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

Province1 City

9 Municipalities

1 - 1st Class

2 - 4th Class

6 - 5th Class

1 City

9 Municipalities

2 - 1st Class

1 - 2nd Class

1 - 4th Class

5 - 5th Class

Municipality

Class

2000 2000 2000 2000 2000 RankAmount Amount Amount Amount Amount(000,000

Php)(000,000

Php)(000,000

Php)(000,000

Php)(000,000

Php)

San Pablo City 375.3

118.5

14.94

172.14

211.52 14

Sta. Cruz 1 79.7 5 9.3 2 11.64 3 2.67 1 28.32 5Pagsanjan 4 25.4

91.6

139.09

130.41

924.64 6

Pila 4 28.3 7 2.2 10 8.51 10 0.2 15 8.32 17

Liliw 5 22.1 12 2.3 9 10.46 5 0.1 18 4.45 20

Mabitac 5 15.6 18 0.87 19 5.58 14 0.2 14 22.95 8Magdalena 5 20

141.7

11.58.5

70.3

1217.63 10

Majayjay 5 19.7 15 1.3 17 8.86 12 0.15 17 11.87 13

Pakil 5 16.2 17 1.3 17 7.73 8 0.3 10 23.95 7

Victoria 5 22.7 11 0.4 20 1.75 20 0.3 11 75.58 1Average 62.5 10.9 3.947 11.95 7.706 10.9 0.677 10.9 22.923 10.1

Drug Budget

Rank Rank

Laguna (Intervention)

% Drug to Health Budget

Rank Rank

Total Budget Health Budget % Health to Total Budget

Table 1A. Baseline Budget Data for the Intervention Group

Municipality

Class

2000 2000 2000 2000 2000 RankAmount Amount Amount Amount Amount(000,000

Php)(000,000

Php)(000,000

Php)(000,000

Php)(000,000

Php)

Tanauan City 91.9 4 4.7 4 5.12 16 1.5 3 31.88 3

Bauan 1 108 3 4.2 5 3.91 18 1.5 4 35.55 2Sto.Tomas 1 210.4

24.9 3 2.33

190.5

710.15 15

Lemery 2 45.7 6 3.5 6 7.63 11 1 5 28.65 4

Taal 4 27.6 8 3.2 7 11.7 4 0.5 6 15.51 12

Alitagtag 5 14.3 19.5 1.4 14.5 9.8 6 0.22 13 15.71 11

Laurel 5 17.8 16 1.4 14.5 7.74 9 0.1 19 7.26 19

Talisay 5 23 10 1.3 17 5.63 15 0.1 20 7.74 18

San Luis 5 20.2 13 2.5 8 12.24 1 0.48 8 19.21 9Sn Nicolas 5 14.3

19.51.7 11.5 12.25

20.16

169.15 16

Average 57.32 10.1 2.88 9.05 7.835 10.1 0.606 10.1 18.081 10.9

% Health to Total Budget

Drug Budget

Batangas (Control)

% Drug to Health Budget

Rank Rank Rank Rank

Total Budget Health Budget

Table 1B. Baseline Budget Data for the Control Group

Table 2. Average Baseline Total, Health and Drug Budgets and Ranks per Group

Averages Intervention Control P – value*

Total Budget 62.5 57.3 0.7623

Rank 10.9 10.1

Health Budget 3.95 2.88 0.2720

Rank 11.95 9.05

Health over Total 7.71 7.84 0.8798

Rank 10.9 10.1

Drug Budget 0.68 0.61 0.7043

Rank 10.9 10.1

Drug over Health 22.92 18.08 0.7624

Rank 10.1 10.9Mann – Whitney Test , alpha = 0.05

Table 3. Comparison of health and drug per capita budgets pre- and post-intervention

Averages Intervention Control P-value

Health Budget

2000

2001

% change

67.21

81.4

14.19

64.24

72.23

8.05 0.6501

Drug Budget

2000

2001

% change

12.31

11.30

- 1.02

11.14

14.29

3.15 0.4497

Drug to Health

2000

2001

% change

22.92

14.49

- 8.43

18.08

19.50

1.51 0.1736Mann – Whitney Test , alpha = 0.05

Table 4. Comparison of purchase of essential and non-essential drugs pre- and post-intervention  Intervention Control P-value

Essential

2000

2001

% change

88.58

91.99

4.26

82.52

84.21

2.89

0.5453

Non-Essential

2000

2001

% change

11.42

8.01

- 11.75

17.48

15.80

9.47

0.5453

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.

Good Day !