the value chain newsletter ii
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A newsletter published by the USAID funded and MSH led Securing Ugandans' Right to Essential Medicines (SURE) Program and the Uganda Ministry of Health Pharmacy DivisionTRANSCRIPT
THE VALUE CHAIN Pharmacy Division-SURE Newsletter |
Issue 2, March 2012
Welcome to the second issue of the Value Chain Newsletter. In this issue, we feature stand-alone stories
from the field highlighting our achievements and successes. This publication will update you on our
collaborative activities toward improving access to essential medicines and health supplies.
MOH and SURE trained Medicines Management supervisor explains the correct method
of dispensing to a health worker in Luwero district. Photo credit: SURE
Program
The USAID funded and Management Sciences for Health led Securing Ugan-
dans’ Right to Essential Medicines (SURE) Program is working with the Uganda
Ministry of Health (MOH) Pharmacy Division and partners to strengthen
pharmaceutical management systems. Since our last issue, the SURE program
has moved into all 45 of its designated districts and has registered ever-
increasing improvement in indicators measuring dispensing, ordering and
reporting, storage, and stock management at public health facilities and private
not-for-profit facilities. The Pharmacy Division in collaboration with other
implementing partners such as STAR E, STAR EC and STRIDES and in
collaboration with SURE has started the roll out of supervision and performance
assessment by trained medicines management supervisors (MMS) into 42 more
districts as part of achieving national coverage. As this issue describes, the
presence of MMS at facility level has transformed medicines management and
led to better availability of essential medicines. Please find out more about our
achievements in the pages to follow and feel free to share a copy of this
newsletter with colleagues. We will keep you updated on our progress!
Distribution of the 45 interven-
tion districts (shaded areas )
IN THIS ISSUE
Field stories…………..........2, 3
Support to JMS………............4
SURE-MUK collaboration.......5
New information sharing sys-
tem…………………….……...5
Breaking cultural barriers……6
The UMTAC ………….. …....7
Stock status reports…………..7
Planned/ongoing activities…...8
Upcoming publications and re-
ports..........................................8
Partners…….………....….…..8
THE VALUE CHAIN NEWSLETTER 2
Stories from the Field
has used the supervision, performance assessment, and
recognition (SPARS) approach in 45 districts in Uganda.
This approach involves mentoring and coaching pharmacy
and stores’ staff at private not-for-profit and public health
facilities in medicines management.
In the last six months, Lebu Akim, a Store’s Assistant at
Koboko Health Centre IV underwent two sessions of
mentoring and coaching by the medicines management
supervisor trained by the SURE program.
“Our system for stock management has improved. We up-
date our stock cards regularly and carry out a physical
count every month, which we never used to do in the past.
Our orders are based on consumption, and we keep
enough stock to last up to the next delivery,” says Lebu.
SURE assessed the facility’s performance after the third
supervisory visit in January 2012. The assessment was
based on five medicines management indicators that
included storage quality and use of stock cards,
appropriate availability of vital and non-vital medicines;
and dispensing quality. The results showed the health
facility’s overall increase in performance in stock manage-
ment from 30% to 63%. Storage management improved
from 54% to 76% and ordering and reporting from 56% to
76%.
Above is the appearance of part of the store with piles of medi-
cines and supplies at Koboko HC IV before intervention.
Photo by Jimmy Ondoma
Lebu Akim, the Stores’ Assistant at Koboko Health Centre IV
store after the intervention. Photo by: Jimmy Ondoma
In Uganda, districts and health sub-districts play a key
role in delivering and managing health services. Although
72% of households live within five kilometers of a health
facility, poor infrastructure and lack of medicines and
health supplies continue to hinder access to quality
services. According to the Annual Health Sector Perform-
ance Report 2009/10, only 21% of facilities had six vital
medicines (artemisinin-based combination therapy,
cotrimoxazole, depo provera, measles vaccine, oral
rehydration solution, and sulfadoxine/pyrimethamine)
available at all times.
Mentoring and Coaching at
Koboko Health Center IV By Jimmy Ondoma and Denis Okidi
Over the years, Koboko HC IV, located in the West Nile
region of Uganda, has experienced challenges in the
management of essential medicines and health supplies
(EMHS). Stock-outs of vital medicines were widespread,
while huge quantities of slow-moving medicines were at
risk of expiring. These problems were attributed to health
workers’ poor skills in logistics management. In addition,
there was no reliable information to guide staff on when
and what to order, because stock cards were not regularly
updated.
