The effect of an educational intervention on the drug purchasing practices of local government officials in a decentralized setting Isidro C Sia M.D., Ph.D.*, Cristina E. Torres, Ph.D.†, Noel R. Juban, M.D., M.S.‡ * Department of Pharmacology, College of Medicine, University of the Philippines Manila † Department of Social Sciences, College of Arts and Sciences, University of the Philippines Manila ‡ Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila

Background  Devolution in the Philippines  change in decision-making  transfer of responsibility & resources from the national to the local government units (LGUs)  the burden of apportioning scant resources for multiple local programs.  need for municipalities to efficiently purchase appropriate & sufficient drugs to address the health requirements of the people.

Levels of Government and Decision-Making Authority  National Level DOH*  Regional Level DOH  Provincial LGU**  City/ Municipal LGU  Village (Barangay) LGU  *Department of Health  ** Local Government Unit

Objective The aim of this study is to improve the drug purchasing practices of local officials using an educational intervention focusing on the principles of rational drug use. We hypothesize that the intervention will increase health budgets for drug purchases and bring about a corresponding increase in the purchase of essential drugs.

Methods  Design: Non-randomized pre-post comparison  Setting: Ten municipalities/cities were chosen at random from the provinces of Laguna (intervention) & Batangas (control).  Subjects: Participants for each municipalities were:  the mayor or representative  mayor’s executive staff:  local planning & development officer  budget officer  accountant  municipal/city health officer and staff  Village/ Barangay officials.

Intervention  The intervention was pre-tested & included two components: 1. Interactive discussion (IGD) - purchasing procedures at the municipal level - budgeting guidelines and procedures - purchasing procedures actual practices being followed in each community 2. Short lecture-discussion  National drug purchase guidelines Executive Order 49 Generics Act of 1988 (Republic Act 6675) Philippine National Drug Formulary (PNDF)  Principles of drug supply management  Rational drug use principles and drug use guidelines for common illnesses

Outcome Measures and Analysis  Outcome measures  Total Municipal or City Budget  Health Budget  Health Over Total Budget  Drug Budget  Drug over Health Budget  Essential Drug Expenditure  Non- Essential Drug Expenditure  Statistical Analysis  Descriptive statistics  Mann- Whitney Test at alpha = 0.05

Table 1. Number and Class of Participating Local Government Units Intervention Province Control Province 1 City 9 Municipalities st Class th Class th Class 1 City 9 Municipalities st Class nd Class th Class th Class

Table 1A. Baseline Budget Data for the Intervention Group

Table 1B. Baseline Budget Data for the Control Group

Table 2. Average Baseline Total, Health and Drug Budgets and Ranks per Group AveragesInterventionControlP – value* Total Budget Rank Health Budget Rank Health over Total Rank Drug Budget Rank Drug over Health Rank Mann – Whitney Test, alpha = 0.05

Table 3. Comparison of health and drug per capita budgets pre- and post-intervention AveragesInterventionControlP-value Health Budget % change Drug Budget % change Drug to Health % change Mann – Whitney Test, alpha = 0.05

Table 4. Comparison of purchase of essential and non-essential drugs pre- and post-intervention InterventionControlP-value Essential % change Non-Essential % change Mann – Whitney Test, alpha = 0.05

Conclusions  One time intervention may not be sufficient to bring change.  There was noted increase in the health budget and per capita health expenditure in the intervention LGUs.  There was a decrease in the purchase of non- essential drugs in the intervention LGUs compared with the control LGUs..

Recommendations  Reinforcements may be done in educating the heads of LGUs regarding rational drug purchasing and use.  Involvement of the village leaders should be encouraged since they have to work with lesser budgets and are the most in contact with the people.  In depth analysis of the processes done by the different LGUs to identify which systems works for whom.

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