By David Mabirizi, SIAPS Deputy Director, Country Programs
Q. What does managing pharmaceutical services have in common with flying planes or performing open-heart surgery?
A. All of these are complex operations that need accurate, timely information to make effective, life-saving decisions.
Here’s why: Sound data helps pharmaceutical managers ensure an uninterrupted supply of medicines; quantify and procure products; gather evidence for treatment protocols; and make sure medicines are safe, effective, and administered correctly.
When we began pharmaceutical systems strengthening work with SIAPS—and its predecessor programs—more than a decade ago, we found that a lack of data and thus inadequate use of evidence in decision making was one of the major factors leading to people not being able to get quality medicines when and where they needed them. That’s why improving information management has been a key SIAPS goal. To that end, we have developed a suite of electronic information management tools that are in use in a number of countries around the world. They help ensure that quality pharmaceutical data are captured and made available for critical functions, from formulating pharmaceutical policy and plans to monitoring supply chain systems and pharmaceutical service provision.
SIAPS used the systems approach, targeting cross-cutting interactions among governance, capacity building, financing, supply chain, and pharmaceutical services to make sure that improvements are sustainable over the long term. We got a boost in these efforts from the wider use of mobile technologies and lower costs for tech infrastructure worldwide. SIAPS assessed local information needs, leveraged mobile and Internet technologies, and strengthened the capacity of local organizations to customize, maintain, and take ownership of pharmaceutical management information tools and data. The program also worked with countries to improve data quality, to make sure that information systems capture data on both product and patient-focused parameters, and to disseminate timely data to stakeholders through appropriate reporting channels.
Roll-outs and results
SIAPS-supported systems produce data that allow health service managers to use critical information, including treatment regimens, consumption rates, and stock data, to make critical decisions. Information that was once laboriously collected on paper can now be accessed in real time. Better planning helps prevent stock-outs and facilitates procurement. Benefits for patient services are enormous. Data helps health facilities monitor prescribing and adherence and manage appointments; on a larger scale, data helps with identifying population trends and can be used to inform national health policy.
The Electronic Dispensing Tool (EDT) is used at more than 700 sites in 12 countries, supporting approximately 800,000 ART patients each year to access antiretroviral treatment. In Namibia, for example, SIAPS is supporting easier access to ARVs by providing assistance to the country’s community-based ART program and, in collaboration with partners and stakeholders, has configured the EDT for dispensing ARVs to community groups. The program captures ART patient information, including adherence to treatment. Namibia also piloted EDT short message service (SMS) patient adherence reminders, bringing behavior change to the patient level. Prescribing data are fed into a national database, where they can be quickly retrieved from a dashboard. This is helping the country monitor uptake of the TDF/FTC-based ARV formulation (Truvada) for pre-exposure prophylaxis of HIV by streamlining management and reporting to the national AIDS coordination program.
RxSolution, one of the first tools launched, is an electronic system used for dispensing medicines and monitoring stock of medicines at service delivery sites. It has been rolled out to 613 sites, including locations in South Africa, Lesotho, Namibia, Swaziland, and Uganda.
Medicine registration is more efficient and transparent with the electronic system Pharmadex, which is in used in Ethiopia, Bangladesh, Mozambique, and Namibia.
e-TB Manager is a comprehensive online platform for managing all data collection, information, and reporting needs for TB programs. It is used to manage patients with TB in 10 countries; globally, it helps manage more than 650,000 TB and multidrug-resistant TB cases. In a nine-country user-experience analysis of e-TB Manager, 81% of users said that the tool helps them improve patient management, patient care, and workplace productivity.
QuanTB is another tool used by TB programs for forecasting, quantification, and supply planning and as an early warning system. To date, has had 2,269 unique downloads by users in 136 countries.It has become the official tool of StopTB Global Drug Facility (GDF) for procurement and as an early warning system; all 28 GDF priority client countries are also reportedly using QuanTB. Georgia, Swaziland, and Philippines have implemented PViMS, an online reporting and analytical tool, to monitor the safety of new medicines.
When Mali’s public sector was using a paper-based system for logistics management, it took an average of six months for information to flow from a district to the national level. A new dashboard, OSPSANTE, was rolled out at 1,200 health facilities and eight warehouses in 50 districts. The monthly reporting rate increased from 40% to 98%. OSPSIDA helps West Africa regional health authorities manage HIV and AIDS commodities. Quantimed is used in nine countries to quantify HIV, malaria, and RMNCH commodities and essential medicines.
The evolution of culture change
Successful uptake of a tool requires more than smart software. A system needs to become ingrained into policy and users’ workflow for lasting behavior change. This takes time, and there were a number of common barriers: Initiating any new project can be seen to increase workload, and increased transparency increases scrutiny. There were issues with equipment security and software maintenance. Still, we had seen information programs work in the private sector, so we know this was achievable. A number of factors worked in unison: Tools were tailored to the needs of users/service providers and local context and they were developed in line with current processes and systems and in collaboration with partners and stakeholders. The tools are user friendly, with direct benefits in terms of efficiency in service delivery and, ultimately, improved health outcomes.
The tools need sustained funding and the infrastructure and human resource capacity to make them scalable and sustainable. This requires backing from leadership and policy. In implementing OSPSANTE, SIAPS supported the Directorate of Pharmacy and Medicines and the regional Directorate of Health in organizing coordination meetings to foster collaboration and accountability. The directorate sends a monthly bulletin of key OSPSANTE findings and recommendations to promote a culture of data use.
Training is another essential element in rolling out a tool. For example, in Bangladesh, SIAPS developed a Service Delivery Point Dashboard Module for the Directorate General of Family Planning’s (DGFP) logistics management information system. The project team’s action plan included training a master pool of trainers to train others and troubleshoot issues and providing specialized training for DGFP IT technical staff on overall system build and its data flow, process flow, data validation, access log, and user management. SIAPS rolled out the tool to all 488 upazila. The stock-out rate fell to 1% in December 2017, from a high of up to 4% in 2014, which helped prevent unintended pregnancies and maternal deaths. Bangladesh became the first country to commit to the Reproductive Health Supplies Coalition’s Take Stock campaign to reduce stock-out rates.
The SIAPS impact includes being a pioneer in promoting electronic data-based decision making in many countries, but no tool is a static product. Tools are always evolving to reflect changing environments and technology. Tool source codes for SIAPS’ pharmaceutical management software tools are available in an open source repository in GitHub. We’ve been transitioning ownership to governments and stakeholders in countries by providing direct and virtual technical assistance, training super users, and bolstering the skills of program managers to successfully own, evolve, and manage their tools. Management Sciences for Health will continue to invest and innovate in information management and data analysis to help make sure that, as in so many fields, evidence in pharmaceutical management helps save lives.
