This is the report of the first continuous results monitoring and support system (CRMS) exercise in Bombali District, which was conducted in May 2016. The purpose of the report is to highlight the findings and observations of the CRMS exercise. A total of 104 health facilities (HFs) (one hospital, 18 community health centers (CHCs), 57 community health posts (CHPs), 26 maternal and child health posts (MCHPs), and two clinics) were assessed using a comprehensive checklist based on selected service and system indicators. The CRMS exercise examined different indicators that focused on stock availability; consumption; expiry; number of patients treated; availability and performance of pharmaceutical information tools; storage conditions; staffing; training; and supervision.
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Inventory Control and Good Storage Practices Training for Primary Health Care Nurses and Pharmacy Staff in Khomas, Ohangwena, and Otjozondjupa Regions, Namibia
Although SIAPS introduced a number of automated inventory control tools, such as the Facility Electronic Stock Card (FESC) and Electronic Dispensing Tool (EDT) for district hospitals, since June 2015, at the primary health care (PHC) level, inventory control and storage practice are a major challenge and the major cause of stock-out of medicines for antiretroviral therapy (ART), tuberculosis (TB), and malaria in all regions in Namibia. To ameliorate these challenges, the MOHSS has revised and distributed standard operating procedures (SOPs) for the management of medicines and medical supplies at PHC facilities in the period of 2015–16, and training on these SOPs has been provided to all staff at the PHC level in the Khomas, Ohangwena, and Otjozondjupa regions in the months of May, June, August, and November 2017. A training was needed to improve inventory control and good storage practices, thereby improving access and restraining increases in the pharmaceutical budget by reducing expiries and damaged pharmaceuticals and at the same time building the training capacity of the regional pharmacists. Facilitation of these trainings was supported by the SIAPS technical advisor. The trainings aimed to improve the management of ARVs, TB medicines, and related health commodities. It was necessary to improve inventory control and good storage practices, thereby improving access and further reducing the increasing pharmaceutical budget by reducing cases of expired and damaged pharmaceuticals.
Supply chain constraints plague current neglected tropical disease (NTD) prevention and treatment programs. The rapid expansion of NTD control activities has not been without pharmaceutical and health system challenges. Inadequate NTD drug management in many countries has resulted in excess stocks, leading to waste resulting from drug expiry or stock-outs, leading to treatment interruption. SIAPS has received funding from USAID to support the Senegal MoH in strengthening the systems for NTD pharmaceutical management. The purpose of the technical assistance is to undertake a rapid assessment of the NTD pharmaceutical management system and understand the integration efforts. Technical review and recommendations have been provided by SIAPS personnel based in the SIAPS West Africa Offices and the office in Arlington, Virginia. SIAPS held meetings with the MoH NTD focal points and supply chain managers to ensure efficient delivery of technical support to the NTD programs, cross fertilization, sharing of lessons learned, challenges, and recommendations and to ensure that the implemented interventions are of the highest technical quality that focuses on country objectives.
Medical Refrigerators Improve Storage Condition at the Peripheral Level and Ensure Quality of Tuberculosis Medicines: Lessons Learned and Opportunities
According to the World Health Organization (WHO), poor-quality medicines and inadequate storage conditions are among the contributing factors that result in poor tuberculosis (TB) treatment outcomes and multidrug-resistant tuberculosis. The recommended temperature to retain the quality of TB medicines is below 25°C, but at the peripheral level in Bangladesh, most TB medicines are stored at the Directly Observed Treatment Short-Course (DOTS) centers of the upazila (subdistrict) health complexes (UHCs) or in the implementing nongovernmental partners’ facilities, where the storage facilities consist of wood or steel lockable cabinets. These cabinets cannot ensure the ideal storage temperature and therefore put expensive and sensitive TB medicines at risk of degradation. In 2012, the US Agency for International Development-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, implemented by Management Sciences for Health, conducted a rapid assessment of TB pharmaceutical management in Bangladesh. One recommendation in the assessment report was that options should be considered for lowering the storage temperature at facilities at the upazila level. Both the fifth and sixth Joint Monitoring Missions of the National Tuberculosis Control Program (NTP), conducted in 2010 and 2014, respectively, put forth recommendations to improve storage standards at the upazila level; however, due to a lack of funding, the NTP could not implement these recommendations.
