Effect of the Bamako-Initiative drug revolving fund on availability and rational use of essential drugs in primary health care facilities in south-east Nigeria.
OBJECTIVE
To compare the level of availability and rational use of drugs in primary health care (PHC) facilities where the Bamako Initiative (BI) drug revolving fund programme has been operational, with PHC centres where the BI-type of drug revolving fund programme is not yet operational.


METHODS
The study was undertaken in 21 PHC centres with BI drug revolving funds and 12 PHC centres without BI drug revolving funds, all in Enugu State of Nigeria. Data were collected on the essential and non-essential drugs stocked by the facilities. Drug use was determined through analyses of prescriptions in each health centre. Finally, the proportion of consumers that were able to remember their dosing schedules was determined.


RESULTS
An average of 35.4 essential drugs was available in the BI health centres compared with 15.3 in the non-BI health centres (p < 0.05). The average drug-stock was adequate for 6.3 weeks in the BI health centres, but for 1.1 weeks in non-BI health centres (p < 0.05). More injections (64.7 vs. 25.6%) and more antibiotics (72.8 vs. 38%) were prescribed in BI health centres than in the non-BI health centres (p < 0.05). The BI health centres had an average of 5.3 drugs per prescription against 2.1 in the non-BI health centres. However, the drugs prescribed by generic name and from the essential drug list were higher in the BI health centres (80 and 93%) than the non-BI health centres (15.5 and 21%, respectively) (p < 0.05).


CONCLUSIONS
It was observed that the BI facilities had a better availability of essential drugs both in number and in average stock. However, the BI has given rise to more drug prescribing, which could be irrational. The findings call for strategies to ensure more availability of essential drugs especially in the non-BI PHC centres as a strategy to decrease medical costs and improve the quality of PHC services, while promoting rational drug use in all PHC centres. More detailed studies (for example, by focus group discussion or structured interviews) should be undertaken to find out reasons for the over-prescription and to develop future interventions to correct this.
Uzochukwu
Benjamin S C
BS
Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria. onwujekwe@yahoo.com
Onwujekwe
Obinna E
OE
Akpala
Cyril O
CO
D003906:Developing Countries / Q000191:economics*; D011307:Drug Prescriptions / Q000191:economics*; D004363:Drug Utilization / Q000191:economics* / Q000592:standards; D018954:Drugs, Essential / Q000191:economics* / Q000600:supply & distribution*; D016568:Drugs, Generic / Q000191:economics / Q000600:supply & distribution; D005381:Financing, Organized; D019538:Health Care Surveys; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D009549:Nigeria; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011635:Public Health Administration / Q000191:economics*; D014480:United Nations; D014944:World Health Organization
D018954:Drugs, Essential; D016568:Drugs, Generic