In July 2011, Pharmacy Division and SURE program
started capacity-building activities aimed at strengthening
EMHS systems at health facilities in the region. SURE
THE VALUE CHAIN NEWSLETTER 3
A patient receives medicine from Sarah Namakula, a dispenser
and nursing officer in-charge at Kojja Health Center IV. Photo
by: Samuel Omalla
Stories from the Field
Kojja Health Center IV Registers
Increase in Medicine Stocks By Samuel Omalla and Victoria Nakiganda
Kojja Health Center (HC) IV in Mukono district (central
region) is one of the facilities that had previously per-
formed poorly, with frequent stock-outs of vital medicines.
“From October to December 2010, we didn’t have cotri-
moxazole 480mg tablets for 37 days. Artemether-
lumefantrine 20mg/120mg tablets (35 kg and above) also
ran out of stock for 32 days,” says Sarah Namakula a nurs-
ing officer in-charge at Kojja HC IV store .
Between December 2010 and April 2011, 68 medicines
management supervisors (MMS) from central and eastern
regions were trained. The role of these supervisors is to
provide on-the-job training to health workers in stock and
storage management, prescribing and dispensing, and
ordering and reporting practices, while collecting data on
indicators to enable them to monitor performance of health
facilities.
Kojja HC IV is one of the facilities receiving supportive
supervision from MMS. Supervision visits conducted in
May and June 2011 revealed an increase in stock of vital
medicines. Kojja HC IV’s stock-out days for cotrimoxazole
480mg tablets were reduced to 17 from 37 days, while
artemether-lumefantrine 20mg/120mg tablets were not
out of stock at all.
The graph below shows improvement at Kojja HC IV after
the baseline and second visit conducted in April and May
2011. Scale 0–4 represents scores for each indicator, the
maximum being 5.
Through regular supportive supervision, more health
workers like Sarah are gaining skills on how to order
medicines correctly, manage medicines stock and the
store, update and fill out stock cards, and dispense
properly. This will minimize medicine wastage, stock
inadequacies, and overstocking in facilities. Monthly
data on medicines stock and facility performance will
also be available for decision making.
Bundibugyo Hospital Appreci-
ates New Changes By Lynda Nantongo and Timothy Nuwagaba
At Bundibugyo Hospital, Angole Ruben has worked as a
store in-charge for 29 years. Now, as a medicines
management supervisor, Angole is using the knowledge
and skills he acquired during the training he attended in
April 2011 to mentor and train other health workers in
the district.
Since then, Angole has worked hard to make his store
stand out as one of the best maintained stores in
Bundibugyo. His efforts have paid off; a team from the
United Nations Children’s Fund that visited the store in
THE VALUE CHAIN NEWSLETTER 4
Business Process Transformation Project Improves Customer Service
Delivery at JMS
Participants at JMS during the start of the team training exercise,
together with the facilitator, Andrew Hayman .
Photo credit. Joint Medical Store
September 2011 likened Angole’s well-maintained store to
those operating in Australia. The district health team, too, is
full of praise for the hospital’s new changes.
“We used to order for medicines and supplies without priori-
tizing. As result, there were frequent stock outs of medicines.
The shelves in the store were unlabeled, and it would take me
a longer time to locate some of the medicines once an order
was placed,” says Angole.
The store is cleaner, essential medicines and supplies are
consistently available, and shelves are labeled according to
medicines’ generic names with updated stock cards on every
shelf. Improvements in dispensing and prescribing practices
include longer dispenser-patient interaction time and use of
dispensing equipment to count medicines . Reporting and
ordering is also better.
With the MMSs mentoring and training other health
workers in their districts, service delivery to the popu-
lation will continue to progress as medicines and
health supplies are made available at facilities.
Angole Ruben (Blue coat) with the Store assistant Eratus Kamero
while updating stock cards. Photo by Lynda Nantongo.
By Andrew Hayman and Andrew Cohen
The Joint Medical Store (JMS) partici-
pated in a business process transforma-
tion project to strengthen the efficiency
and effectiveness of its procurement,
warehousing, and sales functions.
