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Standard Operating Procedures for Planning and Implementing a Continuous Results Monitoring and Support System in Sierra Leone at the Primary Health Unit Level

Since May 2016, the Directorate of Drugs and Medical Supplies (DDMS) and SIAPS have supported district health management teams (DHMTs) to implement the continuous results monitoring and support system (CRMS) in their respective health facilities. By the end of 2017, 10 of the 13 districts and more than 1,000 health facilities had conducted three rounds of quarterly CRMS supervisions, reviewed the evidence in stakeholder review workshops, and produced reports. The indicators tracked are generally classified as service indicators (monitoring treatment uptake, consumption, stock status, and rational use) and system indicators (monitoring availability and functioning of information systems and forms, storage and handling, availability of skilled staff, and capacity building). CRMS supervisors use a checklist and various tools and forms to complete their findings and observations; they also provide real-time mentorship and support to address challenges. The findings and observations of CRMS exercises are summarized and presented to key stakeholders and owners of the system in a CRMS review forum where actionable plans are discussed and operationalized by the next quarterly exercise. The purpose of this standard operating procedure (SOP), which was prepared as a job aid, is to provide a frame of reference for implementing a CRMS to conduct comprehensive, participatory, and responsive monitoring using the first exercise as a baseline to track trends in improvement following continuous engagement of target facilities. This approach is in line with supportive supervision and monitoring system but is more proactive and action oriented.

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Report of a ToT and Cascade Training on Leadership Development Program for Pharmacists from the Public Sector of the Ministry of Health and Sanitation of Sierra Leone

The pharmaceutical sector in Sierra Leone faces several challenges. The Ministry of Health and Sanitation (MOHS), in collaboration with different partners, is in the process of strengthening the capacity of district and peripheral health facilities (hospitals and peripheral health units (PHUs)) to ensure an uninterrupted supply of essential medicines, manage supply chain activities through an improved nationwide pharmaceutical management information system, and promote rational medicine use for better health outcomes. USAID support to the MOHS through SIAPS focuses on pharmaceutical management systems strengthening and supply chain management through capacity building and technical assistance to improve governance, management and leadership, selection and quantification, pharmaceutical management information systems, rational medicine use, and CRMS. The purpose of conducting MSH’s LDP training was to build the capacity of Sierra Leone’s DDMS, district/hospital pharmacists, and SIAPS staff in leadership, management, and governance. The goal was to ensure that the directorate, its district/hospital pharmacists, and SIAPS Sierra Leone staff would be equipped with the knowledge and skills to manage and lead the different components of the program efficiently in a transparent and participatory manner. The purpose of the training of trainers (ToT) for the LDP was to establish a pool of local LDP facilitators who could cascade the program to other DDMS staff and district/hospital pharmacists throughout the 13 districts.

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Training Workshop on Quantification with Quantimed and PipeLine Tools in Freetown, Sierra Leone

The purpose, objectives, and activities of this program are designed to reflect the Government of Sierra Leone’s Health Sector Recovery Plan. Specifically, SIAPS will provide support for strengthening the supply chain system, including capacity-building activities that focus on district-and peripheral-unit levels to assist in restarting programs of the Ministry of Health and Sanitation (MOHS); the DDMS (which is responsible for coordinating and providing pharmaceutical services, including promoting rational use of medicines); the National Pharmaceutical Procurement Unit; and the Pharmacy Board of Sierra Leone.

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Restructuring the Directorate for Drugs and Medical Supplies

The Directorate for Drugs and Medical Supplies (DDMS) plays a key role in providing technical guidance and setting strategic direction in policy formulation, service delivery, standards, laws and regulations, and objectives for the pharmaceutical sector in Sierra Leone. It is also involved in stakeholders’ collaborations and coalition building, resource mobilization and deployment of resources, and monitoring and oversight. SIAPS identified DDMS as the MOHS entity well placed to be capacitated to implement and sustain the interventions SIAPS put in place. It is therefore necessary to review and finalize the DDMS structure at all levels to reflect this expanded role, especially with regard to the ongoing decentralization process, the capacity that must be developed, and aligning DDMS’ work plan with SIAPS. As part of its technical assistance to DDMS, SIAPS supported revision of the treatment registers and the report, request, and issue voucher. SIAPS also provided technical assistance in the training of trainers and national cascade training for introducing the newly developed treatment register.

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Storage Improvement of Peripheral Health Units in Four Districts in Sierra Leone

Proper storage conditions and inventory control have a positive effect on medicine quality, data/recording quality, transparency, and the prevention of loss and expiries that lead to wastage. Medicines can lose their potency over time, and the substances that remain as they break down can be harmful. Poor and disorganized storage can lead to deterioration and result in stock-outs, overstocking, and expiries as personnel will not know what medicines are available. The purpose of the improvement is to prevent early degrading of medicines and improve reporting and stock management practices to create visibility and transparency. It will also help in making timely decisions in cases of stock-out or overstocking.

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Continuous Results Monitoring and Support System

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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Organogram for Sierra Leone Directorate of Pharmaceutical services

Leadership and governance of Sierra Leone’s Directorate of Pharmaceutical Services (DPS) is a key pillar of the health care system. The DPS plays a key role in providing technical guidance and setting the strategic direction for policy formulation, service delivery, standards, laws and regulations, and objectives. It is also involved in stakeholder collaboration and coalition building, monitoring and oversight, resource mobilization, and resource deployment. The DPS is expected to provide leadership and manage the efforts of pharmaceutical health care providers, particularly pharmacy personnel, to ensure that strategic goals and objectives are accomplished at all levels. It was therefore necessary to review the DPS structure at all levels, especially with regard to the ongoing decentralization process and capacity needs.

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Training on Treatment Registers and Paper-based LMIS Tools for Sierra Leone Health Personnel

The purpose of revising the treatment registers and conducting ToT and cascade trainings was to improve the quality of the primary data collected at the health facility level; increase the user-friendliness of the registers; and build the capacity of the DDMS, DPPI, programs, district health management teams (DHMTs), and hospital and PHU staff on the effective use of the registers. The SIAPS, DDMS, and DPPI facilitators’ role was to train facilitators at the district and hospital levels, who could then cascade the program to other DHMT, hospital, and PHU staff in their districts.

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SIAPS Sierra Leone End of Project Report

Project dates: September 2015-December 2017

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Strengthening Governance in Pharmaceutical Systems: A Compendium of Country Case Studies

SIAPS and its predecessor programs have assisted numerous countries in strengthening governance to promote robust decision making, enhance accountability, reduce opportunities for corruption, and improve efficiencies to enable better access to and use of quality-assured medicines. This compendium draws on these experiences and provides a collection of examples of strategies and approaches for strengthening governance in pharmaceutical systems. The compendium highlights accumulated insights into factors that may have enabled or constrained the success of governance improvement initiatives. The intention is to systematically bolster knowledge, in alignment with USAID’s collaborating, learning, and adapting approach, so that stakeholders may examine the applicability of lessons learned and apply them in different settings to maximize resources and attain better development results. The compendium begins by defining governance, then explains its importance in pharmaceutical systems and introduces the framework SIAPS has used to guide its governance strengthening activities. It presents eight case studies on SIAPS’ work in enhancing governance in pharmaceutical systems, summarizes challenges commonly encountered and lessons learned, and closes with some reflections on the usefulness of SIAPS’ governance-strengthening framework.

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