Ms M. Djamaluddin, Indonesia
In 1983, a National Drug Policy was established in Indonesia to:
• ensure availability of drugs in compliance with actual needs and improve equitable distribution and accessibility;
• ensure efficacy, safety, quality and validity of marketed drugs and promote the rational use of drugs;
• protect the public from drug misuse and abuse; and
• develop national pharmaceutical potential for self reliance.
The national drug supply management system
Registration of drugs was introduced in 1971. In 1980, a re-evaluation of marketed drugs was initiated, and currently all drugs need to fulfil requirements of safety, efficacy and quality. All drug manufacturers in Indonesia are required to comply with GMP regulations, and a quality assurance system ensures that consumers receive drugs which meet quality criteria and standards. Only private doctors and hospitals may use brand-name drugs. Since 1989, all public sector health facilities have been required to use generic drugs.
The national essential drug policy was adopted in Indonesia in 1970, and is revised every three to four years. To safeguard drug supply management of health centres, a drug warehouse has been established in every district. The major functions of the warehouses are planning, distribution, management, and maintenance of appropriate stock levels, as well as monitoring drug accessibility and availability in health centres.
Ninety per cent of the raw materials used to produce drugs and medical supplies are imported, and currency depreciation has resulted in a fivefold increase in costs which must be prepaid in dollars. Over 50% of those who are ill must obtain drugs through private sector providers.
A response to the economic crisis has included political support and commitment, as it did during the previous rice crisis. Additional funds were provided to import raw materials to produce generic essential drugs for health centres by State-owned pharmaceutical companies.
Funds were provided to purchase life-saving drugs, supplies, and equipment for emergency departments, as well as for family planning. An early warning system monitors drug supplies at health centres in selected high-risk areas. Internal monitoring/management information systems between health centres and drug warehouses, and reporting systems between district and provincial health offices, have been strengthened.
A first-year report has shown that the availability of key drugs in health centres has been maintained during the crisis. Drugs have been available in pharmacies, with a consistent increase in the lowest-priced drugs and well-maintained availability of generic products.
The key to success was the adoption of an essential drug policy, together with the generic drug policy. The timely availability of funds required to import raw materials and the pooling of procurement among health centres were crucial to control price stability and to ensure continuous distribution of drugs across the country. Other factors included the existence of management information and logistic systems at the district level, the crisis centre, and the early-warning system.