In the past, the Dominican Republic (DR) experienced difficulties supplying sufficient quantities of tuberculosis (TB) medicines and diagnostic commodities to the nation’s health facilities. Recurrent stock-outs and uncertain medicine quality at many health facilities resulted in sub-standard or incomplete treatment for patients and contributed to negative health outcomes.
An assessment of the situation, conducted under the previous USAID-funded Strengthening Pharmaceuticals Systems (SPS) program, showed that stock-outs of TB and HIV/AIDS commodities occurred as a result of flawed procurement estimates and bottlenecks in national distribution mechanisms.
An additional study of the larger pharmaceutical system revealed multiple procurement mechanisms, high procurement prices, a fragmented distribution system, and poor storage practices. These findings led the Ministry of Health (MOH) to move beyond disease-specific solutions and instead implement a unified national pharmaceutical management system, known as Sistema Único de Gestión de Medicamentos e Insumos (SUGEMI).
Recognized by Ministerial Decree as an efficient and sustainable strategy to improve pharmaceutical management across diseases and health areas, SUGEMI aims to improve public pharmaceutical services in the DR to ensure an uninterrupted supply of essential medicines in all health facilities.
The SPS program began this work by developing and expanding the use of SUGEMI standard operating procedures (SOPs), training key personnel in various aspects of pharmaceutical management, implementing pharmaceutical management information systems, and assessing national procurement needs. Through these activities, SPS laid the foundation for SIAPS to continue institutionalizing SUGEMI and move toward improved pharmaceutical supply management and, ultimately, stronger health systems in the DR.
Since 2012, SIAPS has supported the following activities:
- Developing SOPs for the selection, estimation, distribution, storage, dispensing practices, and supervision of medicines and commodities
- Training MOH staff on SUGEMI SOPs
- Developing a certified course on pharmaceutical management (two sessions of the course conducted to date)
- Conducting national-level estimation and programming exercises for commodity procurement in 2012, 2013, and 2014 using the SUGEMI standardized methodology
- Closing a financial gap of USD 3.8 million for antiretroviral medicines
- Assessing warehousing conditions and transportation capacity
- Integrating HIV/AIDS and TB programs within SUGEMI
- Exploring integration of MOH hospital facilities within SUGEMI
- Evaluating the availability and supply of laboratory reagents
- Implementing a logistic model for the delivery of clinical laboratory samples