Taking part in the project were senior
and middle management staff at JMS
who not only analyzed and redesigned
current processes, but also identified and
eliminated activities that did not add
value. For example, as part of the
analysis, at least 67% of such activities
in the “forecast to replenishment”
process were completely eliminated. The
project also resulted in a 72% decrease
in time spent on non-value added
activities for all primary processes. This
led to the creation of new and more
customer-responsive processes.
Uganda SURE facilitated the project,
which began with a one-day workshop
where participants received in-depth
training on three primary processes—
‟order to cash‟, „forecast to replenishment‟, and „purchase to pay‟. Partici-
pants acquired skills in interviewing JMS staff to identify value-added and
non-value added activities, and in designing new processes. They also
used their new knowledge to create process maps indicating the sequence
of activities, departments responsible, and time spent weekly on each
activity, and then
to decide on the
appropr iateness
and value of each
activity‟s contribu-
tion to delivering
customer service.
The bus iness
process transfor-
mation project
enabled JMS to
determine ways to
move forward with
a detailed imple-
mentation strategy
for the revised ac-
tivities.
The workshop and process analysis were part of technical assistance pro-
vided to JMS between August and November 2011 by the USAID-funded
SURE program and RTT, one of SURE‟s implementing partners.
THE VALUE CHAIN NEWSLETTER 5
By Khalid Mohammed
The SURE program is working with one of its partners,
Makerere University (MUK), to institutionalize the training
of medicines management supervisors. The initial agreement
is for MUK College of Health Sciences (MUK CHS) to train
220 MMS from all districts in the country enabling them to
perform in-service training in medicines management (MM).
In parallel to MMS training, as part of getting MM into pre-
service training, MUK will assist in changing the curriculum
of all health training institutions to incorporate MM into the
curricula of all health workers.
In November 2011, MUK conducted its first training, where
20 participants successfully passed the two-week’s course in
supply chain management. While speaking at the closing
ceremony, the deputy principal at MUK CHS said,
“Effective next year, the component of medicines manage-
ment will be included in the college’s training curriculum.”
Adome Odoi, a professor at the college who is spearheading
the drive to change the curriculum, believes that having
MUK conduct trainings in supply chain management will
provide MMS and health workers with knowledge to carry
out their jobs effectively. Odoi thanked the SURE program
for sharing their tools, materials, and expertise that has
bridged the gap between academic concepts and actual
practice in the field.
The Pharmacy Division led by the Assistant Commis-
sioner Health Sciences-Martin Oteba, applauded the
curriculum change and pledged on behalf of Ministry
of Health to provide the technical support necessary to
ensure its smooth implementation.
Institutionalizing Training in Supply Chain Management
A pioneer participant receives a supervision bag and certifi-
cate after attending the MMS training conducted by Maker-
ere . Photo credit: MUK CHS
By Kim Hoppenworth and Tom Opio As a result of monthly data collection on facility
performance by MMS in Uganda, a lot of paper-
based data collection forms were generated. The
number of MMS increased to 146 in October 2011.
However, in the last ten months, data from at least
300 facilities was submitted for analysis, which re-
quired extra time and resources to enable data entry
and analysis.
In September 2011 the use of netbooks was intro-
duced. The netbooks offer a computerized system
for MMS to capture and share data electronically.
The netbooks are installed with Adobe Acrobat X
(pdf data collection software) that allows direct data
entry into an electronic form designed in the same
format as the paper form the MMS were using.
Netbooks Lay Foundation for Easy Information Sharing
Medicines management supervisor Peter Okot (left) demonstrates
how he uses the electronic form installed on the netbook to the Senior
Pharmacist at Masaka Regional Referral Hospital, William Olumu
(right) and Tom Opio, SURE’s District Information Officer (center).
THE VALUE CHAIN NEWSLETTER 6
SURE organized a two-day training where eight MMS
gained hands-on experience on the use of netbooks, filling
out electronic pdf forms, setting up an email account, and
using online support tools such as Team Viewer and
Skype.
The trained MMS are now using netbooks and pdf forms
to collect and submit data, which are easily and quickly
shared using electronic mail. Since MMS enter data
directly and share it electronically, the software facilitates
data collection, aggregation, and initial analysis.
The SURE program has procured netbooks for all MMS
working in the 45 SURE-supported districts. This will not
only equip MMS with computer and communication
skills, but will also improve capacity and performance of
district health facilities in planning, distributing,
managing, and monitoring of essential medicines and
health supplies.
a motorcycle to ease her transport during the supervisory
visits.
