Project Dates: September 2011 – March 2018
Background
Namibia has a population of more than 2.1 million people.[1] It is among the countries with the highest prevalence of HIV with an estimated 18.2% of the population living with HIV.[2] Namibia has implemented a multifaceted approach to control the HIV epidemic by enhancing the availability of ARVs and other essential medicines. SIAPS built upon systems already in place and worked with the Ministry of Health and Social Services (MOHSS) and partners to maximize efficiency and support established pharmaceutical policies and action plans. SIAPS supported interventions enhancing service delivery, health workforce availability, information systems, financing, leadership, and governance.
Project Highlights
- Improved efficiency in medicine registration, regulation, and quality assurance: SIAPS implemented Pharmadex as a medicine registration system and trained medicine dossier reviewers; supported the streamlining of operations at the Namibia Medicines Regulatory Council (NMRC) and established the Therapeutics Information and Pharmacovigilance Center; and supported review of the Namibia National Medicines Policy.
- Increased capacity for pharmaceutical services management: SIAPS supported the University of Namibia’s School of Pharmacy (UNAM-SoP) and the MOHSS National Health Training Center (NHTC), which has trained 256 pharmacists, pharmacy technicians, and pharmacy assistants. SIAPS also structured and institutionalized support supervision and in-service training of over 700 pharmacy staff, nurses, TB field promoters, and medical officers
- Strengthened capacity of institutions to improve pre-service training of human resources: SIAPS incorporated pharmaceutical management content in two pre-service training curricula for training pharmacists, pharmacy technicians, and pharmacy assistants; five pharmaceutical management modules and training materials are now available on pharmaceutical supply management, pharmaco-economics, pharmacovigilance, rational medicines use (RMU), antimicrobial resistance (AMR), and pharmaceutical regulation. SIAPS procured and installed the Electronic Dispensing Tool (EDT; for dispensing ARVS) at UNAM-SoP and NHTC. They also supported NHTC and UNAM in setting up skills laboratories for trainings on EDT and facility electronic stock cards at the two institutions. SIAPS supported UNAM-SoP in developing a strategic plan for enhanced quality training of pharmacists and developed a quality management system manual, competency framework, and standards for pharmacy staff for reaccreditation of NHTC by the Namibia Qualifications Authority. They also developed and trained Pharmacy Council staff on a framework that streamlines and structures licensure of pharmacy personnel to practice in Namibia
- Enhanced the availability and use of HIV information for decision making: e-TB Manager was rolled out from 2 pilot hospitals to 14 hospitals countrywide. The visibility of pharmaceutical and ART data was improved by implementing a pharmaceutical information dashboard at over 50 health facilities countrywide (pmis.org.na).
- Improved service delivery and patient safety: ART adherence monitoring was institutionalized by using ARV pill-pick up early warning indicator (EWI) data from the EDT. Annual analysis and recommendations to MOHSS on HIV drug resistance EWI were supported. Short message service (SMS) reminders were developed and implemented at 10 ART sites to enhance patient adherence to treatment. RMU to combat AMR was promoted through training and technical support for health workers on therapeutics committee activities. SIAPS developed an AMR advocacy and intervention model and a call to action statement, which guided AMR advocacy and containment interventions. SIAPS also supported pharmacovigilance activities, which enhanced reporting on adverse drug reactions, analysis, and informing health workers and policy makers. Annual monitoring of the quality of pharmaceutical services was supported through structured support supervisory visits to ART sites and standardized scored checklists. Infection prevention and control materials were developed and over 100 health workers were trained.
Results
- Reduced variability of ARV regimens, thereby maintaining appropriate medicine stock levels to avoid stock-outs because of PMIS quarterly feedback reports
- Contributed to a 46% reduction in the average number of days to evaluate and make a decision on a regulatory application
- Reduced the medicine registration dossier backlog from 711 applications to 100 over a one-year period in 2015, reflecting an 86% improvement in process efficiency
- 100% of Namibia’s 35 MOHSS hospitals, high-volume health centers and clinics have qualified pharmacy personnel
- More than 80 public health facilities are using EDT for ARV dispensing and ART patient monitoring and reporting, eliminating the burden of manual data entry and data gaps
- Reduced number of ART patients lost to follow-up (from 21% in 2013 to 4% in 2015) because of regular monitoring and analysis of HIV drug resistance EWIs
- Improved compliance to treatment guidelines through an informative assessment of the use of standard treatment guidelines and reporting on ART regimens in the ART guidelines
- Data from SIAPS supported tools is used in the National Supply planning for HIV and other commodities.
Project Legacy
SIAPS enhanced the capacity of the NMRC for faster registration of medicines, post-marketing surveillance of medicine quality, and ensuring medicine safety in Namibia. UNAM-SoP and the NHTC have better capacity and quality for training pharmacy professionals. Through this project and funding from USAID, the Namibia Pharmaceutical Information System has been transformed into a electronic data-driven system that supports MOHSS, UNAIDS, and other partners in developing key strategic decisions on ART patient and commodity management. The EDT has been cited in UNAIDS reports as a data source for country estimates on HIV/AIDS and is used for planning. The MOHSS National TB Control Program relies on e-TB Manager for reporting and planning for services. Support to pharmacovigilance contributed to the continued safety of patients, especially those on ART.
Resources
- Post-qualification Monitoring and Evaluation of Pharmacist Assistants Trained at the National Health Training Centre in Namibia
- Strengthening Pre-service Pharmacy Training on Rational Medicine Use and Antimicrobial Resistance
- Assessment of the World Health Organization’s HIV Drug Resistance Early Warning Indicators in Main and Decentralized Outreach Antiretroviral Therapy Sites in Namibia
- Pediatric Antiretroviral Treatment Uptake, Treatment Adherence, Regimen Switches, and Retention in Care in Namibia
- Consolidating SIAPS’ Five-Year Support to the Ministry of Health and Social Services for Strengthening Pharmacovigilance in Namibia
- Sentinel site active surveillance of safety of first-line antiretroviral medicines in Namibia
- SMS Reminders Improve Patients’ Pharmacy Appointment-keeping for Antiretroviral Refills in Namibia
- Using the Electronic Dispensing Tool to Retain Patients on Antiretroviral Therapy in Namibia
- Promoting Rational Use of Medicines through Therapeutics Committees in Namibia. Kunene Regional Pharmacist’s experience
- SIAPS partners with the University of Namibia to host the third international medicine utilization research symposium
- Pharmacist Assistants Ease the Shortage of Pharmacy Staff at Public Health Facilities
- Pharmaceutical Information Dashboard at pmis.org.na
- Enhancing the Delivery of Antiretroviral Treatment Using Mobile Dispensing Technology in Namibia’s Kavango and Zambezi
- Hastening ARV Dispensing in Namibia’s Public Health Facilities with the Electronic Dispensing Tool: Mr. George Lukonga’s Experience
- Developing and Implementing a Nationwide Electronic Pharmacy Dispensing System in Low-Resource Settings: The Electronic Dispensing Tool in Namibia’s ART Program; http://apps.who.int/medicinedocs/en/d/Js21927en/