Postpartum hemorrhage (PPH) still remains one of the major causes of maternal mortality, accounting for 35% of all maternal deaths. The World Health Organization (WHO) has recommended oxytocin as the most effective medicine for the prevention and treatment of PPH, particularly for facility-based births. Most countries include oxytocin on their essential medicines lists (EML) as the medicine of choice for prevention and treatment of PPH. In most countries, everal oxytocin products are registered. Despite this positive policy framework for oxytocin use, supply chain barriers that limit access to the medicine still persist in many countries. Inadequate forecasting of requirements, weak information systems, and poor distribution practices, and inability to maintain proper storage conditions—temperatures between 2 and 8 °C—throughout the supply chain are all factors contributing to this lack of availability.
In practice, in countries where the average temperature is above 30 °C and where adequate infrastructure for cold chain management is often lacking, maintaining the required storage conditions for oxytocin is a challenge. As a result, oxytocin is often provided by service delivery points outside of a temperature-controlled cold chain, compromising its effectiveness and shelf life. In most countries, EPI cold chains are highly effective in reaching even the lowest levels of the health system. However, they are managed vertically, separately from other essential commodities. One of the barriers to integrating other products into the EPI cold chain is the perception at the country level that this is not permitted. However, some countries, such as Mali, have already attempted integration in some areas of the country and have experiences that may be useful.
The main objective of this activity was to document how oxytocin is currently distributed in Mali so that the experience may be used as a case study to inform how the integration of oxytocin into the EPI cold chain may be achieved.
Évaluation rapide du Système pharmaceutique public en Guinée, mars 2012
To help the ministry understand the strengths, weaknesses, opportunities, and threats in Swaziland’s public health medical supply chain, staff from LMI’s Health Systems Management directorate studied relevant operating procedures and other documentation; conducted a country visit August 10–26, 2012; and developed a complex, multivariate supply chain simulation exercise, including storage facility and transportation optimization excursions.
In summary, the report’s key recommendations are as follows—
-Adopt and implement an SOP to define physical storage operations and management.
-Adopt new, commodity-agnostic storage practices to improve the efficiency of physical space management and work flows.
-Continue transportation route planning and refinement to optimize transportation efficiency throughout Swaziland.
-Establish and refine a Swaziland medical supply chain BoD to improve efficiency, transparency, and accountability of the medical supply chain at all levels, from the CMS operation to the point of care.
As measured against pharmaceutical supply chains in other developing nations, Swaziland has a well-functioning system. Gaps remain—for example, stock-outs occur with unacceptable frequency—but it is relatively efficient, modern, transparent, and effective. Key managers and stakeholders work in a highly collaborative, problem-solving environment, and that is a vital enabler to Swaziland’s remarkable national response to its most severe health problems. With further continued progress along the lines suggested in this report, the future of managing public health commodities in Swaziland should be on a positive trajectory to continual improvement.
Pharmacies that serve health clinics located in tropical areas need infrastructure that will help lower their inside air temperature.
It is very important that medicines are stored below 30°C, remembering that certain medicines must be stored at temperatures below 25°C. Higher temperatures tend to change medicine quality, which can make them less effective.
This guide provides instruction on simple and inexpensive modifications of pharmacy stores to reduce the inside air temperature by up to 4°C.
Technical Report: Baseline Study of the Status of the Supply of Medicines and Medical Supplies in Specialized Health Care Centers in the Dominican Republic
The Dominican Republic’s National Pharmaceutical Management Unit conducted a study to determine the supply of pharmaceuticals and pharmaceutical products in the specialized health care centers (CEAs). The purpose of this study was to establish supply baseline indicators for managing supplies in order to integrate the CEAs into the country’s Integrated System for Medicines and Supplies Management (SUGEMI).
The SIAPS Program in the DRC supported the Kolwezi health district through the CDMEK to improve storage conditions to ensure better medicine quality. This support has consisted of building the capacities of the warehouse management team through regular coaching on the minimum conditions for storing medicines, based on standards for best practices for storage, as well as a financial management approach with the creation of a budget line item drawn from operating costs of storage services provided by the Integrated Health Project (IHP).
- The Use of Pharmaceutical Information for Decision Making in Namibia's National ART Program: Assessment Report
SIAPS conducted this assessment to determine the extent to which pharmaceutical information generated from the Electronic Dispensing Tool (EDT) and […]
The Directorate of Drugs and Medical Supplies (DDMS) plays a key role in providing technical guidance and setting strategic direction […]
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program Inventory of Key Technical Resources
The main purpose of this inventory is to serve as a reference to help stakeholders working in the pharmaceutical sector […]