The PLGI was implemented in the Free State Province from September 2015 to May 2016. Thirty-two pharmacists from primary health care (PHC) centers, hospitals, districts, and the provincial health depot successfully completed the program. The results achieved, together with the challenges faced by the pharmacy district teams, were presented at a final presentation workshop held in Bloemfontein in May 2016.
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Pharmaceutical Leadership and Governance Initiative in the Free State Province, November 2015–May 2016
The LDP was offered to health care professionals in the Northern/Tygerberg Sub-Structure (NTSS), Western Cape Province. Twenty-four health care professionals (12 facility managers and 12 pharmacy supervisors) from primary health care facilities across the sub-structure were enrolled in the program in September 2012. The results achieved, together with the challenges faced by the NTSS facility teams, were presented at a final presentation workshop held in Cape Town in November 2014. Seven of the twelve teams (58%) had achieved their desired measurable results by the end of the six-month period.
Consolidating SIAPS’ Five-Year Support to the Ministry of Health and Social Services for Strengthening Pharmacovigilance in Namibia
The goal of SIAPS in Namibia was to improve the quality and safety of pharmaceutical services to achieve sustained HIV epidemic control. Since 2012, SIAPS focused on interventions that increased the availability of quality antiretrovirals (ARVs), other essential medicines, and services to sustain more than 80% ART coverage of patients in need. SIAPS activities also contributed to ensuring patient safety through pharmacovigilance (PV) activities.
Swaziland is one of three remaining countries in the Southern Africa Development Community Region that do not have adequate regulatory and legislative frameworks to control the use, importation, manufacturing, and exportation of medicines. This is in the face of increased incidence of counterfeit medicines in the region; up to 25% of marketed medicines are substandard, and this is up to 64% for antimalarial medicines, according to a study conducted in 2011. Use of counterfeit and substandard medicines increases the burden of disease because of therapeutic failure, exacerbation of disease, and resistance to medicines. Swaziland’s weakness in medicines regulation and limited regulatory enforcement is also exploited by those smuggling prohibited and counterfeit medicines into neighboring countries.
Technical Brief: Strengthening Drug and Therapeutics Committees to Promote Rational Medicine Use in Mozambique
Mozambique is one of the poorest countries in the world, with approximately 70% of the population living below the poverty line. Many women and children are unable to access essential health services and medicine due to inadequate geographic coverage, financing, and available health professionals. Neonatal mortality is 30 deaths per 1,000, and under-five mortality is 90/1,000. Malaria accounts for approximately 26% of hospital deaths. Dual infections of tuberculosis (TB) and HIV and the threat of increasing multidrug-resistant TB complicate the national TB program response. To support priority programs such as HIV prevention and treatment and maternal and child health, Mozambique’s Ministry of Health and SIAPS are establishing Drug and Therapeutics Committees (DTCs) and training committee members to improve medicine management and use, thereby helping to achieve good health outcomes.
This summary provides examples of best practices for improving accountability and transparency in supply chain management that have been implemented in developing countries with technical assistance from the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. These best practices have improved governance in supply chains and helped eliminate opportunities for corruption and undetected mismanagement, thereby helping to reduce the loss of pharmaceutical products.
Systems thinking is now a widely accepted concept in global health. Governments, donors, and other actors in global health recognize that guaranteeing the availability of medicines is a necessary, but insufficient component to improving health outcomes. Rather, medicines availability must be bolstered by other components, such as ensuring that quality medicines are available and prescribed and dispensed appropriately by health care workers; patients must also use medicines properly. In order to achieve improvements in health for their populations and address health inequities, governments and donors must invest in strengthening health systems. A health system depends on its subcomponent, a pharmaceutical system, for the continuous availability of safe, effective, and affordable essential medicines and other health technologies of assured quality to deliver effective health interventions that improve health outcomes. This is in alignment with USAID’s Vision for Health Systems Strengthening (2015-2019). To this end, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program focuses on achieving positive health outcomes by assuring the availability of quality pharmaceutical products and effective pharmaceutical services.
Strengthening Pharmacovigilance Systems in Swaziland to Improve Patient Safety and Treatment Outcomes
SIAPS mobilized stakeholders from the Swaziland National AIDS Program (SNAP) and the National Tuberculosis Control Program (NTCP) to introduce and implement the Sentinel Site-based Active Surveillance System for Antiretroviral and Anti-TB (SSASSA) treatment programs. SIAPS partnered with the Pharmacovigilance Unit of the MOH to create the protocol and tools for the electronic SSASSA system, and developed a patient recruitment system at HIV and TB sites.
To assess the readiness and willingness of retail drug dispensers in the private sector to participate in TB case detection, SIAPS conducted a baseline survey among pharmacies and accredited drug dispensing outlets (ADDOs) in the regions of Morogoro and Dar es Salaam. Drug dispensers in 122 pharmacies and 173 ADDOs were surveyed to assess TB knowledge and practices, and to inform the development of appropriate interventions to address gaps.
Evaluation and Expansion of Community Case Management of Malaria to Support Informed Decision Making
Working in partnership with the leadership at the MOH and the National Malaria Control Program (NMCP), SIAPS helped develop protocols and job aids for CHWs to guide them in the key steps of case management, and supported initial and refresher trainings for over 520 CHWs from the two districts. To ensure that health facilities also had sufficient capacity to provide effective support to the CHWs, SIAPS conducted additional trainings with health facility and district-level staff to create a network of support for the CCM pilot. SIAPS also helped establish a mechanism to collect and use data coming out of the pilot by building the data collection and analysis capacity of CHWs and health facility staff, and by developing a database at the district level to aggregate data from each health center. Additionally, SIAPS ensured the CHWs had the necessary equipment to provide effective CCM, including mobile telephones, bicycles, commodities boxes, gloves, cups, and spoons.