Download - Grace Adeya, SPS/MSH February 23, 2011
Management of Medicines and Pharmaceutical Supplies for use in the prevention and treatment of Pre-eclampsia and Eclampsia
Grace Adeya, SPS/MSHFebruary 23, 2011
Why Consider Medicine and Pharmaceutical Supplies Management Issues? Effective management of PE/E helps ensure
that medicines and supplies are on hand for immediate administration.
Effective management requires careful product selection, procurement, storage, distribution, and use.
PE/E medicines are in many countries part of the national pharmaceutical supply system Subject to the same structural, financial and
human resource constraints as all products that rely on this supply system
Pharmaceutical Management Cycle
Distribution
Procurement
Selection
ManagementSupport
Use
Policy and Legal Framework
Selection Build consensus on protocol for
PE/E with committee of experts and consult best practices
Use the following selection criteria At what level of health system?
Who will use them? Types of medicines? First-line
medicine? Cost Safety and efficacy Quality and stability (storage
conditions) Availability for procurement Registered for use in country?
Include selected PE/E in national essential medicines list (EML) and standard treatment guidelines (STGs)
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
Selection: Who is making the purchasing decisions at the health facility level?
DRC (N = 30) Mali (N=100)Background of personnel managing medicines at health facility level
7 % pharmacy technicians 80% Nurses
18% - pharmacists3% - pharmacy technicians 4.8% - matron/nurse/midwife22% - no training
Percentage of respondents trained in the management of uterotonic / PE/E medicines 27% 21%
Proportion of Facilities with a copy of the NEML
0% 45%
Percentage of respondents who know MgSO4 is in the NEML
41% 28%
Percentage of respondents who know Oxytocin is in the NEML
90% 65%
Percentage of respondents who know Calcium Gluconate is in the NEML
14% 2%
Percentage of respondents who know Diazepam is in the NEML
37.3% 15%
Procurement
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
Quantity needed Cost Quality: packaging,
cold chain Shelf life Supplier performance Management
information system (MIS) to monitor consumption
Medical Supplies e.g. BP machines
Procurement: Staff knowledge and use of essential data for quantification of requirements
DRC (N = 30)Mali (N=100)
Knowledge of the stock on hand 70% 58%
Knowledge of the quantity dispensed per day 53% 5%
Knowledge of the facility’s consumption for one month 47% 4%
Knowledge of when and how the medicines were used 33% 7%
Ability to use the recorded data for retrospective analysis 10% 10%
The Procurement Cycle
Review Drug Selections Determine Quantities
Reconcile Needs and Funds
Choose Procurement Method
Locate and Select Suppliers
Specify Contract Terms
Monitor Order Status
Receive and Check Drugs
Make Payment
Distribute Drugs
Collect ConsumptionInformation
Selection: Cost and Product versatility issues
Year
Product Name 2007 2008 2009 Average
Diazepam 5 mg/ml (general anticonvulsant/antiepileptic; generalized anxiety; pre-operative)
Average of Supplier (US$) $ 0.06 $ 0.07 $ 0.07 $ 0.07
Average of Buyer (US$) $ 0.08 $ 0.10 $ 0.06 $ 0.08
Magnesium Sulfate 500 mg/ml (PE/E anticonvulsant )
Average of Supplier (US$) $ 0.09 $ 0.10 $ 0.09 $ 0.09
Average of Buyer (US$) $ 0.17 $ 0.17 $ 0.17 $ 0.17
Source: MSH International Drug Price Indicator Guide
Distribution and Inventory Management
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
Effects of heat and light Cold chain equipment and
transportation Cold box or packs Refrigerators Excursion?
Inventory monitoring system Stock cards and registers
Distribution network and transportation Vertical vs. Integrated (How
do PE/E products fit into overall supply system?)
Delivery kit system? Non-facility locations
Distribution: Storage Conditions
Storage ConditionsDRC
(N = 30)Mali
(N=60)
Stock/storage location is secure (locked door, wire mesh on the windows, locked cabinets)
83% 87%
Storage location is visibly free of harmful insects and rodents 83% 83%
Products are arranged well on shelves or pallets 78% 92%
Products are arranged so that identification labels and expiration or manufacture dates are visible
67% 82%
Products are stored and organized according to expiration dates (FEFO) 67% 85%
Boxes and products are in good condition 94% 87%
Boxes and products are protected from water and moisture 94% 80%
Products are protected from direct light and sun at all times 94% 88%
The store has operational refrigerators 28% 43%
The temperature of the cold chain is recorded and monitored regularly 0% 7%
Temperatures of the cold chain are between 2°C and 8°C 0% 3%
Use
Policy: Who is allowed to prescribe MgSO4?
Training in PE/E management: What skills are needed?
Service delivery protocols Indications Dose Contraindications Management of side
effects Skilled birth attendants Client counseling Adverse drug reaction
monitoring
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
USE: Respondents Knowledge of Recommended Treatment
DRC (N = 30) Mali (N=100)Percentage of respondents who know Oxytocin is the recommended medicine for the practice of AMSTL
90% 56%
Percentage of respondents who know MgSO4 is the recommended medicine for the management of PE/E
8% 23%
USE: Product Availability
Medicines AvailableDRC
(n = 18)Mali
(n = 60)
Oxytocin 5 IU/ml ampoule - 46%
Oxytocin 10 IU/ml ampoule 78% 34%
Magnesium sulfate 4 g ampoule 11% 10%
Magnesium sulfate 2 g ampoule - 9%
Calcium gluconate 10 mg ampoule
22% 15%
Diazepam 10mg inj 56% -
Management Support
Standard Operating Procedures
Financing Information management
(MIS) Human resources
Preservice education Continuing education In-service education
Monitoring and supervision
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
Management Support: Advocacy for Maternal Health:
Maternal health issues should always be included among the health priorities.
Are maternal health program personnel at the table when decisions are being made on priorities for procurement
Forum for improved and regular communication between doctors, midwives and pharmacists e.g Drug and Therapeutics Committees
Improved selection, quantification and ordering of uterotonics Clarification of roles and responsibilities of pharmacy,
delivery room and recovery ward personnel
Policy and Legal Framework
Distribution
Procurement
Selection
Management Support
Use
Policy and Legal Framework
EML and STG Registration issues Importation Centralized vs.
decentralized; vertical vs. integrated programs
Financing mechanisms: cost recovery, cost sharing, insurance
Pharmacovigilance PE/E service delivery
protocols Human resources: who is
authorized to prescribe and dispense?
Thank you