Drugs as an essential element in health care must be available at the time they are needed. Accessibility to essential drugs is a public right, therefore it's the government responsibility to make them available. Kepulauan Seribu previously one of sub-districts in North Jakarta covering hundreds of islands, became formally an administrative district according to Law No. 22/1999 (Undang-undang No. 22 tahun 1999). As a new district it is quite probable that not all things yet well done such as drug management in public health care. Health facilities in existence are Public Health Care (Puskesmas) and their sub-units (Puskesmas Pembantu dan Puskesmas Keliling), whereas hospital building is still in progress. Furthermore, neither pharmacy nor drug store exists yet. In this study the effectiveness and efficiency of drug management in Kepulauan Seribu District was assessed using Guidelines on Supervision and Evaluation of Public Drug and Health Supplies Ditjen Yanfar dan Alkes, as well as Rapid Pharmaceutical Management Assessment, an Indicator Approach by PAHO/WHO 1995 to determine patient access, use of drugs and ability to pay. Results showed: 1) Despite of moderately high monthly drug availability in Kepulauan Seribu District, the percentage of essential drug availability and appropriateness of drugs to diseases pattern were inadequate 69% and 79% respectively, 2) Drug affordability was good concerning distnbution. distance and time for most of the people, as the ability to pay, 3) No expired or damaged drugs were found for 26 items of drug studied, but non-prescribed drugs amounted to 37%, 4) Rational drug use for non-specific diarrhoea, upper respiratory tract infection(non-pneumonia) and myalgia was low (23.36%), 5) Drug management was performed by nurses whom competenty for drug providers. Recommends to describe that Pharmacist Assistant is needed to enhance effectiveness and efficiency of drug management. Besides, monitoring and training on drug management help improve rational drug use.