Overview of Ethiopia ARVs and other Medicines Supply Management Issues
Download
1 / 32

Overview of Ethiopia ARVs and other Medicines Supply Management Issues WHO Meeting October 2005 - PowerPoint PPT Presentation


  • 82 Views
  • Uploaded on

Overview of Ethiopia ARVs and other Medicines Supply Management Issues WHO Meeting October 2005. MSH/RPM Plus in Ethiopia. Started operation in September 2003 Funded by USAID/E under PEPFAR Registered by Ministry of Justice as US-PVO in June 2004 Set up a modest office in Addis

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Overview of Ethiopia ARVs and other Medicines Supply Management Issues WHO Meeting October 2005' - tammy


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Overview of Ethiopia ARVs and other Medicines Supply Management Issues

WHO Meeting October 2005


Msh rpm plus in ethiopia
MSH/RPM Plus in Ethiopia Management Issues

  • Started operation in September 2003

  • Funded by USAID/E under PEPFAR

  • Registered by Ministry of Justice as US-PVO in June 2004

  • Set up a modest office in Addis

  • Current staff of 17 (all Ethiopian)


Qualitative and quantitative assessment
Qualitative and Quantitative Assessment Management Issues

  • Human resources – staffing levels & training needs

  • Infrastructure – structural & equipment

  • System/Procedure – components of the pharmaceutical management system

  • Availability


The Pharmaceutical Supply System: ETHIOPIA Management Issues

LEVELS

PUBLIC SECTOR

PARTNERS

PRIVATE SECTOR

EPI/TBL

FP/PMTCT

Other Donors (USAID, JICA, etc)

& Procurement

Agencies

International

WB

GF

Multinational Suppliers

National

Local Manufacturers (12)

HAPCO

PASS/MOH/MOD

Local Importers/Wholesalers Distributors (70)

PHARMID

Parastatal

Regional

Regional Stores (14)

PHARMID Branches (8)

District

Stores

Private

Pharmacies, Druggist Shops, RDVs(2450)

Local

NGOs, CBOs, FBOs, Special Pharmacies

Hospitals, Health Centers

Community

Target Population


Drug import distribution public sector
Drug Import/Distribution: Public Sector Management Issues

Major Players:

  • Pharmacy Administration and Supply Service – PASS/MoH

  • Pharmaceuticals and Medical Supplies Import and Wholesale Share Company - PHARMID

  • Armed Forces and Ethiopian Red Cross

  • NGOs, Donors including the UN

  • Private Commercial Sector – There are 51 importers and wholesale distributors


Public private sector pharmacies
Public & Private Sector Pharmacies Management Issues

(i) Public/NGO Non-profit Pharmacies:

  • Special Pharmacies(USAID/Irish supported pharmacies managed by public health facilities) - 260

  • KENEMA Pharmacies (City Council) - 35

  • Red Cross Pharmacies/Drug Shops/RDVs - 41

  • Hospital/HC Pharmacies (DRF/IPP/OPP)

    (ii) Private for-profit Pharmacies:

  • Pharmacies/Drug Shops/Rural Drug Vendors


Drug Outlets in Ethiopia Management Issues

Private

Public / Quasi-Private (Non-Profit)

SECTOR

City Council

KENEMA

Private

Red Cross

Ownership

Public Health Facilities

Special Pharmacy 260

Out -Patient Pharmacy

In-Patient Pharmacy

Pharmacy 25

Drug Shop/RDV 16

Pharmacy 304

Drug Shop 270

Rural Drug Vendor

Pharmacy 24

Druggist Shop 7

Rural drug Vendor 4

Drug Outlets

PHARMID

Private

Donation

PHARMID

Red Cross

PHARMID

Private

Private

PHARMID

Supply Source

OTC, Rx

ARVs

Hosp Rx, otc

OTC, Rx

Service

OTC, Rx

ARVs

RPM Plus/MSH

2003


Drug supply management cycle approach
Drug Supply Management Cycle Approach Management Issues

Selection & Quantification

M&E

M&E

Management

Support

Use

Procurement

M&E

M&E

Distribution

Policy and Legal Framework


Main areas of investigation for site assessments
Main areas of investigation for site assessments Management Issues

  • Information management

    • What record keeping and reporting procedures are in place to build upon?

