Acute shortages of drugs and medical supplies in public health facilities were endemic in most states in Nigeria, and undermined efforts to improve health care delivery. Early on in the Partnerships for Transforming Health Systems (PATHS) Programme, participating states established Drug Revolving Funds (DRF) for secondary and primary health care levels. In order for these to be robust, the drug supply systems required an underpinning financial management system and an assured source of drug supply. It was also necessary to introduce a ‘safety net’ to ensure that the very poor and vulnerable could access quality drugs through the system.
Drug revolving fund models, developed earlier in Nigeria, were reviewed and a new model was designed. This captured the best elements of previous models and took into account lessons learned from previous implementation experiences. All PATHS supported states rolled out a sustainable drug supply system across the state. A key component was the development of in-state teams of facilitators thus ensuring sustainability and local ownership. Strong community representation on DRF and facility health committees improved relationships between facilities and their communities. Drug availability increased community confidence in their facilities and, in turn, made communities stronger advocates for their local health facilities. With evidence of increased patronage of facilities, government support for the DRF and for strengthening of financial management systems increased over time, albeit to varying degrees.
Key lessons learnt include:
- The need to implement DRF in a holistic manner (i.e. addressing the total environment within which it will operate).
- The value of strong and continuing advocacy in support of the scheme at all levels.
- Identifying and applying an appropriate personnel mix.
- The importance of state-wide rollout resulting in 100 percent population coverage.
- The fact that sustainability is dependent on the presence of a robust monitoring and evaluation system, strong community participation, and the introduction of performance based incentives to operators.