The Policy Environment: The National Drug Policy 1996
One of the earliest post-apartheid health policy instruments issued by the first democratic government in South Africa was the National Drug Policy, issued in 1996 [2] and then appended to the White Paper on the Transformation of the Health System in South Africa in 1997 [3]. Implementation of the national medicines policy was assisted by the creation of an externally funded South African Drug Action Programme (SADAP), within the National Department of Health [26].
The objectives of the NDP 1996 were expressed in three broad groups. The policy set the following health objectives: to ensure the availability and accessibility of essential drugs to all citizens; to ensure the safety, efficacy and quality of drugs and to ensure good dispensing and prescribing practices. To promote the rational use of drugs by prescribers, dispensers and patients through provision of the necessary training, education and information and to promote the concept of individual responsibility for health, preventive care and informed decision making were some other objectives. The economic objectives were to lower the cost of drugs in both the private and public sectors; to promote the cost-effective and rational use of drugs and to establish a complementary partnership between Government bodies and private providers in the pharmaceutical sector. In addition, a number of national development objectives were also set. These were to improve the knowledge, efficiency and management skills of pharmaceutical personnel; to re-orientate medical, paramedical and pharmaceutical education towards the principles underlying the National Drug Policy and also to support the development of the local pharmaceutical industry and the local production of essential drugs. Another national development objective was to promote the acquisition, documentation and sharing of knowledge and experience through the establishment of advisory groups in rational drug use, pharmacoeconomics and other areas of the pharmaceutical sector.
Although the NDP 1996 has been instrumental in guiding a number of important reforms in the pharmaceutical sector, the policy document has not been revised since 1996. Areas in which the policy was somewhat vague, such as in relation to medicine pricing, have evolved considerably but without a clear policy prescription. Other areas, such as the measures to stimulate local production, have never been well developed or implemented as part of health policy. The pro-generic stance and the commitment to an essential medicines approach have been more successfully implemented, although monitoring and evaluation of their impact has been weak. In particular, the extent to which rational medicines use interventions have been successful has received less attention than might have been desired.
