that need improvements, for example Zimbabwe identified the following issues: lead time for tenders, private procurement, inspection, information on adverse drug reactions, supervision, accounting and finance procedures.

(b) Achieving the objectives of NDP

The four objectives of most NDP: availability and accessibility of essential drugs, quality and rational use of drugs were assessed using a rating system from 1 to 5 based on the results of the 10 outcome indicators (see Table 4, Annex 5 and Annex 6 which also contain some explanations of the methods used for the rating). Availability of essential drugs (OT1 and 2) was quite good in most countries with the exception of Zambia. In the case of the Philippines, the availability was low mainly in the public sector. As these indicators take into account only a very limited basket of the most essential drugs, even a rate like 3 is not a very satisfactory result. The picture in terms of accessibility to essential drugs is slightly less impressive; in many countries the situation mainly in the private sector is not good (Bulgaria, Guinea, India, the Philippines and Viet Nam). Quality of drugs remains an important problem in the poorest countries (Chad and Guinea) but is also not very good in countries like India, Thailand and Viet Nam. For example, in this last country 25% of the samples failed quality control tests. Finally, the rational use of drugs is very rare with some countries performing better (the Philippines, Zimbabwe). For instance in India 66% of the prescriptions surveyed in the public sector contained at least an injection; in Thailand the percentage of children receiving antidiarrhoeals from private drugstores was 96%.

(c) Reviewing strengths and weaknesses of NDP

Each participant identified the strengths and weaknesses of his/her country NDP through a broad analysis of the results of the indicators. It should be stated again that it was a preliminary analysis which will be refined once all the data will be reviewed and validated. For some countries the main strength they discovered was the fact that there are well established structures: legislation (Bulgaria, Chad, Colombia, Mali), quality control systems (Viet Nam), procurement procedures (Mali), distribution and logistics systems (Bulgaria), reliable health data (Bulgaria), well accepted EDL (Mali, Viet Nam); for others, the most important strength of the policy was its integration in broader health and economic policies (Colombia, Thailand, Zimbabwe). For instance "the main strength of the Colombian NDP is its inclusion in the context of the System of Social Security established in the country with the health reform. It provides a good structure for components related with legislation and regulation, essential drugs selection and drug registration, and drug allocation in the health budget. These components of the policy are working quite well in terms of process for the population already covered by the Social Security System". For the Philippines, the main strengths were the comprehensiveness of the policy involving all stakeholders and the fact that the NDP programme is officially integrated in the Department of Health.

For many countries, weaknesses of the NDP include lack of implementation of rules and regulations (Bulgaria, Chad, Colombia, Guinea, Mali, the Philippines, Sri Lanka, Thailand and Viet Nam); no real commitment to monitoring including strengthening of data collection (Mali, the Philippines, Sri Lanka, Viet Nam and Zimbabwe); not enough concerns for financing and pricing issues (Bulgaria, Zimbabwe); lack of financial resources (Chad, Guinea, Mali, Viet Nam); and low emphasis on continuing education and training in RUD (Bulgaria, Colombia, India, Mali, Sri Lanka and Viet Nam).