CAMBODIA EXPERIENCE ON MTP (MONITORING, TRAINING, PLANNING) TO REDUCE INAPPROPRIATE MEDICINE

2. CAMBODIA EXPERIENCE ON MTP (MONITORING, TRAINING, PLANNING) TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPITALS

3. 1-Background -Previous indicator-based supervision and monitoring program in Cambodia did not show significant improvement. -Inappropriate prescribing practices in health facilities -Intervention to improve prescribing is uneasy to conduct, especially in private facilities -Self-initiative, self-conduct, self-assessment, self-decision making -Interventions needs to be incorporated in the existing management system

4. 2- Objective • To learn lessons from experiences in drug use interventions in the past • To discuss the problem of drug use in the health care system • To discuss the efforts in improving drug use carried out so far • To develop the innovative strategy for rational drug use in the health care system.

5. 3-Intervention Method • Select pilot hospitals for MTP implementation • Assign 6 people as MTP team • Training of MTP Team on MTP process • Schedule the meeting to: • define problems on drugs use • develop an innovative strategy to improve drug use • define target • monitor the implementation and evaluate the achievements • National evaluation workshop

6. 3.1-Flow of activities in MTP Indicator Indicator Indicator M M M M M M P P P P P T T T T T InitialWorkshop EvaluationWorkshop

7. 3.2-Self-monitoring vs MTP Periodic evaluation at MOH Self- Monitoring strategy Indicator Indicator Indicator Indicator Indicator Indicator Indicator M T P M T P M T P M T P M T P MTP approach

8. 3.3-Monitoring - To identify the specific drug use problem - To select a priority problem - To determine indicators and data source - To identify the target of intervention When MTP has been running: - To follow up commitments from the previous session - To measure the impact of intervention - To conclude the achievement 3.4-Training - To discuss the problem agreed in the Monitoring in more details - To collect supporting information - To collect related scientific information to set up the norms or standard reference, e.g., reference books, standard treatment guidelines, etc. - To collect information about the intervention efforts considered effective, and to discuss the suitable intervention strategy to choose. - To agree upon an intervention strategy and to discuss the intervention steps. 3.5-Planning - To set a target of achievement - To set measures to achieve target, including the sequence of activity, the program, and the person responsible for execution. - To agree on who is responsible for the execution of the plan. - To facilitate communication and coordination among MTP team members - To agree upon schedule of the next MTP session.

9. 4-Experiences on using MTP - First phase 6 Hospitals - Second phase 7 Hospitals

10. 4-Result 1(Kandal Abs Reduction in Normal Delivery)

11. 4-Result: 2 (Kg Cham Reduce Abs in post Cesarean) % of patients receiving antibiotics Reduction of the average medicine cost per patient from 15.3 to US$ 6.1 (US$ 2000/month)

12. 4-Result: 3(Siem Reap: Reduce Abs in Traumatology)

13. 4-Result: 4 (OM Chhey: IV fluid reduction in normal delivery)

14. 4-Result: 5 (BB: IV fluid reduction in Maternity and Traumatology Ward)

15. 4-Result: 6 (BB: Abs reduction in Malaria)

16. 4-Result 6 (BBAbs Reduction in Malaria)

17. 5-STRONG POINTS • MTP is strongly supported by the DG for Health • WHO supported both, budget & Technical expert to develop MTP in CAMBODIA. • Existing Technical Working Group in each RH acting as DTC for improving the Use of Drug. • Existing network of supervision and monitoring system from central to Province and OD level. • Good cooperation with National Programs. • Sustainable achievement

18. 6-WEAK POINTS • Some hospitals have difficulty to define a real strategy for improving drug use • After the end of financial support and intervention from central level no data will be collected and achievement will not be monitored and reported • Time availability of MTP team member • Transfer of some MTP team members to other facility • Reduction of hospital income for drugs.

19. 7-Summary of result

20. 8-Conclusion(1) • Flexible approach, not time-consuming, not costly • Good for sensitive issues • Interventions seems not too “sophisticated” • Encourage DTC to initiate activities and internal experts to contribute • A comprehensive approach, a combination of adult learning and managerial strategies. • Involved stakeholders in hospital, the “negative” consequences of rational drug use could be discussed accordingly

21. 8-Conclusion(2) • MTP can be implemented in both sector public and private. Its can be solve problem themselves, if there are any supported from PHD. • MTP can be extended in nationwide, if they select the right people to be train them. • MTP reduce health care cost, if they strictly monitor, supervise and providing the training to prescribers. So the community will be participation and support • To reduce the prescribing problems and improving RUD for healthcare workers and patients.