scholarly journals Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Lirosha Moodley ◽  
Fatima Suleman ◽  
Velisha Ann Perumal-Pillay
Keyword(s):  
South Africa ◽  
Resource Allocation ◽  
Burden Of Disease ◽  
Standard Treatment ◽  
Pharmaceutical Expenditure ◽  
Pharmaceutical Services ◽  
Essential Medicines ◽  
Healthcare Budget ◽  
Essential Medicines List ◽  
Heavy Burden

Abstract Background South Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector. Method Qualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed. Results This study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly. Conclusion This was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.

scholarly journals Comparative Research for the Healthcare Budget and Burden of Disease in Perspective Resource Allocation

2019 ◽  
Vol 34 (Suppl 1) ◽  
Author(s):  
So-Youn Park ◽  
Seok-Jun Yoon ◽  
Hyesook Park ◽  
Min-Woo Jo ◽  
In-Hwan Oh
Keyword(s):  
Resource Allocation ◽  
Burden Of Disease ◽  
Comparative Research ◽  
Healthcare Budget

scholarly journals Use of evidence and negotiation in the review of national standard treatment guidelines and essential medicines list: experience from Ghana

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii104-ii120 ◽  
Author(s):  
Augustina Koduah ◽  
Brian A Asare ◽  
Edith Gavor ◽  
Martha Gyansa-Lutterodt ◽  
Edith Andrews Annan ◽  
...  
Keyword(s):  
Review Process ◽  
Standard Treatment ◽  
Service Providers ◽  
Treatment Guidelines ◽  
Essential Medicines ◽  
National Standard ◽  
Expert Committee ◽  
Research And Practice ◽  
Essential Medicines List ◽  
Standard Treatment Guidelines

Abstract Understanding how countries review their national standard treatment guidelines (STGs) and essential medicines list (EML) is important in the light of ever-changing trends in public health and evidence supporting the selection and use of medicines in disease management. This study examines the 2017 STGs and EML review process, the actors involved and how the list of medicines and disease conditions evolved between the last two editions. We examined expert committee reports, stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review process occurred in both bureaucratic and public arenas where various actors with varied power and interest engaged in ways to consolidate their influence with the use of evidence from research and practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the Minister of Health assessed the 2010 edition through technical sessions considering the country’s disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare managers scrutinized the assessed guidelines and medicines list in public arenas. In such public arenas, technical discussions moved towards negotiations with emphasis on practicability of the policies. Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG, with the EML including 153 additional medicines and excluding 56 medicines previously found in the 2010 EML. Furthermore, the level of care categorization for Level ‘A’ [i.e. community-based health planning and services (CHPS)] and Level ‘M’ (i.e. midwifery and CHPS with a midwife) evolved to reflect the current primary healthcare and community mobilization activities for healthcare delivery in Ghana. Ghana’s experience in using evidence from research and practice and engaging wide stakeholders can serve as lessons for other low and middle-income countries.

scholarly journals Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Tashni Govender ◽  
Fatima Suleman ◽  
Velisha Ann Perumal-Pillay
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Standard Treatment ◽  
Treatment Guidelines ◽  
Essential Medicines ◽  
Tertiary Institution ◽  
Essential Medicines List ◽  
Primary Health ◽  
Retrospective Audit ◽  
Standard Treatment Guidelines

Abstract Background The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development. Method An observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software. Results 107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use. Conclusion This study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

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