Browsing by Author "Holloway, KA"
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Publication Impact of a cost sharing drug supply scheme on the quality of service in public health facilities(Institute of Medicine, 1998) Holloway, KA; Gautam, BRAbstract Insufficient drug availability undermines primary health care in Nepal. This study investigated the impact of cost-sharing drug schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged, on the quality of service provided. A cross-sectional survey was conducted & WHO indicators used. It was found that the CSDS did improve drug availability and utilization rates. Further drug use was more rational in the CSDS in terms of prescribed drugs being dispensed and antibiotics being prescribed and dispensed in full course. In other respects the quality of care in CSDS was similar to non-CSDS facilities and was poor. Low staffing levels probably contributed to this. Of particular concern was the inadequate sterilization practices and sterile injection technique in most health facilities (CSDS & non-CSDS). Keywords: cost-sharing, prescribing habits, quality of care, drug use, facility utilization, user feesPublication User fees and the cost of irrational prescribing(Institute of Medicine, 1998) Holloway, KA; Gautam, BRAbstract Lack of funds, insufficient drug availability and irrational prescribing undermine primary health care in Nepal. This study measured the cost of irrational prescribing and the impact of different kinds of user fee on the cost of irrational prescribing. The study took place within cost-sharing drug re-supply schemes (CSDS) in rural hilly E. Nepal, where the drug supply is supplemented and a nominal user fee charged. A before-after non-randomized controlled trial was conducted. The cost per prescription, the cost of irrational prescribing (wastage) per prescription and % drug cost recovery were measured. It was found that more than one-third the value of all drugs dispensed to patients had been irrationally prescribed and that item fees were associated with 20% financial savings due to reduced irrational prescribing as compared to flat fees. If all irrational prescribing were eliminated it maybe that an amount of drugs equivalent to value of the annual HMG drug indent would last the year round in many health facilities.