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Strengthening Registration and Quality Assurance Systems for Generic ARVs, Related Medicines, and Devices in Namibia

In Namibia, USAID has been providing funding for technical assistance in the areas of pharmaceutical management and systems strengthening since 2003. During this period, the Rational Pharmaceutical Management Plus (RPM Plus) and Strengthening Pharmaceutical Systems (SPS) programs were implemented. RPM Plus supported interventions that largely focused on strengthening systems for the antiretroviral therapy (ART) and prevention of mother-to-child transmission of HIV programs. SPS focused on strengthening systems based on World Health Organization (WHO) building blocks, increasing the number of pharmaceutical personnel available for service delivery, strengthening policy coordination, and improving the regulatory functions of the NMRC. SIAPS focuses on further strengthening of regulatory and management systems in the pharmaceutical sector under the governance and health systems strategic area to support HIV and AIDS and other public health services.

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Establishment of Pre-Service Mid-Level Pharmacy Training in Swaziland: From Assessment to Implementation

To assess the feasibility of launching a pharmacy training program or programs in Swaziland, the assessment considered the establishment of different pharmacy training programs with different training models, taking into consideration market requirements in both the public and private sectors. The feasibility assessment recommended the ideal curriculum to be adopted for Swaziland.

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Technical Brief: Strengthening Namibia’s Pharmacy Sector and Workforce

Namibia faces a dual public health burden of HIV and AIDS and tuberculosis (TB). Critical to the treatment and management of these diseases is an effective workforce that can provide quality pharmaceutical services throughout the country. Pharmacists and pharmacist assistants (PAs) play critical roles in dispensing life-saving medications, monitoring patient health and progress, and educating both patients and other health professionals about proper medication use, storage, and dispensing practices. To meet the high demand for quality pharmaceutical services and to ensure that pharmacy personnel needs are being met, the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program supported the Government of the Republic of Namibia in the long-term planning of pharmaceutical human resources and building the capacity of two local institutions to provide pre-service and in-service pharmaceutical management training.

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Systems-based Approaches to Improving Medication Adherence

With the shift from a disease landscape that focuses on the treatment of acute and short-term illnesses to one that faces an increasing burden of chronic diseases that may require life-long medicine use, the role of medicines in ensuring a healthy population is more important than ever.

However,even when medicines are available, patients may not take them as directed. In other words, they may not adhere to the treatment prescribed to them. This problem is surprisingly widespread. Several studies have estimated that in developed countries, only approximately 50% of patients who suffer from chronic diseases take their medicines as directed.

This document suggests a health systems strengthening (HSS) approach to addressing
medication adherence issues, with a particular emphasis on its application in low- and middle-income settings. Chapter 2 reviews the importance of considering health systems in improving medication adherence and introduces a system-based framework, while Chapters 3–5 discuss approaches, interventions, and activities that span the health system as described at the
macro, meso, and micro levels and provide implementation examples.

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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.

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Strengthening Pharmaceutical Services Through Structured Supportive Supervision in Namibia

An assessment of Namibia’s pharmaceutical system conducted in 2009 identified a number of capacity building challenges to be addressed to improve pharmaceutical services. These challenges included shortages of key staff, unmanageable workloads, and inadequate storage space for medicines. In response, the Ministry of Health and Social Services (MOHSS) identified several key mechanisms to address these challenges and strengthen the pharmaceutical sector including improving the functionality of drugs and therapeutics committees (DTCs), expanding use of the Electronic Dispensing Tool (EDT) to track pharmaceutical products and patients, revising the current method of stock management, and harnessing data for decision making.

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Analyzing Options for Strengthening Pharmaceutical Systems

To promote informed decision making in selecting appropriate interventions to address complex issues faced by health and pharmaceutical systems, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program has prepared this guidance document for technical assistance providers, policymakers, and key stakeholders in pharmaceutical systems to use as they consider system improvements and intervention alternatives. This approach involves active engagement of relevant stakeholders throughout a systematic assessment and comparison of options based on current system considerations, viability of potential interventions in view of their operational characteristics, existing legal and regulatory frameworks, and potential cost implications.

