Guinea

Background

Guinea is a coastal West African country with a population of approximately 10.63 million. Malaria is a major public health issue, with 992,146 reported confirmed cases (health facility) in 2016;[1] 92% of infections are caused by Plasmodium falciparum; and, according to national health statistics, the morbidity rate for malaria is 148/1,000. Among children under the age of five, malaria accounts for 31% of consultations, 25% of hospitalizations, and 14% of hospital deaths.[2] Pharmacie Centrale de Guinée (PCG) and the private sector remain the main instruments for the procurement and supply of health commodities. However, the PCG faced many governance and financial challenges and was not able to ensure the uninterrupted availability of pharmaceuticals. A shortage of medicines and insufficient reporting of essential commodity logistics data impacted the country’s ability to develop accurate forecasts of malaria commodity requirements.

The goal of the SIAPS program in Guinea was to ensure the availability of quality pharmaceuticals by strengthening pharmaceutical sector governance, enhancing capacity to improve pharmaceutical services, and making pharmaceutical management information available for evidence-based decision making. While the main focus of activities remained malaria, the scope was broadened to aid in the Ebola outbreak in Guinea and to expand the logistics management information system to other key disease programs.

Program Highlights

Governance in the Pharmaceutical Sector

  • Supported the Ministry of Health (MoH) to undertake a systematic national assessment of the pharmaceutical sector to guide the revision of the country’s pharmaceutical laws and policies, administrative structures, and processes
  • Supported the National Directorate of Pharmaceuticals and Medicines (DNPM) to revise the national pharmaceutical policy, 2012 edition, and develop and implement the Pharmaceutical Master Plan
  • Supported the national committee established by the MoH to draft new pharmaceutical legislation to address challenges faced by the MoH, as the country’s existing medicine-related law had not been revised since it was issued in 1994
  • Assisted the DNPM to review and update the National Essential Medicines List (NEML) in 2013 and 2016. With technical assistance from SIAPS, the therapeutic flow charts were revised to promote rational medicine use. In light of WHO guidelines, SIAPS collaborated with the PCG to update 13 standard operating procedures (SOPs) and supported the PCG’s first competitive tender for procurement of essential medicines and prequalification of products and suppliers.
  • Assisted the DNPM to undertake a comprehensive national supply chain assessment, the results of which provided a strategic view of the country’s public-sector medicine management system and its operational performance and identified facilitating or constraining factors in the pharmaceutical management system
  • Assisted the MoH to facilitate consultative meetings with all supply chain stakeholders to develop governance documents for the Logistic Management Unit (LMU); provided office furniture, equipment and supplies; and supported LMU operating costs from January to September 22, 2017

Pharmaceutical Management Capacity Building

  • Used competency-based training materials (e.g., medicines for all training) to build the capacity of supply chain staff from all cadres
  • Reorganized the National Directorate of Pharmaceuticals and Laboratory’s Medicines Registration Department
  • Restructured quality assurance teams at the PCG and trained them on the new SOPs
  • Assisted the PCG in implementing SAGE L100 i7 Enterprise Resource Planning, which integrates procurement, finance, human resources, warehousing, and client relations functions

Pharmaceutical Information

  • [Click to enlarge]

    Strengthened Guinea’s system for collecting, aggregating, analyzing, validating, and displaying logistics data for evidence-based decision making for health supplies
  • Supported the Programme National de Lutte contre le Paludisme (PNLP), Health Management Information System, and other MoH partners to redesign the reporting system for malaria epidemiological and logistics data
  • Built the capacity of health workers through training, supportive supervision, and mentorship
  • In mid-2014, assisted the PCG to quantify Ebola commodity needs and develop a distribution plans
  • Trained 90 pharmacists and Ebola logisticians on Ebola commodity logistics
  • Drafted a malaria case management plan in the context of the Ebola outbreak

Supply Chain Management

In 2012, there was a prolonged stock-out of artemisinin-based combined therapy (ACT). SIAPS supported the PCG and PNLP to distribute ACT to more than 400 health facilities and provided new reporting tools to improve the availability of malaria logistics data.

  • Contributed to the startup of the new ACCESS project in six districts of Guinea and the systematic introduction of artemether-lumefantrine to replace artesunate-amodiaquine
  • Created a service level agreement with the PCG for the storage and distribution of PMI-funded malaria commodities and a shift from a push to a pull system
  • Provided assistance for infrastructure improvements for both the PCG and health facilities in PMI-supported regions
  • Supported the integration of Ebola-related commodities into the current quality control system at the PCG

Results

  • A supervisor from the National Malaria Control Program explains emergency distribution and the new reporting system to the chiefs of health centers in a district of Conakry. Photo by SIAPS Staff. [Click to enlarge]

    The draft law, with input from national and international legal and health experts, has been technically validated by stakeholders and submitted to the MoH for endorsement.
  • The NEML, which was endorsed by the MoH, has been printed and disseminated.
  • The therapeutic flow charts are being used to upgrade health care workers’ knowledge in priority disease case management.
  • Using the SOPs, the PCG launched its first international tender in October 2014.
  • SIAPS has built the capacity of nearly 1,100 health workers in pharmaceutical management at the health facility level through improved inventory management.
  • The revised quantification results were used to develop supply plans and identify financial resources needed to support the malaria program’s prevention, diagnostic, and treatment objectives through 2022.
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    SIAPS’ interventions in strengthening the Guinea pharmaceutical management information system have contributed to improved inventory management and increased medicine availability. Facility reporting rates in PMI zones improved from an estimated baseline of 30% in 2012 to 99% in the first three months of 2015, and this performance was consistently maintained through July 2017.
  • Health facilities with stock-outs of a preselected group of malaria commodities for three or more days in the last three months[3] decreased from 76% (2013) to 28% (2017).
  • With the implementation of SAGE L100 i7, the efficiency of PCG operations has improved access to high-quality information; improved cash flow; and built tight links among procurement, storage, distribution, and finance.

Project Legacy

Improving the availability of essential medicines has contributed to universal health coverage and reduced malaria-related morbidity and mortality in Guinea. The national supply chain assessment results serve as a baseline for future pharmaceutical system strengthening efforts and have helped to identify practical options to inform decision making about interventions that may ultimately contribute to improved health commodity security in Guinea.

Resources


[1] Malaria disease burden; http://www.who.int/malaria/publications/country-profiles/profile_gin_en.pdf?ua=1
[2] Guinea National Health Statistics
[3] Source: EUV Survey