the effect of an educational intervention on the drug purchasing practices of local government...
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The effect of an educational intervention on the drug purchasing practices of local government
officials in a decentralized setting
Isidro C Sia M.D., Ph.D.*, Cristina E. Torres, Ph.D.†, Noel R. Juban, M.D., M.S.‡
* Department of Pharmacology, College of Medicine, University of the Philippines Manila† Department of Social Sciences, College of Arts and Sciences,
University of the Philippines Manila‡ Department of Clinical Epidemiology, College of Medicine,
University of the Philippines Manila
Background Devolution in the Philippines
change in decision-making transfer of responsibility & resources
from the national to the local government units (LGUs)
the burden of apportioning scant resources for multiple local programs.
need for municipalities to efficiently purchase appropriate & sufficient drugs to address the health requirements of the people.
Levels of Government and Decision-Making Authority
National Level DOH* Regional Level DOH
----------------------------------------------
Provincial LGU** City/ Municipal LGU Village (Barangay) LGU
*Department of Health ** Local Government Unit
Objective
• The aim of this study is to improve the drug purchasing practices of local officials using an educational intervention focusing on the principles of rational drug use.
• We hypothesize that the intervention will increase health budgets for drug purchases and bring about a corresponding increase in the purchase of essential drugs.
Methods Design: Non-randomized pre-post comparison Setting: Ten municipalities/cities were chosen at random from the provinces of Laguna (intervention) &
Batangas (control). Subjects: Participants for each municipalities were:
the mayor or representative mayor’s executive staff:
local planning & development officer budget officer accountant municipal/city health officer and staff Village/ Barangay officials.
Intervention The intervention was pre-tested & included two components:
1. Interactive discussion (IGD) - purchasing procedures at the municipal level- budgeting guidelines and procedures - purchasing procedures actual practices being followed in each community
2. Short lecture-discussion National drug purchase guidelines
Executive Order 49
Generics Act of 1988 (Republic Act 6675) Philippine National Drug Formulary (PNDF)
Principles of drug supply management Rational drug use principles and drug use guidelines
for common illnesses
Outcome Measures and Analysis Outcome measures
Total Municipal or City Budget Health Budget Health Over Total Budget Drug Budget Drug over Health Budget Essential Drug Expenditure Non- Essential Drug Expenditure
Statistical Analysis Descriptive statistics Mann- Whitney Test at alpha = 0.05
Table 1. Number and Class of Participating Local Government Units
Intervention Province
Control
Province1 City
9 Municipalities
1 - 1st Class
2 - 4th Class
6 - 5th Class
1 City
9 Municipalities
2 - 1st Class
1 - 2nd Class
1 - 4th Class
5 - 5th Class
Municipality
Class
2000 2000 2000 2000 2000 RankAmount Amount Amount Amount Amount(000,000
Php)(000,000
Php)(000,000
Php)(000,000
Php)(000,000
Php)
San Pablo City 375.3
118.5
14.94
172.14
211.52 14
Sta. Cruz 1 79.7 5 9.3 2 11.64 3 2.67 1 28.32 5Pagsanjan 4 25.4
91.6
139.09
130.41
924.64 6
Pila 4 28.3 7 2.2 10 8.51 10 0.2 15 8.32 17
Liliw 5 22.1 12 2.3 9 10.46 5 0.1 18 4.45 20
Mabitac 5 15.6 18 0.87 19 5.58 14 0.2 14 22.95 8Magdalena 5 20
141.7
11.58.5
70.3
1217.63 10
Majayjay 5 19.7 15 1.3 17 8.86 12 0.15 17 11.87 13
Pakil 5 16.2 17 1.3 17 7.73 8 0.3 10 23.95 7
Victoria 5 22.7 11 0.4 20 1.75 20 0.3 11 75.58 1Average 62.5 10.9 3.947 11.95 7.706 10.9 0.677 10.9 22.923 10.1
Drug Budget
Rank Rank
Laguna (Intervention)
% Drug to Health Budget
Rank Rank
Total Budget Health Budget % Health to Total Budget
Table 1A. Baseline Budget Data for the Intervention Group
Municipality
Class
2000 2000 2000 2000 2000 RankAmount Amount Amount Amount Amount(000,000
Php)(000,000
Php)(000,000
Php)(000,000
Php)(000,000
Php)
Tanauan City 91.9 4 4.7 4 5.12 16 1.5 3 31.88 3
Bauan 1 108 3 4.2 5 3.91 18 1.5 4 35.55 2Sto.Tomas 1 210.4
24.9 3 2.33
190.5
710.15 15
Lemery 2 45.7 6 3.5 6 7.63 11 1 5 28.65 4
Taal 4 27.6 8 3.2 7 11.7 4 0.5 6 15.51 12
Alitagtag 5 14.3 19.5 1.4 14.5 9.8 6 0.22 13 15.71 11
Laurel 5 17.8 16 1.4 14.5 7.74 9 0.1 19 7.26 19
Talisay 5 23 10 1.3 17 5.63 15 0.1 20 7.74 18
San Luis 5 20.2 13 2.5 8 12.24 1 0.48 8 19.21 9Sn Nicolas 5 14.3
19.51.7 11.5 12.25
20.16
169.15 16
Average 57.32 10.1 2.88 9.05 7.835 10.1 0.606 10.1 18.081 10.9
% Health to Total Budget
Drug Budget
Batangas (Control)
% Drug to Health Budget
Rank Rank Rank Rank
Total Budget Health Budget
Table 1B. Baseline Budget Data for the Control Group
Table 2. Average Baseline Total, Health and Drug Budgets and Ranks per Group
Averages Intervention Control P – value*
Total Budget 62.5 57.3 0.7623
Rank 10.9 10.1
Health Budget 3.95 2.88 0.2720
Rank 11.95 9.05
Health over Total 7.71 7.84 0.8798
Rank 10.9 10.1
Drug Budget 0.68 0.61 0.7043
Rank 10.9 10.1
Drug over Health 22.92 18.08 0.7624
Rank 10.1 10.9Mann – Whitney Test , alpha = 0.05
Table 3. Comparison of health and drug per capita budgets pre- and post-intervention
Averages Intervention Control P-value
Health Budget
2000
2001
% change
67.21
81.4
14.19
64.24
72.23
8.05 0.6501
Drug Budget
2000
2001
% change
12.31
11.30
- 1.02
11.14
14.29
3.15 0.4497
Drug to Health
2000
2001
% change
22.92
14.49
- 8.43
18.08
19.50
1.51 0.1736Mann – Whitney Test , alpha = 0.05
Table 4. Comparison of purchase of essential and non-essential drugs pre- and post-intervention Intervention Control P-value
Essential
2000
2001
% change
88.58
91.99
4.26
82.52
84.21
2.89
0.5453
Non-Essential
2000
2001
% change
11.42
8.01
- 11.75
17.48
15.80
9.47
0.5453
Mann – Whitney Test , alpha = 0.05
Conclusions One time intervention may not be sufficient to
bring change.
There was noted increase in the health budget and per capita health expenditure in the intervention LGUs.
There was a decrease in the purchase of non- essential drugs in the intervention LGUs compared with the control LGUs..
Recommendations Reinforcements may be done in educating
the heads of LGUs regarding rational drug purchasing and use.
Involvement of the village leaders should be encouraged since they have to work with lesser budgets and are the most in contact with the people.
In depth analysis of the processes done by the different LGUs to identify which systems works for whom.
Good Day !