In 2014, the catastrophic Ebola epidemic aggravated Sierra Leone’s already weak pharmaceutical supply system. The country’s public-sector systems for the storage, distribution, and waste disposal of medicines were in dire need of improvement. A “push system” of medicine delivery resulted in frequent stock-outs or overstocks. In September 2015, SIAPS received two years of funding to provide technical assistance to rebuild and strengthen the pharmaceutical supply chain management system and promote rational medicine use in all 13 districts of Sierra Leone in the post-Ebola period. Key stakeholders included the country’s Directorate of Drugs and Medical Supplies (DDMS), which is responsible for coordinating and providing pharmaceutical services; the newly restructured National Pharmaceutical Procurement Unit responsible for procurement, warehousing, and distribution of pharmaceuticals and medical supplies for the public health sector; and the Pharmacy Board of Sierra Leone, which is the pharmaceutical regulatory agency.
Governance and leadership: SIAPS and the DDMS created the DDMS organogram and terms of reference for different units and developed the leadership capacity of directorate personnel. SIAPS supported the development of the Antimicrobial Resistance National Strategic Plan and the launch of Drug and Therapeutics Committees (DTCs).
Supply chain management: SIAPS helped the country institute a continuous results monitoring and support system (CRMS) using a series of indicators to track, monitor, and improve factors that influence medicine availability, pharmaceutical management, and rational medicine use.
Disposal of expired products: SIAPS, as a member of the Free Health Care Initiative Forum of the Ministry of Health and Sanitation (MOHS), and partners joined those involved in supply chain management in Sierra Leone—DDMS, UNICEF, DFID, Clinton Health Access Initiative (CHAI), Crown Agents and IPA (CAIPA), and Sierra Leone’s National Pharmaceutical Procurement Unit/Central Medical Store—to collaborate on a plan to handle products for reverse logistics and proper disposal.
Use of information for decision making: SIAPS conducted training in its electronic data management tools (Quantimed, Pipeline, and QuanTB) and supported the National AIDS Secretariat in establishing the Sierra Leone Pharmaceutical Dashboard, a web-based early warning system. A revised treatment/pharmacy register was introduced to capture patient uptake, priority diseases treated, actual drug consumption, and stock status data of tracer and key pharmaceuticals to be used at health facilities (24 hospitals and approximately 1,200 peripheral health units (PHUs)).
ResultsDTCs were launched in four hospitals, and 24 pharmacists from around the country were provided with leadership and management training. As a result, 17 pharmacists are trainers of trainers or facilitators to cascade the leadership development program (LDP) to all districts. In addition, 35 pharmacists from the public sector were trained by the facilitators on the basic principles and practices of the LDP. By July 2017, all 13 districts had completed two cycles of CRMS and 10 had completed three cycles. All districts that have completed the CRMS cycles have uploaded the results of their reviews to the dashboard. SIAPS provided shelves, pallets, and storage cabinets to address storage problems identified during the CRMS exercise. To date, 50 health facilities have been assessed for storage adequacy. As part of the waste disposal initiative, expired products were segregated and packed at PHUs; returned to the districts; and transported to a central area in Freetown, where DFID funded CAIPA and its predecessor, Aecom, to oversee disposal using five mini-incinerators. All health facilities using CRMS (nearly 1,000 nationwide) participated in the pharmaceutical waste management initiative. Facility managers use a claim and return form for documenting the product name, quantity, batch number, expiration date, and price.
A new treatment register is in use in more than 1,500 PHUs in all districts. A web-based dashboard (http://slpharmadb.org/) was introduced, and data from each health facility and supply structure serve as an early warning system to avert potential stock-outs, avoid emergency procurements, and ensure an uninterrupted supply of all key products. The quantification committee, with technical assistance, conducted a multiyear forecasting and supply exercise for essential medicines and consumables and the quantification of TB and HIV products.
SIAPS has assisted the DDMS to strengthen the supply chain system in Sierra Leone. As a result:
- The web-based tool will improve forecasting, enable timely procurement, decrease wastage, and minimize the risk of stock-outs.
- Through the CRMS, the country will improve overall pharmaceutical management and rational medicine use and promote drug safety and security. The DDMS will take ownership to provide continue technical assistance to ensure sustainability and good leadership in the management of pharmaceuticals in Sierra Leone.