    • What transaction forms are used between facilities and suppliers (RHBs, PHARMID etc.)?

    • What methods of communication and information exchange are used?

    • What basic MIS system can be put in place to improve accountability and stock status and patient tracking?


Main areas of investigation for site assessments1
Main areas of investigation for site assessments Management Issues

  • Human resources

    • What is the current status of pharmacy and lab man power in the target facilities?

    • How can the number of pharmaceutical personnel be increased to cope with increasing workload?

    • What other methods are there to tackle the manpower problem?

  • Infrastructure

    • How adequate and appropriate are the infrastructure and storage conditions of pharmaceutical and laboratory facilities in the target sites?

    • What infrastructure improvements can be initiated and at which target facilities (working space, shelving, security, privacy, record keeping, etc)?


Findings staffing training
Findings - Staffing & Training Management Issues

  • Shortage and high attrition rate of professional staff (There are 26 pharmacists -46% in HF, 36 Druggists -75% in HF, 30 Pharm Technicians -83% in HF, 14 Pharmacy Assistants -100% in HF, and 4 clerks)

  • Limited management capacity at regional, district and health facility levels

  • Inadequate training on rational drug use and drug supply management

  • Lack of standard operating procedures, current reference materials or manuals


M e and inventory control
M&E and Inventory Control Management Issues

  • Inventory control systems (bin cards, stock cards etc.) not adequate [only 64% of PMTCT facilities have bin/stock card]

  • Weak monitoring and evaluation system

  • Limited quality assurance of drugs due to shortage of human resources, weak information system, and lack of quality assurance management system.



Additional findings from the assessment of 15 art target sites
Additional Findings from the Assessment of 15 ART Target Sites

  • 80% of the sites receive supplies from PHARMID

  • 80% of sites use stock cards but only 53% of sites regularly update and 47% report stock status

  • Only 60% use bin cards but only 40% update them

  • 33% of the facilities realized that there is loss due to damage, expiry and pilferage but only 1 facility had a system of recording such losses

  • Only 67% reported some kind of supervisory visits

  • 88% of the sites had stock of essential drugs on the day of the visit

  • 67% use past consumption data for quantification


Appropriate tools
Appropriate Tools Sites

  • Patient profile card

  • Daily drug dispensing register

  • Monthly activity reports

  • Periodic supervisory tools and feedback mechanism

  • Expiry date tracking chart

  • Adherence follow-up chart

  • Temperature monitoring chart for commodities

  • Facility supervisory checklists

  • Inventory management stock cards, bin cards, requisition slips, ADR reporting formats etc.

  • Simple locally sustainable computer software where applicable


Sample monitoring indicators
Sample Monitoring Indicators Sites

  • % patients who could correctly describe how the prescribed medication should be used

  • % ART sites that had ARV drug by type was out of stock for more than 5 days during the last quarter

  • % of ARV drugs expired during the last quarter

  • Cost of loss due to expiry of ARV drugs

  • % of defaulters of ART program


Demonstration of computer system in the making
Demonstration of Computer System in the Making…… Sites

PHARMID / PASS LEVEL

Drug supply management

PHARMID BRANCHES/RHB LEVEL

Drug stock management, client care and dispensing

HEALTH FACILITY LEVEL


Collaborative vision for hiv aids patient monitoring system
Collaborative Vision for HIV/AIDS Patient Monitoring System Sites

HMIS

Clinical System

Pharmacy System

Patient Profile

Diagnostic System (Laboratory, Rad. etc.)

