Rapid Evaluation, Rapid Solutions: First End Use Verification Survey in Guinea

The baseline EUV survey evaluated malaria drug management and treatment practices in 25 facilities.

Guinea pharmacist holding malaria medicine. Photo by SIAPS Guinea staff.
Guinea pharmacist holding malaria medicine. Photo by SIAPS Guinea staff.

The End Use Verification (EUV) survey is a routine assessment of the supply chain of malaria medicines/products and of the diagnosis and treatment of malaria at the health facility level. EUV surveys are typically conducted more than once per year in countries supported by PMI and they provide a wealth of information regarding a variety of indicators, ranging from training and supervision levels of medical staff to how patients are treated for malaria and how medicines are ordered, received, stored, managed and dispensed.

Guinea was recently added as a PMI country given the burden of disease for malaria as well as its recurrent problems with stock-outs of medicines in public health facilities, shortages of medical staff and infrastructure challenges ranging from inaccessible roads to lack of electricity.  To assess the availability and use of malaria commodities in health facilities, SIAPS Guinea in collaboration with the National Malaria Control Program (Programme National de Lutte contre le Paludisme or PNLP) and a range of partners, conducted the first EUV survey in December 2012. The implementation of the survey was truly a team exercise, involving data collectors/evaluators from the Central Pharmacy of Guinea (PCG), several departments within the Ministry of Health (including PNLP, National Inspectors and Statisticians), Monitoring and Evaluation specialists from USAID partners MCHIP and Faisons Ensemble, and pharmacists or physicians in charge of supervision at the health district and regional level.

EUV was first introduced in November as part of a national workshop, and it was met with significant interest. A national committee then worked on customizing the survey questionnaire to the Guinean context and on establishing the criteria for sampling facilities in PMI regions. This baseline survey evaluated facilities on both drug management and malaria case management practices. A team of 15 data collectors/team supervisors from key partner institutions participated in a two-day orientation, which also included a pre-test at two health facilities in Conakry. The regional health directors, along with the health districts and the selected facilities were notified in advance about the survey visit. Five data collection teams were deployed to the five PMI regions and surveyed a total of 25 facilities (15 health centers, 6 hospitals and 4 PCG warehouses) from December 17-22, 2012.

The teams reunited in Conakry to debrief and discuss their respective experiences.  No major challenges were reported in the implementation of the survey. Feed-back from the in-country team members indicates that they benefitted from participating in a rigorous survey, which will further enhance their data collection and supervisory skills. Following the debrief, findings from the survey were entered into an indicator-based database, developed in January 2013 by SIAPS and PNLP’s Monitoring and Evaluation team, and were captured in a summary report and a full-length report.

A key aspect of the EUV survey was that preliminary observations were shared and discussed on the day of the visit with each facility and with health district authorities, to increase the chances of corrective actions being taken in real time. Detailed results and recommendations that affect the majority of health facilities were formulated and discussed with the regional and prefectural health directors as part of a national meeting that took place in March 2013. The results of the survey will serve to improve the supply chain for malaria products, as well as to strengthen pharmaceutical management and treatment practices. A follow-up EUV survey was initiated in April 2013.