Introducing management principles into the supply and distribution of medicines in Tunisia

A number of strategies have been proposed by various organizations and gove rnments for rationalizing the use of drugs in developing countries. Such st rategies include the use of essential drug lists, generic prescribing, and training in rational prescribing. None of these require doctors to become a ctively involved in the management of the drug supply to their health centr es. In 1997, in the Kasserine region of Tunisia, the regional health authoritie s piloted a radically different strategy. This involved the theoretical all ocation of a proportion of the regional drug budget to each district and su bsequently to each health centre according to estimated demand. Medical sta ff were given responsibility for the management of these budgets, allowing them to control the nature and quantities of drugs supplied to the health c entres in which they worked. This paper outlines the process by which this strategy was successfully imp lemented in the Foussana district of Kasserine region, and explores the pro blems encountered. It describes how the theoretical budgets were allocated to each district and how the costs of individual drugs and the consumption of drugs in the previous year were calculated. It then continues by giving an account of the training of the staff of the health centres, the preparat ion of a drug order form and the method of allocation of the theoretical bu dgets to each of the health centres. The results give an account of how the prescribing habits of doctors were c hanged as a result of the strategy, in order to take into account the costs of the drugs that they prescribed. They show how the health centres were a ble to manage their budgets, spending overall 99.8% of the budget allocated to the district. They outline some of the changes in the prescribing habit s that took place, demonstrating a greater use of appropriate and essential drugs. The paper concludes that doctors and paramedical staff can successfully man age a theoretical drug budget, and that their involvement in this process l eads to more rational prescribing within existing resource constraints. Thi s has a consequence of benefiting patients, satisfying doctors and pleasing administrators.