Introduction

1. Contribution of Botika ng Barangay to improved access to essential medicinesPablo Alcocer Vera ECTA/HSPSPManila, 26 January 2010

2. Introduction • AO 144: omnibus AO • Summary • Operators train + seed PHP 25,000 in drugs and medicines (OTC and Rx). • DoH procurement (PPI/MMD) for the first seed capital. • SLTO • Supervision by pharmacist 2 times/month. • Aim: 2 BnB per Barangay by 2010 • 15,000 BnB claimed open as January 2010

3. What is happening? And, whatever is, how much is happening?

4. EC BnB Evaluation: objectives • Specific objectives: • Perform a BnB project overall situation analysis (cross-sectional evaluation) in order to identify organizational, legislative or managerial gaps in the actual system and recommend feasible solutions and improvements. • To propose a monitoring system of the BnB operations, derived from the situation analysis, in order to feed back key decision-making bodies at different levels; mainly LGU, CHDs, NDP-PMU50

5. Study methodology • Cross-sectional study: • conducted at BnB level, provincial, regional and national, • Structured interview based on using a detailed questionnaire • Training on how to conduct interview was provided to surveyors. • Sample Size: n=389 (95%,5%) in 7929 BnB population in database at time of survey • Sample selection: • Inclusion Criteria: BngB opened before 12/31/07, • Random stratified sample per province in 28 EC TA HSPSP and MHSPSP supported prov. 5

6. Study limitations • Database used to select BngB was not up-to-date, therefore re-sampling was necessary and re-sampled BngB not always met inclusion criteria (opened before 12/31/2007). • For many indicators, data was not available therefore sample size much smaller on a number of indicators as it was planned.

7. RESULTS BnB survey: Selected operational quantitative indicators Functionality 3 levels (after 2 years): • Open and with operator: 87% • Annual sales >PHP 18,000: 27% • Level 2 + sales, inventory and prescriptions books: 6.68% Training:84% operators trained (53% of cases more than 3 months before opening). Location: 56% within 5 minutes nearest health facility; 90% reported no private pharmacy in the Barangay SLTO: 59% already received Price list visibly displayed: 24%!

8. RESULTS BnB survey: Selected indicators • Financial viability: Annual Sales: 54% of BnBs > PHP 24,000; Median sales per BnB PHP 14,000 (Health Plus PHP 65,000). Median sales per person PHP 9.09; Median sales per client PHP 23 RDF: median PHP 15,000 (caution! Only 43% sample produced data) Accounts payable:median PHP 2,268 (caution! little data available, problem financial management) AP Ratio (against sales): >0.3 27% BnBs on risk. If mark-up is 30% and you have payables >30% then you cannot replenish stocks.

9. RESULTS BnB survey: Selected indicators • Supply Median purchased 2008: PHP 9,989 Median number of purchases:8 60% from private suppliers+low purchase power=likely higher prices 35% BnBs with expired medicines at the moment of the visit (reported many instances of close to expire with the seed capital, but also low demand, RHU without doctor, low sales, difficulties to dispose)

10. RESULTS BnB survey: Selected indicators • Monitoring and supervision Submitted 4 sales reports/year: 31% Submitted 4 inventory reports/year: 21% Visits by SP during 2008: 63% received none! 26% 1 or 2 visits

11. RESULTS BnB survey: Selected indicators • Prices and affordability Median Price Ratio (against MSH International Drug Price) very comparable to international non for profit suppliers. Affordability (number of days of minimum wage): affordable for acute infections treatment, considerable burden for treatment of hypertension.

12. RESULTS BnB survey: Selected indicators Prices and affordability FIES 2006 Average family income for the lowest income group: PHP32,000 Annual cost for Metoprolol of one family member=180x12= PHP 2,160 = 6.7% of annual income of the family not counting any other medical cost. FIES shows that lowest income groups spend only 1.7% on medical care This suggests: Most poor people cannot afford low cost medicines (Metoprolol 50mg tablets) if they have to pay out of pocket. 12

13. RESULTS BnB survey: Qualitative reported issues • Supply constraints: • Difficulties preparing inventory reports=what and how much to order • Absence of regular supply (link to absence of regular ordering) • Receipt of near-to expired medicines from DoH • Lack of suppliers of BnB meds at BnB prices • Operations issues: • Lack of incentives for operator • Lack of cabinets, forms, computer • Difficulties keeping and maintaining records • Clients prefer branded medicines • Too many informal/illegal outlets/individuals selling meds • Constrains with the management of credits

14. Conclusions and Recommendations • SUPPLY SYSTEM • Regulated vs free • Centralized vs decentralized • Push vs pull • Further study • MONITORING SYSTEM • Regular support should be close to BnB (LGU, municipal) • Supervision by trained health worker (not necessarily by SP) • Collection of routine data and analysis at different levels • Investment! And identification unique code. • Ownership transferred to LGUs

15. Salamat po!