Our Experience:
Drug Revolving Funds

Optimizing the effectiveness and sustainability of DRF schemes in Nigeria

2009-2019

Situation

Drug Revolving Funds (DRF) are a scheme where drugs and medical consumables are sold at cost-price, plus a mark-up, and the revenue is used to replenish stocks, while ensuring that the drugs remain affordable to those who need them. The DRF system, when implemented at maximum capacity, has the potential to promote access and ensure the availability, affordability, and sustainability of quality drugs and medical consumables.

However, DRF schemes in select states in Nigeria were facing challenges, including lack of drug availability and accessibility, high level of either sub-standard, adulterated or fake drugs in circulation across the country, as well as limited accountability, transparency and capacity within the DRF management system – which severely limited the sustainability of the system.

Solution

Akesis, as part of the consortia that implemented the following projects:

As part of two DfID-funded projects, the Partnership for Transforming Health Systems Phase 2 (PATHS 2) (2009 to 2014) and Maternal, Neonatal and Child Health Phase 2 (MNCH 2) (2014 to 2019), Akesis was responsible for strengthening the DRF schemes in select states in Nigeria.

To accomplish this, Akesis helped the states set up Drug Management Agencies backed up by a legal framework. We also worked to establish and strengthen public service and community-based accountability structures, build capacity of those operating the DRF scheme, and strengthen operational systems, such as procurement, warehousing, distribution, record keeping and reporting, among others. 

Results

> Set up Kano State Drugs and Medical Consumables Supply Agency, including four zonal stores strategically located to better reach all 700+ health facilities running the DRF scheme in the state

> Increased procurements from NGN 22,650,000.27 to NGN 945,389,333.96 per annum. In addition, the procurement pattern shifted from an emergency procurement system to a contract agreement procurement system, helping to improve the affordability and consistency of DRF item prices.  

> Achieved balance between procurement and sales, supporting program sustainability.

> Minimized rate of DRF drug expiry as a result of continuous capacity building efforts.

> Decreased percentage expiry in relation to procurement from 11.35% between 2008-2009 to 0.08% between 2014-2015.

> Increased availability of tracer drugs in health facilities (from 25% of drugs available in 2007 to 93% available in 2014).