This paper describes an evidence-based approach for the critical and systematic analysis of intervention options in pharmaceutical systems, supported by practical examples and technical annexes that the reader may use to tailor the approach to a variety of technical areas and problems.

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Guidance for Planning the Introduction of New Reproductive, Maternal, Newborn, and Child Health Medicines and Supplies

The purpose of this document is to provide guidance to program managers in ministries of health at national and sub-national levels as well as personnel in other interested organizations on actions to take and factors to consider when expanding access to essential RMNCH commodities. While this document focuses on RMNCH medicines and supplies, it may be used as a guiding document and planning tool for other essential medicines and supplies. This guide addresses several pharmaceutical management issues (pharmaceutical policies, effective medicine management, strengthening regulatory systems, information needs, and product quality and safety practices) that are often overlooked when considering the introduction of new products. The systems strengthening approach described in this document focuses on governance, human resources, information systems, financing, and service delivery, with the provision of medical products cutting across these sub-systems. The goal of this guidance document is to assist managers to systematically plan for the successful introduction of new medicines and supplies by harmonizing and aligning efforts among all stakeholders involved in the process.

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Post-Qualification Monitoring and Evaluation of Pharmacist Assistants Trained at the National Health Training Centre in Namibia

Namibia has a decentralized public health system with 14 administrative regions. It is challenged by a dual burden of HIV and AIDS and tuberculosis (TB) as well as by the persistent shortage of pharmaceutical personnel. Well-trained pharmacist assistants (PA) are central to ensuring that the correct medicines are available in sufficient quantities as well as for counseling patients on the proper use of medicines and monitoring patients’ adherence to antiretroviral therapy (ART) and other treatments. The National Health Training Centre (NHTC) has conducted this first formal workplace assessment of PAs who have graduated from the institution since 2007 in response to support from the US Agency for International Development (USAID) for a series of systematic interventions to strengthen the capacity and quality of PA training. Broadly, the USAID-funded SIAPS program supported the NHTC to conduct a tracer study to inform strategies for improving the PA training program and its reaccreditation by the Namibia Qualifications Authority (NQA). Specifically, the study assessed: the proportion of NHTC PA graduates who are working in a PA role; the PAs’ satisfaction with the training they received at the NHTC; employers’/supervisors’ satisfaction with the PAs’ services; and strengths and weaknesses of the PA training program. Stakeholders’ recommendations for improving the PA training program were also obtained.

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SIAPS Supply Chain Management Training: Report

The United States Agency for International Development (USAID)’s Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, implemented by Management Sciences for Health, and its predecessor programs have provided technical assistance (TA) support to strengthen public health pharmaceutical management systems in countries around the world for about a decade and a half.

A significant proportion of SIAPS TA support to countries is for strengthening health supply chains for HIV and AIDS, tuberculosis (TB), malaria, and maternal, newborn and child health (MNCH) programs. The TA support involves developing and implementing appropriate country or regional strategies and interventions to close gaps and bottlenecks in key supply chain functional areas––quantification, procurement, warehouse (storage) and distribution management, inventory management, logistics management information systems (LMIS), transportation, and waste management. Through this effort, SIAPS has contributed to improvements in supply chain operations, responsiveness, and effectiveness, thus ensuring availability to patients of essential health commodities.

Human resource capacity development is critical to SIAPS mission. SIAPS would like to enhance supply chain staff capability in areas such as framing supply chain strategies, developing, implementing and applying appropriate key performance indicators to monitor effectiveness of tailored TA approaches and interventions for addressing gaps in various supply chain functional areas.

To this end, SIAPS conducted a three-day supply chain management capacity development workshop for its technical staff involved in supply chain efforts.

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