The provision of access to quality and affordable essential medicines is a critical element in implementing primary health care. In most African countries, access to primary healthcare care is grossly limited, leading to increased deaths and diseases from preventable causes.
Bad management, poor funding, shortage of drugs, and absence of health-promoting amenities in rural communities continue to plague health systems across Africa.
It was for this purpose that the Drug Revolving Fund (DRF) was set up to solve the problems in the financing of primary health care in sub-Saharan Africa and to develop a capacity for sustainable delivery of satisfactory care.
For African countries to fully benefit from the DRF scheme, it must be adopted as a health system reform approach that addresses service delivery, drug supply, financing, and management
However, decades later, many African governments are still yet to establish DRFs in their communities, and in some countries where it has been adopted, governments and other donors have mostly been lukewarm in their commitment or antagonistic.
What is the Drug Revolving Fund (DRF)?
Drug Revolving Fund (DRF) is a scheme where medicines are sold at a light mark-up on the cost-price, and the revenue generated is used to replenish stocks, ensuring that medicines remain affordable and sustainably available.
The DRF scheme is established with a one-time capital investment (seed money), typically provided by the government, donor agencies or interested communities which is used to purchase an original stock of essential and commonly used medicines to be dispensed at prices sufficient to replace the stock of medicines and ensure a continuous supply.
When the DRF system is implemented at maximum capacity, it promotes access and ensures that quality drugs and medical consumables are sustainably available and affordable in public health facilities.
Historical perspective on DRF
The DRF has its origin in the Bamako Initiative, which was adopted to tackle the poor availability of medicines in sub-Saharan Africa, especially at the primary health care level. In 1987, in Bamako, Mali, African health ministers adopted the Bamako Initiative with financial and technical support from agencies like the World Health Organisation (WHO) and United Nations Children’s Fund (UNICEF). The Initiative also proposed the use of an essential drug list and the development of realistic national drug policies to support the provision of essential drugs.
Challenges confronting DRF in Africa
Reports from various African countries where the Bamako Initiative has been employed show that DRFs, when efficiently managed, can create revenue capable of covering significant components of recurring costs in the health system through community financing.
The Bamako Initiative was rapidly adopted in Benin and Guinea and led to a revitalisation of their primary health care systems, ensuring more efficient delivery of quality care in rural communities. Community ownership, fostered by local budgeting and decision-making, has been an essential pillar for the success of DRF in these countries. Nigeria has also been one of the major supporters of the DRF, viewing the initiative as a strategic opportunity to strengthen healthcare delivery at the primary health care level.
However, the implementation of the DRF has not been without its challenges in Africa. Weak political, socioeconomic, managerial, and administrative structures all have negative consequences for the DRF system operation. This has been especially true regarding the establishment of sustainable mechanisms for drug replenishment and of the management of DRFs by health ministries at the community level.
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Most DRF systems in Nigeria failed mainly due to the inability of the hospitals and healthcare centres to pay for the drugs supplied. In recent times, a few states, with the help of some donor agencies, are reviving their DRF systems with strong governance and financial management. But time will tell if lessons of the past have been learnt.
Strategies to ensure the success of the DRF scheme in Africa
For African countries to fully benefit from the DRF scheme, it must be adopted as a health system reform approach that addresses service delivery, drug supply, financing, and management in an integrated and coherent way.
Key strategies that need to be employed to ensure the success of the DRF scheme in Africa include:
1. Strong partnerships between government authorities, public health organisations, the private sector, and other stakeholders should be formed to establish DRFs across Africa while leveraging on the expertise of each player. Through such collaborations, each player will contribute its technical and financial resources to the long-term transformation of the healthcare supply chain in African communities. A good example is a partnership between Bloom Public Health, its partners and a State Government in Nigeria to establish a DRF in that State.
2. Flexibility in approach and regular adaptation of strategies will be crucial to meet changing needs. It is not a one cap fits all. Each State should identify a model that gives maximum benefit to its citizens. Hence, we cannot ignore the value the private sector can bring to the DRF system.
The DRF provides a strategic opportunity to revolutionise primary health care across Africa. With strong political willpower and commitment from public health professionals and other stakeholders, the availability of safe, quality, and affordable medicines can be achieved across all local healthcare facilities. The strength of the private sector needs to be deployed for a sustainable DRF system.
Professor Anyakora is the CEO of Bloom Public Health and a public health expert.
Odibeli is a pharmacist and the Research and Communications Coordinator at Bloom Public Health
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