Dominican Republic

Project Dates: September 2012 – December 2016

[Click to enlarge]

Background

A 2009 SPS study[1] determined that the primary cause of inefficiencies and stock-outs was the fragmentation of the supply process into multiple vertical systems organized around disease control programs.

 In 2010, a Ministerial Decree established SUGEMI as the institutional mechanism for organizing the pharmaceutical supply system in public health care facilities.

Project Highlights

Since 2012, USAID funding through SIAPS has enabled the reorganization of the pharmaceutical supply system using a systemic approach across all health system functions that contributed to improved access to medicines.

The following activities and processes contributed to the organization of SUGEMI:

– Eighteen manuals and operating procedures for the implementation of SUGEMI in primary care units[3] and hospitals[4]

– Six operating procedures on transport logistics of biological samples[5]

– Training of 6,000 specialists responsible for implementing the SUGEMI operating procedures

– Estimating and procuring medicines and supplies for HIV, tuberculosis, hospitals, and primary care units

– Certificate courses in pharmaceutical management[6] and rational medicine use launched

Results

– The availability of ARVs increased from 76% (2011) to 96% (2016), while availability of medicines for non-communicable diseases increased from 71% (2011) to 92% (2016). [17]

– Despite a limited increase in the allocated budget for the purchase of medicines since 2011 and no reduction in the price of medicines during this period, the quantities of medicines and medical commodities acquired doubled by 2015. A probable explanation for this finding is SUGEMI’s introduction of a standardized methodology for the estimation of procurement needs (figure 1).

Figure 1. Availability of general-use medicines in first-level health facilities in the Dominican Republic (2011–2015) [Click to enlarge]

– Towards the end of 2014, the USAID investment was having a positive financial return: for each dollar that USAID invested, the Dominican government could save or mobilize USD 601.[18]

Figure 2. SIAPS activities in the Dominican Republic [Click to enlarge]

Project Legacy

The transition from a vertical to an integrated supply system produced operational efficiencies in the Dominican Republic. Efficiency at SUGEMI increased the availability of ARVs and essential medicines for first-level use and generated significant savings for the government.