The main and the most common activity of each VDF was the sale of drugs, but the way this was managed varied. In the present study, from the field-visits of 349 VDFs in the eight sample provinces, three main operational forms of VDF were found: (1) the single VDF; (2) the VDF cum groceries (private groceries and multi-purpose funds or cooperative stores); and (3) community center for primary health care (CCPHC) (Table 3).

The single VDF

The single VDF predominated in the survey. It formed about 57% of the total number of VDFs, with significant provincial differences, Prajinburi in the central led the way with 92.3% followed by Chiangrai in the North with 74.0% and Songkla in the South with 72.7%. Mukdaham and Chaiyapoom in the North-east had the lowest figures with 9.5% and 12.5% respectively. Differences in perceptions regarding the essential roles of the VDF among policy implementators at provincial/district levels seemed to be an important explanation for such differences in coverage³⁰.

The single VDFs were found to have most difficulties in maintaining their activities. Among those which were reported to be functioning, performance was found to vary greatly. Many had no drug sale activity for a couple of months, some had regular sale activity but only a few drugs available on sale, some showed no participation any more of other villagers. According to the field visit data almost one-third of the single VDFs (31.3%) reported that their last sale activities occurred longer than two weeks before the survey. On the basis of the mailed survey data, the amount of drugs sold per month of 37% of the single VDF (n=1,949) is below 100 Bahts, which is barely sufficient for economic survival.

In Chiangrai where many single VDFs were found to be still operational, the qualitative data from the case study villages reveals how they survive. Four out of six single VDFs in Chiangrai, during about six years of operation, had changed their caretakers almost every year. Some were managed by requiring all concerned VHV/VHCs to take in turn the responsibility of looking after the VDF for one year.

From these cases, it is obvious that it was unrealistic to engage an individual VHV or VHC, or village head, or other villagers to look after the VDF on a long-term basis. The opportunity cost of time was too high for the VDF manager, who was not earning his/her living from that activity. Since the monthly sale value was not high, the share of five to 35% of monthly net profits which went to the responsible VHV or VHC was absolutely not an adequate financial incentive. Moreover, drug replenishment of the stock through the official health system was usually rather difficult. Support and supervision from the responsible health center and district hospital were rarely adequate. Given the infrequent drug sale activity and low sale volume, the prospect for survival of the majority of this type of VDF has become increasingly slim.

Table 3: Operational forms of village drug funds by province

The VDF groceries and the multi-purpose funds

In order to be able to survive, the drug provision function of the VDF was merged in some villages with that of groceries- referred to here as “VDF groceries”. In practice, the VDF groceries followed one of two, organizational lines. In some villages, particularly in the Northeast, it was the MOPH’s policy to merge all existing single PHC funds³¹, including the VDF, into a larger multi-purpose village-based fund operating a cooperative store. In other villages it was the local initiative (villagers and/or responsible tambon health workers) to add VDF drug provision to private groceries in order to save the VDF from disappearing. This could again take two routes - either the owner of an existing private grocery was asked to take care of VDF drug provision or the existing VDF manager found it more practical and of course profitable for himself/herself to invest in and operate a grocery side by side with the VDF drug provision.

Once merged with groceries, the drug sale activity of the VDF would just become a part of the grocery business. Drugs became one commodity among many; highly demanded commercial drugs, usually including prescription drugs, were also added.

The role of VHV or VHCs, if they were involved in these VDF groceries, was different from those in the single VDFs. In the multi-purpose cooperative store, for example, the VHV or VHCs could be one among a group of staff, who had to take turns to look after the business. They might be salesmen/saleswomen, stock checkers or accounting auditors. Their roles as health educators or even drug use information providers, disappeared in these situations.

The community center for primary health care (CCPHC)

In many villages with a CCPHC, defunct VDFs were reported to have been restarted, or existing ones merged as part of CCPHCs. The CCPHC is a further development of the national PHC Programme in the 7^th National Health Development Plan (1992-1996). Conceptually, it is expected to be like a village PHC office where all village health development activities will be coordinated, and health information will be provided. The government health officials will use it as a place for giving supervision and technical support to the VHV and VHCs. At the CCPHC, five VHVs, in conjunction with a periodic health center mobile service, are expected to provide preventive screening services (e.g. measuring blood pressure level) and curative care, and also engage in other community-based PHC activities. According to the MoPH concept, the CCPHC will be an effective strategy to help solve the problem of inactiveness of the VHV/VHCs. So far there has not been any systematic evaluation of CCPHCs.