Research On Strategies Of Essential Medicines Availability In Community Health Service Facilities

Objective:To analyze the measures and problems to promote essential medicines' availability in Community Health Service facilities in China, to know the equipping, the use and influencing factors of Community Health Service facilities to provide essential medicines totally and to provide suggestions to consummate national essential medicines policy.Methods:Material is obtained through an investigation carried out in 2007 on baseline survey in 29 key communicate cities. The investigation covers 193 districts, of which 2 community health centers and stations are surveyed. In each facility, 100 out-patient prescriptions were collected by random sampling method. Also, we investigated facilities in Xi'an, Wuhan, and Beijing by same method. Prescriptions in 2008 are collected. Interviewing method is used to investigate 40 insiders and 20 experts. Data is recorded by epidata 3.02 and analyzed by SPSS 12.0. In theory analyzing part, interested group analyzing, system analyzing and summarizing are used.Results:1.Systmatically describe measures on promoting access to essential medicines, rational use of medicines, affordability, availability and trips of essential medicines, sustainable drug financing, supply management system, quality control and evaluation.2.Result of Baseline survey: in 1917 community health service centers, an average of 517 medicines were stored, of which 150 is chemical medicines and 367 are traditional Chinese medicines. In 5212 heath stations, an average of 298 medicines is stored, of which 91 is chemical medicines and 207 are Chinese medicines. Drug use situation: In 9 health facilities in Tianjin, 139-260 medicines are within the list, 36-460 are medicines are outside the list. 37.08% medicines used in the city are within the list, 62.92% are outside the list. The result shows that, the range of medicines used in Tianjin far exceed the recommended range set by ministry of health. Referring WHO essential medicines list ver. 07, the value of usage rate of essential medicines, essential medicines in a single prescription, prescription rate of essential medicines, rate of prescription contains only essential medicines are 27.97, 0.59, 43.67, and 9.11 respectively. The values are far below ideal value. In drug use situation, 2.51 drugs are prescribed in a single prescription, 35.11% prescriptions contain intravenous injection, 0.56% contain hormones, 43.58% contain antimicrobials, 12.30% contain more than one type of antimicrobials. The values are higher than recommended value of WHO. The average cost per prescription is 53.31.3. The practice in prompting access to essential medicines includes using community essential medicines list, non-profit medicines sales of essential medicines, sustainable drug financing, pooled procurement, dispensing mechanism, separation of medical service and medicine sales, and trusteeship of medicines sales department.4. Influencing factors of access to essential medicines includes configure of health facilities, human resources, management, and reimbursement plan. Investment by government, class of health facilities, and holder of facilities exhibits significant influence. All indicators are more negative in facilities with discrete income and cost management. Difference is statistically significant (P<0.001).5. Models on interest groups, influencing factors, progressive relations and strategy of access to essential medicines in community health facilities are built.Conclusions and suggestions:The access to essential medicines is low. The influencing factors are complicate and twisted. There are many Interest groups posing influences, strategy is too complicated and scattered and needs integrations and plans. There is much work to be done in promoting access to essential medicines. We suggest that essential medicines list should be reviewed and improved; running mechanism of heath facilities should bettered; supervision should be strengthened; accomplished mechanism on use of essential medicines in community should be established; improving advertising and education on essential medicines to increase awareness of essential medicines.Innovations and limits:We use WHO frame of strategy on promoting essential medicines to carry out systematical analysis; Models are establish base on the result of analysis; interest group analyzing method is used to establish frame model on execution subject of implementing access to essential medicines strategy. Limits in our study include unsophisticated analyzing; model needs further research and adjustment.