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APHA Scientific Session and Event Listing

Recorded presentation

Maggie Huff-Rousselle, MA, MBA, PhD, Social Sectors Development Strategies, Inc., 1411 Washington Street, No. 6, Boston, MA 02118, 617 421 9644, mhuffrousselle@ssds.net

Based on a documentation review, over 60 stakeholder interviews, and direct observation, this case study analyses the challenges of establishing a public sector pharmaceutical system in a post-conflict context – Timor-Leste. Following decades of conflict with Indonesia, Timor-Leste became an independent state in 2002. The health infrastructure was in total disarray, with more than a third of health facilities destroyed, and those remaining were severely damaged. New policies and the legal framework for the pharmaceutical sector were developed relatively quickly, largely through international advisors. Although the crisis in human resources was severe (as more than 80 percent of qualified public sector staff had returned to Indonesia), a sophisticated organizational framework was envisioned, centralized in an Autonomous Medical Store. The heavy dependence on expatriates was complicated by language incompatibility between local and international staff, and the lack of integration of nationals into planning and implementation processes was an ongoing limitation. The case study reviews key functions of the supply system, including: product selection and a national formulary as processes dependent on external assistance; procurement hampered by inappropriate World Bank procedures; constructing warehousing without stock-volume information; establishing a distribution system with a network of fledgling facilities emerging; projected financing of the supply system through development of a “business plan” for an AMS under foreign management. In its exploration of the transition from post-conflict situation to health system development, the case study identifies lessons that are broadly applicable to foreign aid and external assistance in any developing country context.

Learning Objectives:

• Describe and discuss how and why sophisticated organizational frameworks and/or financing mechanisms are unlikely to succeed in an unsophisticated or unstable country context.
• Identify ways in which donor agency regulations can undermine the establishment of effective and transparent procurement mechanisms.

Keywords: Developing Countries, Drugs

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation