Developing Better Terms of Reference to Improve the Performance of Pharmaceutical Sector Committees: Case Studies from South Africa

In South Africa, there are numerous governance structures that make crucial decisions about selection, procurement, distribution, and use of medicines, diagnostics, and other pharmaceutical products. A challenge commonly encountered is that critical committees either do not exist or where the committee is in place, it does not function optimally. One of the most underlying causes of poor functioning of committees is the absence of or weak terms of reference (TOR). In 2015, the Affordable Medicines Directorate (AMD) of South Africa’s National Department of Health (NDOH), requested assistance from SIAPS in strengthening the TOR of several national committees, including those involved in selection of medicines for inclusion on the National Essential Medicines List (NEML). SIAPS developed a TOR guidance document that can be used in the development or review of TOR. The purpose of this brief is to share the guidance document and the processes SIAPS and their counterparts followed to develop new and revise existing TOR for three different pharmaceutical sector committees in South Africa.

Inventory of Key USAID and Global AMR-related System Strengthening Resources/Interventions

This inventory is a selected list of resources and interventions that support antimicrobial resistance (AMR) containment. The objective of this inventory is to provide a list of key resources, tools, and interventions that create or strengthen systems that are necessary to improve antimicrobial use and AMR containment. Along with the full references, links are provided directly to the documents or to sites from where the documents can be downloaded. The intention is to periodically update the inventory as new resources, tools, and evidence-based interventions become available.

Laboratory Information Management and Utilization Training

The training materials in this compilation were developed by technical advisors from SIAPS. The training was conducted in November 2014. This will serve as a guide for trainings in LIMU. Sessions follow the spectrum of information management from data organization, analysis, and interpretation to the utilization of information for information sharing, planning, and decision making. A stakeholder analysis, which is important to prepare and disseminate audience-specific reports, is also included.

Supporting drug and therapeutics committees in Sierra Leone to promote safe, appropriate medicine use

Irrational medicine use and poor pharmaceutical management at all levels are widespread problems in many developing countries, including Sierra Leone. Misuse, underuse, and overuse of medicines; weak systems that compromise medicine safety; the waste of scarce resources due to expiry; and the rise of antimicrobial resistance (AMR) are particularly worrying because they directly affect health outcomes. Because of a lack of sound data for decision making, health workers may need to select products for medicines lists, supply, and prescribing based on observation and preferences. SIAPS is facilitating the selection of appropriate, safe products to be procured and used at different levels of the public health system. Promoting rational medicine use cuts down on waste, improves health outcomes, and helps prevent the spread of AMR.

Human Resource Capacity Development for ART and Pharmaceutical Services in Namibia, October 2014-September 2015

SIAPS Namibia applied the capacity building approach to support the Ministry of Health and Social Services to enhance the capacity of two local training institutions—UNAM-SoP and the NHTC—to train pharmacists and PAs, respectively. With SIAPS technical assistance for defining a career path for PAs, UNAM-SoP started training pharmacy technicians, a new cadre in Namibia. SIAPS also continued its efforts to enhance the capacity of individuals through pre- and in-service training to ensure that health workers have adequate skills to administer quality pharmaceutical services. The capacity building interventions were done through training workshops and on-the-job technical assistance provided during support supervisory visits (SSVs) and remotely.

Analysis of Passive Surveillance Data Collected by the Swaziland Pharmacovigilance Unit, October 2016-March 2017

With support from SIAPS, the Swaziland National Pharmacovigilance Unit (NPVU) has been monitoring the safety of medicines used in the county by collecting and collating reports of adverse drug reactions (ADR) and other medicine-related problems through its spontaneous reporting system established under the country’s Ministry of Health in 2009. In addition, SIAPS has been supporting active surveillance for ARV and TB medicines. ADRs and other medicine-related problems are reported to the NPVU by health care providers using a paper ADR reporting form. Completed forms are sent to the NPVU or collected from health care facilities on a quarterly basis for data entry and analysis. SIAPS supports the collection of the forms and has seconded a data clerk to the NPVU to enter the data from the forms into Microsoft Excel. SIAPS support was further sought to analyze PV data and build the capacity of the PV team to undertake routine analysis of those data. The main objective of the work was to analyze PV data generated from the spontaneous reporting system in Swaziland to inform clinical practice (rational medicine use) and improve patient outcomes.

Pharmacovigilance Monitoring System (PViMS) User Guide

The user guide primarily serves as a reference in reporting an adverse event (AE) through PViMS. It also serves to guide reporters and investigators in completing a correct and accurate AE report. This guide outlines the key data needed, starting from the initial alert to the completion of an AE report in PViMS.

SIAPS Ukraine End of Project Report

Project dates: September 2012 – June 2017

Leadership Development Program Training to Strengthen Pharmaceutical Management in Sierra Leone

In May 2017, SIAPS held a Leadership Development Program (LDP) training to build the capacity of the Directorate of Drugs and Medical Supplies (DDMS), district and hospital pharmacists, and SIAPS field staff. It was the first such training in the country.  The program aims to train pharmacists on basic principles and practices of good leadership, management, and governance to help them identify challenges like system and budget constraints—and to lead their teams in handling them with maximum efficiency, collaboration, and transparency. Another training goal is to help pharmaceutical managers optimize the SIAPS-supported Continuous Results Monitoring and Support System (CRMS), which has been implemented nationwide. The training created a pool of local LDP facilitators who can extend their knowledge to other DDMS staff and to pharmacists throughout all 13 districts in Sierra Leone.

Pediatric Antiretroviral Treatment Uptake, Treatment Adherence, Regimen Switches, and Retention in Care in Namibia

In Namibia, a preliminary review of EDT records suggests that children form a small proportion of the patients accessing ART in any given setting, nationally composing 8% of the patients on ART in the MoHSS facilities. Over the years, managing children has been complicated with formulations that have not been friendly for children, complicated regimens, and occasional stock-outs of pediatric ARVs. These challenges may increase the number of children that might receive suboptimal care, including delayed or no interventions in face of poor adherence, ultimately leading to suboptimal response to treatment. This can then increase the risk of HIV drug resistance and leads to short survival of HIV-infected children. Findings from this assessment will provide much needed evidence on trends in pediatric HIV treatment uptake, levels of adherence, and retention among those on treatment. Ultimately, the evidence generated will support MoHSS policy makers and leaders in modifying and strengthening interventions aimed at enhancing treatment uptake, adherence, retention, and viral load suppression among HIV-infected children in Namibia.