Carrying more than 8,000 yuan in his clothes, Lan Zeyu rushed to the next place to deliver medicines; Lan is a medicine-courier for Dayi Traditional Chinese Medicine Co., Ltd. in Chengdu, the capital city of Sichuan Province. Lan's company is responsible for medicine-deliveries to rural hospitals in Dayi County. He carries medicines to 10-odd towns and villages throughout the county, with a 100-kilometer commute every day.

In 2002, Sichuan took the lead in establishing a rural medicine supervision network and service network. Now, both networks have made progress: 90 percent of the towns and villages are covered by the networks. The rural residents in Sichuan can enjoy safe and affordable medicines.

Delivery ensures drug quality

The clinic in Sima Village, Dayi County, is bright and clean. Drugs and equipment are neatly stowed. The raggedness and shabbiness of a rural hospital has become a thing of the past.

The Chengdu rural medicine supervision network included the rural hospital four years ago, making it a destination for rural medicine-delivery, clinic doctor Liang Wei said. The company distributes medicines to the clinic and guarantees the medicine's quality, while the government allocates funds to fit up the clinic. Since the implementation of "two networks", the rural drug-supply channel has been normalized, and covert operation in medicine procurement has been limited.

In the past the rural medicine market in Sichuan Province was quite chaotic. Fake and substandard medicines prevailed in the market, with drugs for people and animals mixed together. Drug prices were kept at an incredibly high level.

In 2002, the Sichuan government implemented a pilot project for direct drug delivery. A company was chosen through public bidding as the "exclusive" enterprise to distribute medicines. The company collects the demands and medicine-purchase plans from various medical bodies, then directly sends safe and cheap drugs to township hospitals and village clinics. The deliverer needs to show the price of every kind of drugs to the hospital and clinic when distributing. The company promises to send the medicine within 48 hours no matter what the distance may be, and within a 24-hour timeframe for emergencies.

The government also encourages township and village retail pharmacies and individual clinics to participate in the network. Based on local conditions, some areas have adopted another method. The "exclusive" enterprise delivers medicines to the township hospitals and these hospitals forward the medicines to village pharmacies and individual clinics without raising prices.

"These two kinds of medicine-delivery systems guarantee that safe and affordable medicines can reach farmers in a timely fashion," said Liu Weide, deputy director of the Sichuan Food and Drug Administration. "Both methods control drug supply channels, ensure drug quality at the grassroots level, and guarantee drug safety for farmers."

"Makeup control" to reduce drug prices

A high drug price in rural areas has hindered rural medical reform. "Drugs have the highest limited price," explained Tang Lingli, a senior officer of the Chengdu Food and Drug Administration. "Some village clinics persist in selling drugs at high prices or reduce the price a little - then quote the highest limited price as an excuse. Yet the highest limited price is set for urban dwellers, it is not suitable for rural situations."

How to reasonably control drug prices has always been crucial for rural medical reform. Since 2004, Chengdu has set "makeup controls" for the drugs distributed to rural areas. The "exclusive" enterprise delivers the medicine to township and village hospitals at a price 6 percent higher than the wholesale price. Then those hospitals can raise drug prices up to 30 percent higher than the price set by the company.

The delivery enterprise submits a price list to local price control agencies to review after calculating medicine-delivery prices and sale prices. Then the enterprise extends the list to all the townships and village hospitals and clinics to follow the price, under the supervision of price control agency, drug coordinator and ordinary citizens. "On the one hand, the drug price goes down; on the other hand, relevant enterprises and medical departments can earn profit. It is an effective supplement to current rural drug price policies," said Tang. "Since the implementation of 'makeup controls', drug prices in Chengdu have already fallen 10 to 20 percent."

Safe drugs for herdsmen and farmers in remote ethnic minority areas

"Considering of the geographic location and cost, many businesses are reluctant to sell drugs to remote ethnic minority areas," stated Liu Weide. Both Ganzi Tibetan Autonomous Prefecture and Aba Tibetan and Qiang Autonomous Prefecture are wide but sparsely populated areas. Herdsmen and farmers live widely dispersed from each other. Few village clinics and retail pharmacies can meet the people's demands here.

At the end of 2006, Sichuan Food and Drug Administration cooperated with Sichuan Kelun Pharmaceutical Co., Ltd., delivering medicine chests containing 120 kinds of non prescribed drugs to rural areas in Ganzi and Aba prefectures. Then the medicines were passed to herdsmen and farmers in remote areas via a "horseback medicine-bag".

"The horseback medicine-bag is convenient for ordinary people," explained Liu. In the past, a small ailment tended to become a serious illness due to drug shortages. Now with the medicine chest of non-prescription drugs and the "horseback medicine-bag", people can buy high-quality drugs at reasonable prices. Couriers are all local residents familiar with the region and routes. They can send medicines to any doorstep regardless of weather conditions. Moreover, drug prices are well under control. Since the adoption of direct medicine-delivery, various costs during drug circulation process have been greatly reduced.

"Crack downs on fake medicine have made great progress," said Liu Jinyue, a market researcher in the Sichuan Food and Drug Administration. Relevant drug supervisory bodies shouldered the responsibility of strictly overseeing drug circulation. "This prevents any overdue drugs or fake drugs from entering the medicine-chest and medicine-bag, and effectively combats illegal activities centered on producing and selling counterfeit drugs."

Last year, rural medicine chests and "horseback medicine-bags" demonstrated positive results. 60 medicine chests went to the Aba Tibetan Autonomous Prefecture, covering more than 60,000 people. Six counties there set up 50 rural medicine chests, providing benefits to 110 administrative villages, 11,200 families and 53,750 herdsmen.

(China Development Gateway by Sun Wan February 29, 2008)