yeager_systems for improving drug management

8/2/2019 Yeager_Systems for Improving Drug Management

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Pharmaceutical

Management for Maternal

Health: Assuring access toquality medicines and

supplies

Beth YeagerMay 4, 2012

Dhaka, Bangladesh


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Dimensions of Access to Medicines


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Accessibility and Availability

Country % births attended by skilled

attendant1Stock-outs of oxytocin in

public facilities?2

Afghanistan 14.3% Yes, rarely

Bangladesh 18% Yes, regularly

India 47% Yes, frequently

Indonesia 73% No

Nepal 19% Yes, occasionally

1WHO Global Health Observatory; Births Attended by Skilled Health Personnel Interactive Map;http://gamapserver.who.int/gho/interactive_charts/mdg5/atlas.html , accessed 4/11/20122 USAID/MCHIP Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia Status Report 2011
http://gamapserver.who.int/gho/interactive_charts/mdg5/atlas.htmlhttp://gamapserver.who.int/gho/interactive_charts/mdg5/atlas.html


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Affordability

Example from Bangladesh:

Location of delivery Total cost of health care during

pregnancy, delivery, and postpartum

period as percent of average annualincome

Home 15%

Basic obstetric facility 35%

Comprehensive obstetric facility 452%

Borghi, J. et al. 2006. Household Costs of Healthcare during Pregnancy, Delivery, and the Postpartum Period: A Case Study from Matlab,Bangladesh. Journal of Health, Population, and Nutrition24 (4) 446455.


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Acceptability

PolicyMakers

WomenProviders


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Elements of Pharmaceutical Management to

Assure Quality of Products


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Selection

Protocol for case management based on consensus of experts

and internationally recognized best practices

Criteria should include:

Consideration of types of health providers at different levels of the

system

Cost

Safety and efficacy

Quality and stability

Registration status

Availability for procurement

Agreement between STGs and EML

Are appropriate storage

conditions for oxytocin

present?

Is misoprostol included in

EML for ob/gyn indications? Who is allowed to prescribe

misoprostol?


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Procurement

Quantity needed Management information system to monitor

consumption; supply data

Quality standards

Packaging

Storage conditions/capacity

Shelf life of products

Supplier performance

Centralized vs. decentralized


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Procurement (2)

Do tender documents provide sufficient specificity

on characteristics that may affect quality? (e.g.

packaging for misoprostol)

Will re-packaging be necessary? What data are used for quantification?

Is data on morbidity available?

Have needs of lower levels of the health system beenconsidered?

Have multiple uses of medicines (e.g. oxytocin) been

considered?


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Distribution

Distribution network and transportation

Vertical vs. integrated

Frequency

Conditions during transport

Cold chain; light; protection from weather

Quality assessment at distribution points

Are appropriate conditions maintained

during distribution (e.g. oxytocin)?

How are medicines distributed to lower

levels of system (e.g. community-based

distribution of misoprostol)?

Is this system really working?


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Inventory Management

Stock cards and registers

FEFO; stock rotation

Reporting

Physical inspection Disposal of expired products

Is consumption recorded

at all levels?

Are records reconciled

(e.g. pharmacy vs. deliveryroom)?


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Storage

Temperature monitoring

Cold chain (oxytocin)

Humidity (misoprostol)

Light

Ventilation

Clean environment/absence of insects/rodents

Security


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Use

Service delivery protocols Who is allowed to prescribe?

Indications, dose, contraindications

Management of side effects

Job aids

Product availability

Dispensing

Labeling

Packaging

Counseling


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Management Support

Standard operating procedures

Management information system

Human resources

Financing

Monitoring and supervision


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Policy, law and regulation

EML; STGs

Registration

Importation

Financing mechanisms

Human resources

yeager_systems for improving drug management

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