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Researches Health System

 Trần Thị Mai Oanh, Nguyễn Khánh Phương,  Nguyễn Thị Thủy, Hoàng Thị Phượng, Vương Lan Mai et al.

Place of publication: Health Strategy and Policy Institute 
Year of publication: 2011
The National drug policy in Vietnam enacted with the Government Resolution 37/CP, dated June 20, 1996, acts as the yardstick for development planning in the pharmaceutical industry.  The  national drug policy demonstrates strong support and commitment of the government in meeting the public need for medication, and also offers comprehensive and long-term strategies to achieve identified objectives , including regular and adequate supply of quality drugs to users; safe, rational and effective use of drugs, among others. After 15 years implementing  the national drug policy, the need for a full-scale evaluation of how the policy works out to inform subsequent updates of the national drug policy in the next phases, meeting the practical needs in the industry, adapted to the current context, emerges.  
(1) review the organization and implementing process of the National drug policy for 1996-2010; (2) review the results of the national drug policy for 1996-2010 by its key elements ; (3) assess the impact of the national drug policy, 1996-2010, on such objectives  as ensuring access to drug, quality of drugs and  safe and rational use of drug. 
Methodology: A cross-sectional design was used, combing with site survey and desk study. Surveying activities took place in the 6 provinces of Hanoi, Lao Cai, Binh Dinh, Gia Lai, Ho Chi Minh City and Dong Thap. The facility survey using structured forms took place across 32 health facilities from central to commune levels and 30 private drug retailers. Exit interviews were  conducted with 576 after-care patients at the observed health facilities and 520 drug buyers at private drug retailers. Additionally, 423 child acute diarrhea medical records and 442 child pneumonia medical records were collected from various hospitals for analysis of drug consumption. A qualitative study consisting of focus groups and in-depth interviews with representatives of various pharmacy regulators, academic institutions, drug testing facilities and hospital pharmacies. The study applied World Health Organization’s indicators used to assess National Drug Policy implementation and adapted measurement methods of these indicators. 

Key findings
1) The national drug policy in Vietnam plays a vital role in setting policy directions for the entire pharmaceutical sector. Nearly all prominent achievements of the pharmaceutical sector in the last 15 years are associated with the national drug policy in all areas, from public administration, production and supply to quality assurance and safe/rational use of drugs.
2) The early national drug policy focused mainly in 10 pilot provinces, with support from the Vietnam-Sweden Health Cooperation Program. In most of the remaining provinces, the action plan for the national drug policy is also integrated into the annual work plan of the local pharmacy sector. Implementation of the national drug policy, however, faces numerous challenges, given the lack of specific fund allocation and adequate monitoring and evaluation. 
3) In terms of guaranteeing access (adequate and regular supply), the study indicates that The average availability percentage of medicines across surveyed facilities was 55-56%.  This figure is lower as moving to lower level of health facilities. There was significant variation of availability between localities with higher percentage in large cities comparing with rural provinces.. Availability of locally made generic drugs remains low in all the surveyed areas, especially in the public sector. Supply of medication to health insured patients is well catered to in public health facilities, with 95% of the medicines prescribed. 
4) In respect of affordability, evidence shows that drug retail prices in Vietnam are about 12.1 times higher than the international reference price for innovator brand drugs, and 1.4 times higher for the lowest cost generic drugs. The gap between innovator brand product and the lowest generic ones in Vietnam was much higher than world and region references. For the same product, the retail price for patients at public health facilities was lowest comparing with private drug outlets and hospital pharmacies. In general, Vietnamese people can afford to pay for generic medicines while costs of innovator brand products were beyond their ability to pay.
5) As regards with quality aspect, expired medicines were not found in any investigated facilities. However, only 20% of facilities satisfied all criteria for storage condition. In average, investigated facilities satisfied 70% of criteria for storage condition.
6) Concerning with safe and rational use of medicines, the study found progress in a number of following indicators. The average number of drugs used in an inpatient course tends to decline compared to 1996 and 2004, and self-prescription of antibiotics drops from 42.4% in 2004 to 30% in 2010. This, however, is contrary to a few other worrying developments, including 50% of outpatient prescriptions relying on antibiotics; indications of antibiotics in the districts and communes being as high as 60%; more than 50% of the prescriptions made containing vitamins; indications of essential and generic drugs being quite low, at 40.8% and 28% respectively, compared to the international reference level of over 80%. Prescription drugs sold over the counter account for 40%. About 40% of child acute diarrhea cases do not follow standard prescribing regimens of WHO and Vietnam. In case of child pneumonia, there are virtually no cases prescribed with first-line antibiotics as recommended by the World Health Organization. Use of domestic drugs is recorded at 67.1%, but varies strikingly between different levels of care. This rate at CHCs is 91.6%, whereas it is only 25.7% at the national level. Combination antibiotics use is 48.6%. Antibiotics interaction rate is 28.3%.

1) An updated national drug policy for the new period of development should be introduced, geared to actual circumstances, to address existing and potential gaps in the field of pharmacy.
2) The national drug policy should be rolled out in line with a plan of action developed once the policy is in place, to guarantee sufficient resources and with appropriate monitoring and evaluation strategies applied to the targets of the national drug policy.
3) The generic drug policy needs to be developed in a holistic and consistent manner, from production, supply, quality control to consumption, to make sure that end-users gain access to quality medication at reasonable prices, and not bear the burden of drug costs.
4) A national strategy for use of antibiotics is needed, with the first step being budgetary planning for the implementation of the newly launched national program for antibiotics use and monitoring.
5) More communication on rational and safe use of drugs for patients, customers and communities is required.
6) Data collection on drug use in the community should be conducted, through household surveys on a national scale.

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