Implementation of reforms under the National Drug Policy

Overview

In South Africa’s decentralized system, medicines for public sector health facilities were selected by each provincial department of health. Drug procurement was not evidence-based, medicines were overpriced, and stores were filled with non-essential medicines. In 1995, an essential drugs programme was established that was largely successful in its efforts to improve medicine selection and procurement. Selection of medicine is increasingly based on the needs of the population, evidence of effectiveness and product quality. A preference was given to generic drugs supported with local suppliers. The paper discusses the implementation of the national drug policy reforms and analyses how this brought benefits from improvements in the selection, procurement and use of essential medicine both in the public and private sectors. It emphasizes that evidence based essential medicine lists on the basis of comprehensive standard treatment guidelines were an important step for their success. Further, the paper suggests that ensuring the availability and accessibility of essential medicine to all citizens at low cost needs a strong primary health care network, integrated policy actions, supportive environment, ownership, transparency, and monitoring and evaluation mechanisms.

Synthesis report

The South Africa case study is part of a synthesis report that applied a causal framework to synthesize lessons from ten case studies of various health system reforms which aimed to improve the efficiency in health systems.