Social Pharmacies in Paraguay: An Efficient Response to a Real Problem

Cecilia Gonzalez, with a medical prescription obtained from her local health service provider, goes to her neighbor’s home where the community’s pharmacy is located. There she is able to buy medicine at a much lower cost than in commercial outlets. As a result of social pharmacies such as this one, low-income population located in municipalities in Itapua and Misiones departments in southern Paraguay now have easy access to low-cost medicines and health supplies.

This has all been made possible through the Social Pharmacy program, a program implemented by local governments with technical assistance by USAID/Paraguay and CIRD, a local non-governmental organization (NGO).

Money for the pharmacies is channeled through a revolving fund managed by the local health councils in each community, in coordination with the municipal and departmental governments and the departmental health council. The managers of the fund are responsible for the selection and procurement systems, distribution, supplies and medicine stocks, and the management of basic medicines.

The prices for medicines are kept low because the revolving fund allows local government to buy medicines in bulk from suppliers. In order to target the program to those most in need, only low income families have access to social pharmacies. The results are impressive. Ms. Gonzales and 26,000 low-income families now have access to medical supplies at affordable prices.

“In Itapua, we started the social pharmacy program with 50 million guaranies (US $7500) provided by the departmental government and 18 basic medicines; now we have more than 100 medicines and more than 300 million guaranies (US $44,000) in the revolving fund,” said Victoria Baez, a voluntary coordinator with the social pharmacy program in the Department of Itapua.

In communities where the social pharmacy program does not exist, the reality is very different. Chronic shortages of medicines, contraceptives, and other medical supplies in hospitals and health centers are very common problems. People are forced to seek treatment from unsafe traditional health providers, buy self-prescribed medication, or simply speculate on the causes and cures of illnesses. Ministry of Health data shows that 4.2 percent of family expenditures are for health care. But for the rural very poor, medicines account for half of their total health care expenditures. The high cost of medicines is an important barrier to poor people’s access to proper health care.

Another important element of this very successful model is that it is based on volunteer labor at all levels. Each social pharmacy is run by a volunteer with some background in health promotion who is trained in the administrative procedures necessary to manage the service. The departmental warehouse is also managed by a volunteer professional who has the legal authority to administer central procurement and distribution of pharmaceuticals.

Volunteer work and community commitment are linked to another key principle: no gifts. People have to pay the basic costs of the medicines and that is what makes the social pharmacies sustainable.

Social pharmacies can be considered a “win-win” for all participants. The activity provides legitimacy for mayors and other politicians because it shows their commitment to a concrete program that responds to an immediate and priority need. The community- organized local health councils show that they can deliver and manage a program that is popular, and ordinary people can make a difference by volunteering their time to improve the quality of life in their community.

Due to the success of this program, the Ministry of Health and donors such as the World Bank are interested in replicating the model in other regions of the country.