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Improving Access to Medicines by Integrating Pharmaceutical Care Services in Public Health through F1+ Botika ng Bayan (BNB)

 

            In 2016, President Rodrigo Duterte highlighted his administration’s commitment to health by ensuring that “no one goes home without buying medicine” and the revival of Botika ng Bayan outlets near government centers was identified as a program strategy in order to make this happen

        

           The President further suggested to utilize PAGCOR funds exclusively for medicines utilization of all Filipinos. While such funds were not officially transferred to DOH, the Department of Health still pushed for the revival of the Botika ng Bayan in recognition of its potential to improve access to medicines and health services—a major contribution towards the achievement of universal healthcare in the Philippines. The DOH, however, is making sure that lessons from previous BNB implementation are taken into consideration to ensure the successful revival of the BNB program.

        

          In this light, 3 sites were launched as F1+ BNB pilot sites in July 2018, namely the RHU of San Mariano in Isabela, the RHU of San Remegio in Cebu, and the Lingap Center in Davao City. One major modification and a critical enabling factor in the implementation framework of the revitalized F1+ BNB is the exclusivity of the operational management of these pharmacy outlets to local government units (LGU) through their RHUs, government centers or hospitals (such as the Lingap Center or Military Hospitals for Botika ng Bayani BNBi). This mainly translates to activation of existing RHUs into becoming a government-operated pharmacy which is then referred to as ‘F1+ Botika ng Bayan’ that dispenses free medicines to Filipino patients. The DOH recognizes the need for stronger partnership with the LGUs to lay a strong foundation for accountability and commitment to demonstrate results for the implementation of the F1+ Botika ng Bayan.

 

          This initiative aims to achieve the following objectives:

1.      To ensure access to safe, effective and quality medicines to patients prioritizing the marginalized, underserved population, vulnerable populations (PWD, elderlies, children, indigenous populations (IP), those living in Geographically Isolated and Depressed Areas (GIDAs) and Urban Poor Areas), active uniformed personnel and their dependents;

2.      To reduce out-of-pocket expenses by providing free essential medicines to health facilities catering specially to underserved population;

3.      To establish partnerships with Local Chief Executives (LCE), Medical Center Chief of Uniformed Personnel, Hospitals and other government agencies in the implementation of the F1+BNB and F1+BNBi program;

         

          RHUs are already providing free medicines to patients through the different DOH programs. However, a typical RHU may experience challenges in ensuring availability of stocks due to multiple factors. For one, there had been no clear coordination mechanism to monitor stock levels at health facilities to allow responsive replenishment process from the DOH central warehouses. This is an issue which was temporarily tackled through stock transfers made by the Public Health Pharmacists based on requests of some program coordinators but are now being systematically addressed through the restructuring of the Supply Chain Management Service to establish coordination mechanisms between program allocation and distribution planning of central warehouses. Data quality issues also hinder the DOH to transition from a push system into a pull system of distribution. This is partly due to the lack of a dedicated person accountable for supply management of medicines at the health facility level. Each program has a coordinator responsible for patient care, program expansion and supply management of their own commodities—tasks which may prove overwhelming when there is a huge number of patients to be served. The lack of a harmonized tool for data collection of inventory levels of health commodities makes it difficult for planning and decision-making at the central level. While it is recognized that many other factors contribute to the supply chain management issues of DOH, the capacitation of RHUs into having BNBs is one of the strategies taken by the DOH to improve the supply management in the health facilities. This capacity building also formalizes the dispensing activities of RHUs, which by law must be licensed by the Food and Drug Administration. All these in combination with a strong partnership between the LGU and the DOH is implemented to ensure sustainable implementation of the BNB program.

           

           In collaboration with the Philippine Pharmacists Association (PPhA), the DOH also conducted the F1+BNB dissemination meeting and presented the output of the efforts during the initial implementation of the Program. The report contained the data, recommendations for improvement and the standards and operational framework of the revitalized BNB.

 

           Undersecretary and Chief of Staff Rolando Enrique Domingo of the DOH opened the meeting which was held on 30 January 2019 at the Bayleaf Hotel, Manila. “Achieving the Universal Health Care would not be possible without the assistance and expertise of the Pharmacists. Access to Medicines is an integral part of the UHC and having the medicines in health facilities are not just enough. These essentials must be used rationally; this is where our Pharmacists are very much needed,” said Usec. Domingo.

            

       Together with Usec. Domingo, the event was also attended by the officials and board of trustees of the PPhA led by its President Dr. Yolanda Robles.

       Dr. Robles said, “The PPhA fully supports the Department of Health in its initiatives to strengthen access to medicines through the FOURmula One Plus Botika ng Bayan program. These highlight the main point of recognizing the importance of Pharmacists as key to integrated management of medicines at the service delivery point.”

       “With the renewal of our commitment, we (the PPhA) would like to be part of the implementation of the UHC and the F1+BNB,” Dr. Robles also added.

       Also present during the event were Usec. Carolina Taiño and the different directors from DOH Central Office. The FDA headed by Deputy Director General Maria Lourdes Santiago and Atty. Katherine Austria-Lock, OIC – Director of Center for Drug Regulation and Research (CDRR) likewise attended the meeting.