An assessment of the operations of the exemption schemes and the effect on the revolving drug fund (Cash and Carry System): a Study in Cape Coast District, Ghana
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Date
1999-02-14
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Abstract
There has been the expansion of free medical care including drugs to a category of people in the country to include paupers, health personnel excluding their dependants, aged above seventy years and pregnant women attending antenatal care in 1997. These exemptions obtain their drugs from the health institutions by means of the Revolving drug fund (RDF) or cash and carry system, with Government of Ghana providing funds periodically for reimbursement.
It is therefore important that health managers ensure that the exempt get access to free medical care and also the mechanism of reimbursing the drug account of exempt drug bills is timely to make continuous funds available for the revolving drug fund.
The main objective of the study was to assess the operations of the exemption schemes and the effect on the cash and carry system in health institutions in Cape Coast District. A cross-sectional retrospective study of the management of free drugs given to the category of exempt at the health facilities between January and June 1998 was investigated three weeks in the months of August and September 1998.
The method of assessment involved qualitative and quantitative interviews for key informants especially head of units at the health institutions by means of questionnaires and an assessment guide routine data was collected from the outpatients department, maternity, pharmacy and accounts. Only health institutions operating the cash and carry system were assessed and the study was also limited to management of outpatients who were exempt.
Results from the assessment showed difficulty in the identification of outpatient paupers and aged above 70 years for them to gain access to exemption, late allocation of funds for exempt and shortage of drugs for exempt at the health institutions. Moreover, there was delay in reimbursing the drug accounts of exempt drug bills, therefore locking up drug funds. Fortunately this did not affect the stocking of essential drugs at the health facilities. The District Hospital had a huge RDF capital and the locked up drug money was a small fraction. The other health institutions, Ewim Health centre and Adisadel health centres purchased drugs on credit from the Regional Medical Stores between January and June 1998, these institutions however had small revolving drug funds, for continues stocking of essential drugs.
Recommendations were made to the health institutions to enable statutory category of exempt gain access to exemption and also a time frame given for the reimbursement of the drug account concerning exempt drug bills, because the credit from the regional medical stores ceased in September 1998. Consideration should also be given to recapitalization of RDFs of Ewim and Adisadel Health Centres.
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A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of the Degree of Master of Science in Health Services Planning and Management, 1999