Care & Support System

Management System


Supply chain of arv drugs

Information Flow Sites

Supply Chain of ARV Drugs

  • Information for International Community and National Publications

  • Consolidated information for ARV quantification and scaling up

  • Report on the supervisory visits and directives to the branches

  • Information based on periodic surveys of ART centers or Patients

PASS / PHARMID HQ/ DACA / HMIS

PASS/ PHARMID BRANCHES / DACA/ HMIS

  • Consolidated information based on data from the health facilities

  • Report on the supervisory visits and directives to the ART centers

  • Information based on periodic surveys of ART centers or Patients

  • New patient enrollment (by gender and age) in different programs (ART, PEP, PMTCT), revisiting patients, defaulters, change in regimen, drug substitution, and total drug consumption, current stock position, drug requirements, patient satisfaction and quality of care information

ART Service Centers

ART Patients


Arv drug inventory management at the facility level
ARV Drug Inventory Management Sitesat the Facility Level

  • Drug Main Store

    • Stock cards, Bin cards, Temperature recording chart, Expiry date tracking charts

ARV drugs

Requisition slips

Stock and consumption report

  • Drug Dispensing Pharmacy

    • Individual patients cards

    • Drug dispensing register

    • Bin cards

    • Stock status and daily drug consumption report

    • Temperature recording chart for commodities

    • Expiry and adherence tracking charts


Supply chain of arv drugs1

RPM Plus MIS Support Areas Sites

Supply Chain of ARV Drugs

PASS/ PHARMID HQ

  • Strengthen

    • Procurement

    • Storage, inventory and distribution system

    • Simple MS Access based computer system* + training on the use of information + Supervisory tools and procedures

PHARMID BRANCHES/ RHBs

  • Strengthen

    • Storage, inventory and distribution system

    • Simple MS Access based computer system* + training on the use of information+ Supervisory tools and procedures

  • Strengthen

    • Quantification, storage, Inventory ,expiry tracking, adherence tracking and follow-up system

    • ADR monitoring and reporting system

    • Individual patient counseling and drug history recording system (computerized or manual)**

HEALTH FACILITIES

ART Patients


Current challenges
Current Challenges Sites

I. Difficulty in meeting minimum requirements by the new sites:

  • GF money earmarked for site renovation has not been put to use

  • Pharmacies at new sites have no confidential counseling rooms and/or booths

  • Many sites have no lockable cupboards, filing cabinets, shelves


Challenges contd
Challenges (contd …) Sites

II. “Integration” of ETAEP and GF ART drugs and services - the technical details of the integration need to be worked out urgently (eg. Distribution outlets, flow of information)

lll. Need to revise Regimen and Dosage Forms List of ARV drugs permitted for importation – list does not include:

> Tenofovir

> Triple combinations

> Pediatric solid and liquid formulations are limited

> 2nd line regimen is incomplete


Challenges contd1
Challenges (contd …) Sites

  • Unreliability of suppliers due to manufacturing constraints (e.g. Stavudine; new orders for GSK’s AZT-containing drugs now need > 5 months to be processed)

  • Good news: many generic manufacturers are coming on the market (partial shipment within 3 weeks!)

    V. Significant difference in the pattern of ARV prescribing by clinicians (next slide)


Challenges contd2
Challenges (contd …) Sites

VI.Acute Shortage of Pharmacy Staff – one pharmacist serving > 1200 patients at Zewditu

  • The need for training mid-level pharmacy personnel to handle ARVs and fully participate in ART

  • Unavailability of data clerks


There is a need for pharmacy data clerks to record drug movement, track expiry and monitor patient profile.


Computerized ARV Drug Use and Stock Management Tool at Zewditu Hospital – data is being maintained by RPM Plus staff, because the facility could not assign a data clerk. Data clerks are urgently required at all facilities!


Thank You ! Zewditu Hospital – data is being maintained by RPM Plus staff, because the facility could not assign a data clerk. Data clerks are urgently required at all facilities!


ad