The National Drug Policy in Practice (A Case Study of the Dangme West District)

Abstract

Objective The main objective of the study was to determine which component of the National Drug Policy was working and which was not. Thus this study aimed to compare the current practices in the implementation of the Drug Policy with findings obtained in 1996 and 1998 and to determine strengths and weaknesses of some of those strategies adopted in the implementation process. The study took place in the Dangme West District. Subdistrict health staff working in the ten Health Centres and Community Clinics and who were responsible for dispensing were interviewed to assess knowledge of Rational Drag Use / Drug Storage /Drug Distribution components of the essential drag concept and to determine implementation arrangements and status of implementation. Key personnel of private sector health facilities and drag shops were also interviewed using the same criteria and questionnaire. At the community level, heads of households were interviewed to determine level of and impact of the drag distribution component of the policy implementation by measuring accessibility, availability and perception of cost to the individual as an indicator of how far the goal of the NDP had been achieved. Summary of Key Findings and Recommendations 1. Knowledge of MOH policies 1.1 Finding: Knowledge of MOH policies is very scanty 1.1.1 Recommendation: Distribution of policy documents must be improved. The re was a need to disseminate information about the whole policies and not just components of a policy in order to improve intersectoral collaboration. 2. Implementation of components of the NDP 2.1 Findings: The training component of the NDP was very well implemented. Training had been given to 78.6 % of public sector respondents in the last two years and to 61.5% of the private sector respondents. 2.1.1 Recommendation: In addition, training programmes must tackle the beliefs and attitudes of trainees if behavioural change is aimed at. Secondly the target group of trainees must be expanded to include staff especially those in the community clinics who act in the absence of the in-charge. 2.2 Finding: Facilities in the private sector are inspected more regularly than the public sector facilities. Facilities are inspected 85.7% of the time in public facilities and 92,3% in Private Sector facilities. 2.3 Finding: Storage facilities and practices are generally good in 50% of public sector facilities and in 84.6 % of the private sector facilities. Stockouts were experienced more often in the public facilities and 60% of the public facilities reported no experience with expiration of drugs in storage in contrast with the 100% ‘no expiry" rate in the private sector. The Stock control component of the policy is not working very well in the public sector. 2.3.1 Recommendation: Improved storage facilities and practices Budgets must be made for the construction of or improvement of storage facilities of in all health facilities especially those in the public sectors. Better storage facilities will reduce the occurrence of deterioration of goods in storage and prevent he use of scarce resources on replacement drugs. 2.3.2 Recommendation: Third Party contacting of dispensary services Alternatively other mechanisms such as third party contracting could be established for employing independent private sector pharmacists to man dispensaries in health facilities to provide services to clients. 2.4 Finding: Out of 119 respondents (heads of households) interviewed on ability to purchase drugs, 84.3% reported that they found drugs affordable 2.5 Finding: 73% of the 119 respondents reported that drugs were easily accessible 2.6 Finding: Counselling on drug use is performed excellently by the Medical Assistants and persons in charge of the community clinics and not by the Dispensing Assistants. The best interaction between clients and service providers were found at the community clinics. 2.6.1 Recommendation: To improve communication between the Dispensary Assistant and the patient dispensary windows should be widened.