Abstract

Gamal Khalafalla Mohamed Ali

This paper presents a comprehensive evaluation of a country where a revolving drug fund (RDF) has lasted for fifteen years and serves more than three million patients annually, with more than SDG 2.8 million (Sudanese Pound) (US$11.1 million) annual turn over. Regardless of the fact that the supply of medicines and improvement in public health facilities utilization are among the main objectives of user fees policy, there is little information on the effect of RDF on accessibility of essential medicines and its impact on the utilization of public health services where RDF schemes have been introduced. We measured the percentage of prescribed medicines dispensed to patients in selected health facilities (both RDF and non-RDF), the availability of essential medicines in a twelve month period in order to determine whether the cost of the medicines is a barrier to utilization of public health services with RDF scheme in Khartoum State (KS). Structured interviews with users (186), personal observations, and archival as well as statistical records were used to capture data of interest relevant to the study objective. The average availability rate of key items was greater (93%) in the RDF facilities compared to 86% in non-RDF facilities. RDF records also showed that the availability of medicines in the RDF health facilities ranged from 95 to 100% in the twelve months period studied. Data from the household survey, demonstrated that over a third (36%) of respondents did not consult public health facilities when a member of a household was ill two weeks prior to the date of interview. Of note, only 9% of them said that this was because of unavailability of medicines. This study suggests that the RDF scheme adopted by KS made essential medicines available at its health facilities and increased health services utilization compared to those without RDF scheme. Therefore, sustained availability of low cost medicines near where people live that benefit previously disadvantaged poor population, particularly the vulnerable rural groups is achievable through RDF.