One of the conditions for success was the strong commitment of the actors involved and the participating countries to proceed with bulk purchasing. The little participation of one of the members in the real bulk purchasing in spite large participation in the development of the system illustrates the need for strong commitment.

The political agreement and support have been indispensable for the start and the continuity of the system. To achieve acceptable results, the daily management of the system must remain at the technical level.

An agreement describing clearly and in detail the procedures, the responsibilities and the commitment of the partners, has allowed the system to continue without regular complaints.

The permanent and independent executive secretariat has proven - in light of the two examples studied - to be not only a key condition but almost indispensable for the system to be successful. The participating countries have a lot of interest in the system to the extent that the system has continued even after the withdrawal of two of its members. Even the countries that have had to retreat temporarily from the system have expressed their commitment to renew their participation in future.

The Gulf countries - in spite of relatively large budgetary resources have adhered to the system during the 20 years of its existence. They have even progressively extended the spectrum of this co-operation from drugs only, towards a product range varying from syringes and X-ray products to disposables for cardiac surgery.

Bulk purchasing has had a positive impact on the quality assurance of pharmaceutical products acquired through the system, and the system has allowed to increase the general level of quality assurance of drugs in the participating countries.