Establishing a cost recovery system for drugs, Bo, Sierra Leone. The Bo PMM Team

Abstract

Preliminary studies: Focus group discussions and health facility inventories in a rural district hospital indicated a shortage of basic drugs and supplies.

Interventions: The project procured obstetric drugs and supplies through a commercial source outside normal government channels. They were managed through the standard district system and made available at prices calculated to cover costs and an 85% mark-up. Obstetric emergency drug packs were created to ensure 24-h availability. Patients from the study area unable to pay at time of treatment were given credit and followed up.

Results: No shortages of obstetric drugs occurred after interventions were introduced. Prices of drugs to obstetric patients ranged from 46% to 68% of the prices charged by the government hospital and private pharmacies. Of 26 obstetric patients from the study area who received drugs in 1993, 12 paid in full and nine paid in part. The total amount billed during 1993 was US $2537, of which $1451 was recovered.

Costs: Improvements cost approximately $17,500, of which 83% was used for the initial supply of drugs.

Conclusions: Cost recovery systems for drugs can help maintain consistent drug supplies at health facilities. Careful pricing is critical. For the system to be sustainable, the mark-up must cover defaulters.