“I never thought that I would be able to learn how to
ride, but I managed. I was the only lady that passed in my
group. Now, I don’t fear riding a motorcycle because I
realized that no one can know I am a lady when I wear
the helmet and the riding suit. Even the community has
got used to seeing me riding my bike. It feels good and I
make my supervision schedules without worrying about
transport,” says Doreen.
Despite the scar on her right leg that she got after hitting
a log while riding a motorcycle, Doreen has not given up.
She is responsible for supervising five facilities in her
district. Four facilities are located far from Doreen’s
facility, and the motorcycle has made it possible for her
to plan, get to clinics, and work with staff comfortably.
Other health workers are now seeing her as a contact
person to pass on their needs to the District Health Offi-
cer. She has requested and delivered dispensing trays and
also redistributed medicines from over-stocked to under-
stocked facilities using the motorcycle.
Today, 26 female MMS like Doreen have completed
motorcycle riding training—breaking the barriers
entrenched in the Central Ugandan culture.
“One month after the training, half of the MMS includ-
ing those who had no prior knowledge and experience
in using computers submitted data using the pdf
electronic form,” said Kim Hoppenworth, SURE’s Dis-
trict Computerization Coordinator.
Women MMS Break Cultural
Barriers in Central Uganda By Samuel Omalla
In a region where only a handful of women can ride
motorcycles due to cultural norms and taboos, Doreen
Naluggwa, a 30-year-old Clinical Officer at Seeta Nazigo
Health Center III, in Mukono district, is one of the few
women who have broken the norm. She had never thought
of riding a motorcycle until early 2011 when she received
an invitation to undergo a six-day motorcycle defensive
training course.
In November 2010, Doreen attended a two-week course in
medicines management organized by the SURE and Phar-
macy Division which she passed successfully. But to serve
as a medicines management supervisor, she also had to
learn how to ride a motorcycle, after which she would get
Doreen Naluggwa puts on her protective gear before starting
her journey to a health facility to provide supportive supervi-
sion. Photo Credit: SURE Program
THE VALUE CHAIN NEWSLETTER 7
MOH Makes Stock Status Re-
port Official MOH Document By Morris Okumu
Having declared the stock status report an official govern-
ment document, the Uganda Ministry of Health (MoH)
requires that the report be presented every two months to
all levels of management.
“The MoH publishes on a bi-monthly schedule a national
stock status report that is shared with all partners. This
report is discussed by the Health Policy Advisory Commit-
tee and published on our website. The report is very infor-
mative and has provided basis for actions on so many
issues,” said Dr Asuman Lukwago, Acting Permanent
Secretary MoH while addressing the board and manage-
ment of Medicines Stores Department of Tanzania.
In 2010, SURE and Pharmacy Division launched the stock
status report, which highlights challenges, bottlenecks, and
potential solutions to mitigate stock-outs and expiries of
antiretrovirals, HIV test kits, artemisinin-based
combination therapies (ACTs), anti-TB medicines, repro-
ductive health commodities, laboratory products, and other
selected tracer medicines. The report was developed to
respond to the need for better coordination to ensure
commodity security. It quickly produced results; it trig-
gered a donation of first-line antiretrovirals for the public
sector by US government, as well as a donation of ACTs
from UK’s Department for International Development—in
both cases averting a looming stock-out.
New Committee for Appropriate
Use of Medicines By Dorthe Konradsen
Although several health sector strategic documents stress
the importance of using medicines appropriately, Uganda
had no organizational entity focused on medicine use and
therapeutics. To address this gap, the SURE program in
close collaboration with the Pharmacy Division and the
Quality Assurance Departments proposed to the Ministry
of Health to urgently create a national body to promote
appropriate use of medicines in the public sector.
January 13, 2011 marked the launch of the first national
committee in charge of appropriate use of medicines—the
Uganda Medicines and Therapeutics Advisory Commit-
tee (UMTAC). The goal of UMTAC is to promote
availability and appropriate use of medicines and health
supplies in the public sector.
