SIAPS received two years of funding from the U.S. Agency for International Development (USAID) in September 2015 to provide technical assistance to rebuild and strengthen the post-Ebola pharmaceutical supply chain management system and improve the supply chain and rational medicine use in Sierra Leone. To support these goals, SIAPS provides technical assistance for systems strengthening activities including governance and leadership, supply chain management and information for decision making.
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Inefficient and irrational use of medicines is a well-documented problem in both developed and developing countries. It leads to cost increases and adverse clinical effects for patients. The inappropriate use of medicine can be reduced if health care professionals involved in the different aspects of medicine use promote good practices for medicine management and use. An appropriate forum for the development and implementation of medicine policies is the Drug and Therapeutics Committee (DTC).
In Mozambique, the establishment of hospital DTCs was officially requested by the Ministério da Saúde (MISAU) (Ministry of Health) in the document The Departamento de Farmacia Hospitalar (DFH) (Department of Hospital Pharmacy) in the Direcção Nacional de Assistência Médica (National Directorate of Medical Assistance) of MISAU also took on the establishment of hospital DTCs as a priority intervention to improve the appropriate use of medicines at the hospital level. SIAPS has provided technical assistance to assist hospitals in establishing DTCs to improve medicine use, and in the collection and analysis of medicine use information for decision making as part of its support to counterparts in the pharmaceutical sector.
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.
Using the pharmaceutical systems strengthening approach, SIAPS supported the GPPTC in three critical systems-strengthening areas. First, SIAPS facilitated the development and approval of provincial guidelines to establish pharmaceutical and therapeutics committees (PTCs) at all health facilities in Gauteng Province. The guidelines reinforce the governance mechanisms supporting the PTCs, outlining expected compliance to procurement practices and assessing pharmaceutical expenditures. Second, SIAPS strengthened human resources capacity through the implementation of a workshop on financial management for pharmacists, carried out in tertiary hospitals and at the district level. Third, SIAPS strengthened information systems through the implementation of financial reporting software at the depot level.
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.
The Systems for Improving Access to Pharmaceuticals and Services (SIAPS) Program Mozambique has been working with DFH and partners in the pharmaceutical sector and in priority health programs to assist pharmaceutical services in improving the availability of pharmaceutical products and appropriate use at the service delivery points with the aim of achieving desired health outcomes. SIAPS technically assists hospitals to create DTCs to improve medicine use, as well as the collection and analysis of medicine use information for decision-making as part of its support to its counterparts in the pharmaceutical sector.
In August 2013, SIAPS supported the DFH to conduct a two-day DTC orientation workshop. This orientation covered the DTC’s main functions, roles, and responsibilities, as well as how to monitor and identify medicine use problems, and to implement interventions and strategies, including use of standard treatment guidelines (STGs) and essential medicine list, to improve medicine use. During the workshop, the participants presented the status of their hospital DTC, and reviewed Mozambique’s current official DTC’s terms of reference (TOR) and made recommendations for additions and modifications. In addition, with SIAPS technical guidance, the participants conducted a brief study on prescribing indicators in a clinic in Maputo. The study found that more than 60% of patient encounters received an antibiotic. This orientation was attended by 49 health professionals, including physicians, pharmacists, dentists, laboratory technicians, and hospital administrators from the 11 hospital DTCs, the Ministry of Health (MOH), and nongovernmental organizations that support clinical services and supply chain operation.
In South Africa, the provision of pharmaceutical services is guided by the National
Drug Policy (NDP), which was adopted in 1996. The health goal of the NDP is ―to
ensure the availability and accessibility of essential medicines to all citizens. Within a
resource-constrained environment, irrational medicine use has the potential to
compromise available health care resources, hence posing a serious threat to the
functioning of the health system. The development and use of national essential
medicines lists (EMLs) as well as the establishment of pharmaceutical and
therapeutics committees (PTCs) have been identified as key interventions to
promote rational medicine use (RMU).
The irrational use of medicines is a pervasive problem that threatens healthcare systems and quality of patient care in countries worldwide. The World Health Organization (WHO) estimates that 50% of patients receive unnecessary medicines and half of patients take their medicines incorrectly.
Irrational use behaviors include polypharmacy (the use of too many medicines per patient); the use of incorrect medicine(s) for a particular indication; the use of medicines with uncertain or unproven efficacy; inappropriate self-medication, particularly with prescription-only medicines; and taking medicines in incorrect dosages or for an improper duration.
To counter the problems of irrational use, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program and Ministério da Saúde (MISAU) (Ministry of Health) are working together in Mozambique to improve medicine management and use. SIAPS is seeking to create sustainable Drug and Therapeutics Committees (DTCs) to monitor and identify medicine use problems and to implement interventions to improve medicine use at the local health-facility level. SIAPS will also support the revision of the National Essential Medicines List (NEML) and development of new standard treatment guidelines (STGs) to complement those that are currently available.
This technical report provides information on the DTC workshop conducted on August 4-5, 2014, and on field visits to two hospitals in the Maputo area: Maputo Central Hospital and Matola Provincial Hospital. These field visits were designed to meet with hospital officials and DTCs, as well as to develop specific DTC activities to address medicine use problems.
SIAPS/South Africa works with government health offices and health facilities to build the capacity of Pharmaceutical and Therapeutics Committees (PTCs). PTCs oversee and promote safe and cost effective use of medicines. In three South African provinces, rational medicine use has resulted in significant cost savings.
In the Republic of South Africa’s Gauteng Province, the Provincial Pharmaceutical and Therapeuticals Committee (PTC) developed guidelines to support an integrative PTC network to optimize available resources and the rational use of medicines. These guidelines provide practical tools to hospitals and district PTCs to ensure the quality of therapeutic care with respect to
good governance principles.
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