By Harriet Kagoya, Senior M&E Advisor and Chipo Chirefu-Toto, Senior Finance and Operations Manager for the SIAPS Program
Mr. George Lukonga is accustomed to dealing with 200 to 300 patients being treated with antiretroviral therapy (ART) on a daily basis. Lukonga is the Senior Pharmacist Assistant at the Katima Mulilo Hospital in the Zambezi region of Namibia, which has the highest HIV prevalence (23.7%) in the country.
Dispensing antiretroviral medicines (ARVs) to the hundreds of patients who visit the ART pharmacy daily was a daunting task before Lukonga and his colleagues were trained to use the electronic dispensing tool (EDT). Prior to the EDT, it took an average of 10 to 15 minutes per patient to dispense ARVs, which resulted in long and frustrating queues for the ART patients.
The dispensing of ARVs has since improved to an average of one to two minutes per patient, according to Lukonga, which was verified by a joint Ministry of Health and Social Services (MoHSS)/Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program team. This remarkable improvement is the result of the use of the EDT by health facilities coupled with technical support from SIAPS.
The project is funded by the President’s Emergency Plan for AIDS Relief and implemented by the United States Agency for International Development (USAID).
SIAPS trained health workers on how to use the EDT and has been providing on-the-job technical support to the trained staff to ensure that they are proficient in the use of the tool. Lukonga is one of the health workers who has benefitted from this intervention. He received EDT training in September and October 2014 with a refresher in June 2015, and continues to be technically supported by SIAPS as needed.
Lukonga has been instrumental in training nurses from outreach facilities in the Zambezi region on the use of the EDT, which enables them to accurately capture ARV and ART patient data. With support from Ms. Grace Adeniyi, the Regional Pharmacist, Lukonga took the innovative approach of conducting EDT refresher trainings during the nurses’ monthly meetings at the hospital.
The Electronic Dispensing Tool
The EDT is a software program that helps pharmacy staff efficiently manage both patients and ARVs. This includes monitoring patients’ adherence to ART, retention rates, dispensing or medication history, the ART regimen and any status changes, appointment keeping, inventory management of ARVs, and monitoring early warning indicators of HIV drug resistance to ARVs. EDT was initiated during the Rational Pharmaceutical Management-Plus project, a predecessor of SIAPS, with funding from USAID.
Fifty hospitals, health centers, and clinics across the 14 regions of Namibia are currently using the EDT. The MoHSS continues to decentralize ART services to primary health care (PHC) facilities through the nurse-initiated and managed ART strategy to bring services closer to patients residing in rural or remote communities.
To ensure that ART dispensing data continues to be promptly availed at both the district and national levels, highly efficient data collection systems are needed at PHC facilities. The USAID-funded SIAPS Program continues to support the MoHSS to roll out mobile EDT (mEDT) data collection terminals at the PHC level. The mEDTs are used to collect dispensing data at outreach and PHC facilities and to automatically merge dispensing transactions with the main site’s EDT database.
Efficient use of the EDT and mEDT reduces the waiting time for patients, eliminates the burden of managing a paper-based system, and improves both stock management by public facilities and data quality for the ARV program.