Speaking at the launch, former Director General—Health
Services at MOH, Dr. Kenya Nathan Mugisha said,
“One of the main challenges facing medicines and health
supplies management in the health sector is lack of an
authoritative channel through which health workers can
access information on current practices in rational
medicines use, prioritization of requirements and con-
tinuous education on rational medicines use. UMTAC
inauguration is a timely intervention to ensure that we
have in place a structure to mitigate the challenges.”
Some of the members that attended the Uganda Medicines
Therapeutics and Advisory Committee launch. Photo credit:
SURE Program
UMTAC has already held three meetings to review,
update, and finalize the essential medicines, laboratory
commodities, and health supplies lists, and also identified
necessary changes to the Uganda Clinical Guidelines
2010. The new lists classify all the essential medicines and
supplies into “vital,” “essential” and “necessary,” an im-
portant step to prioritize the use of scarce resources. Once
complete, the lists will guide health facility staff in
ordering medicines and supplies and the National Medical
Stores in making procurement decisions. SURE continues
to support UMTAC to update the Essential Medicines List
and develop the Essential Health Supplies List; while the
US Centers for Disease Control and Prevention supports
the development of Essential Laboratory Commodities
THE VALUE CHAIN NEWSLETTER 8
The Pharmacy Division and SURE program ac-
knowledge support from— MOH Resource Centre and technical programs (AIDS Control Program,
National Tuberculosis and Leprosy Program, Central Public Health Labo-
ratories, National Malaria Control Program, and Reproductive Health Pro-
gram)
Makerere University Kampala
National Drug Authority
Joint Medical Store
National Medical Store
Uganda Medicines Therapeutics Advisory Committee
Euro Health Group
Pharmaceutical Healthcare Distributors (RTT)
Management Sciences for Health
US Agency for International Development
US Centers for Disease Control and Prevention
District Health Officers /Chief Administrative Officers
Medicines Management Supervisors
Implementing partners
About the SURE /MoH Collaboration SURE is a five-year program ending in 2014 funded by the US government
through the US Agency for International Development. The program is imple-
mented by Management Sciences for Health, and works closely with the
Pharmacy Division to improve availability and accessibility to quality essential
medicines and health supplies in Uganda. SURE and the Pharmacy Division
support commodity management, human resource capacity at central and
district levels, improved management information and reporting systems,
monitoring and evaluation; and strengthening management and planning to
optimize resource utilization.
Ministry of Health (MOH)
Republic of Uganda
Plot 6 Lourdel Rd, Wandegeya
P.O. Box 7272. Kampala Uganda
Tel: 256-41-340884
Fax: 256-41-340887
Email: [email protected] |
www.health.go.ug
Securing Ugandans’ Right to
Essential Medicines (SURE)
Management Sciences for Health
(MSH) Uganda office
Plot 15, Princess Anne Drive,
Bugolobi
P.O BOX 71419. Kampala, Uganda
Tel: 256 414 235 038
Fax: 256 414 235 035
Email: [email protected] |
www.sure.ug
For more information and to
contribute to the next issue please
Contact Julian Natukunda at
or call +256 (0) 759 800 155
This newsletter is made possible by the
generous support of the American people
through the US Agency for International
Development (USAID), under the terms of
cooperative agreement number AID-617-
A-00-09-00003. The contents are the
responsibility of Management Sciences for
Health and do not necessarily reflect the
views of USAID or the United States
government.
Events, Ongoing and
Planned Activities
Updating of the essential medi-
cines and health supplies lists
and treatment guidelines
Roll out strategy for the online
ARV ordering and reporting (web-
based) system
RxSolution pilot is finalized. Roll
out to the first 10 facilities to be
conducted this year
National Drug Authority (NDA)
and SURE will begin piloting the
new inspection tool for pharma-
cies in public health sector.
MOH-PD and SURE conducted
the 3rd Regional Pharmacists‟
meeting (February 2012)
Organized a meeting between
DHOs and medicines manage-
ment supervisors for Western and
Central regions
Makerere University College of
Health Sciences completed 3rd
MMS training in medicines man-
agement (March 2012)
New and Upcoming
Publications/Reports
The Pharmacy Division and SURE
program have undertaken a number
of assessments to improve pharma-
ceutical health delivery in Uganda.
Once finalized, publications are
expected on the following
Second kit system survey
Annual pharmaceutical health
sector performance
Concept paper—SPARS strategy
The national TB logistic assess-
ment
A new national essential medi-
cines and health commodities
logistic manual