Gail Mkele, Sue Putter Health Systems Strengthening through the Pharmaceutical

Leadership Development Program (PLDP)

Lindile Mabuya 28 August 2014

Mission Saving lives and

improving the health of the world’s poorest and most vulnerable people

by closing the gap between knowledge and action in public health.

Journey

- History of Pharmaceutical Leadership Development Programme

- Overview of the PLDP

- Approach taken to achieve measurable results

- Examples/Case Study

- Acknowledgements

History of the PLDP Committee of Heads of Pharmaceutical Services

requested support to build leadership and management capacity (2008)

Modules added to meet the needs of pharmacists

SPS/SIAPS adapted the MSH leadership development program (LDP) developed in Aswan,

Egypt in 2000

Rolled out in Free State/Northern Cape, Eastern Cape, Kwa-Zulu Natal, Western Cape, North West

and Limpopo*

PLDP piloted in Gauteng (March – August 2011)

WHO Building Blocks Health System Strengthening

Leading and Managing for Results Model

When applied consistently, good leading and managing practices strengthen organisational capacity and result in higher-quality services and sustained improvements in health.

PLDP Workshop Schedule Workshop 1

(5 days) Workshop 2

(5 days) Workshop 3

(5 days) Workshop 4

(5 days) Workshop 5

(2 days) Final

Presentation

Introduction to Leading and Managing Practices

Strengthening

Health Systems

Planning

M & E – concepts and frameworks*

Introduction to the Challenge

Model

Identify a team challenge and develop team

challenge model

Developing an M&E Plan

Developing indicators

Data sources and

data quality

Legislative Framework

Financial Management in Pharmaceutical

Services*

Advanced Medicine Supply Management*

Human Resource Management*

Good

governance in pharmaceutical

services*

Ethics in Pharmacy

Teams work on challenge

Preparing the

abstract, poster and

presentation

Final preparation

Presentation

to Stakeholders

Coaching Visits PLDP facilitators meet with teams to encourage and monitor progress on the leadership challenges as well as help teams reflect on their commitments

Technical Modules

Monitoring and Evaluation

Legislation, Governance and Ethics

Financial management for pharmaceutical services

Advanced Medicine Supply Management

Human Resource Management

Monitoring and Evaluation • M&E concepts and

frameworks are introduced early in the process

• A rigorous process of developing the measurable result, indicators and an M&E plan is followed

• Teams identify possible data sources, data quality issues which may occur and ways to mitigate these

Legislation, Governance and Ethics • Provide an overview of South

African legislation which may impact on pharmaceutical services

• Introduce characteristics of good governance

• Explore potential governance related problems that can affect delivery of pharmaceutical services

• Strategies to improve governance

• Explore ethics and ethical dilemmas

Financial management for pharmaceutical services

• Understanding and interpreting the Public Finance Management Act and Treasury Regulations

• Empowering participants to plan and budget

• Financial risk management • Strategies to mitigate risk • Financial reporting • Understanding the auditing

process

Advanced Medicine Supply Management

Quantification

Inventory Management

Analysing and controlling

pharmaceutical expenditure

How can the pharmaceutical management framework be applied when managing medicine supply?

Leadership & Management

Analysing and controlling

pharmaceutical expenditure

Pharmaceutical Management Framework

Human Resource Management

• Legislation and directives that govern employees in public service

• Explore pillars of HR management

• Case studies and role play on conflict management, grievance and disciplinary procedures

• Strategies for improving work climate and motivating staff

The PLDP approach

• The PLDP uses a novel approach that combines pharmaceutical management knowledge and sound leadership practices

• Working in teams, participants tackle a workplace challenge by applying the challenge model

Mission

Vision

Current situation

Measurable Result

Challenge statement

Root causes

Priority actions

Using the Challenge Model • Create a shared mission

and vision • Assess the current

situation • Scanning the

environment

• SWOT analysis • Conceptual Framework • Stakeholder Analysis

Using the Challenge Model (cont’d)

• Focus on one challenge in the workplace

• Define one measurable result

• Develop an M&E plan • Identify obstacles and

root causes • Five Why’s

Using the Challenge Model (cont’d) • Articulate their challenge • Select priority actions • Develop a detailed action

plan • Align and mobilise key

stakeholders • Implement the plan • Monitor and evaluate

progress towards achieving the desired result

“The Challenge model gave us a dynamic framework in which to practice our leadership skills,” PLDP participant

Examples of quality improvement activities implemented

• Salatchi • 85 years old • Nearest health facility – GJ

Crookes (20 km) • 1 day each month dedicated to

collecting her chronic medication • $$$ on travel and long waiting

times = her reality

• Naleeni • Pharmacy manager at – GJ

Crookes • Dedicated to ensuring that

Salatchi’s medicine was always available at the hospital

• Limited resources and high patient volumes = her reality

• New reality - Stroll to the community centre around the corner, collect medicine and return home

• Also the new way of life for ~400 patients in her community for the past year

One of three community based collection points for chronic mediation established by GJ Crookes hospital

I spend less than 30 minutes in a queue and within an hour, I would be back home resting‖

(Joanna another patient)

Examples of quality improvement activities implemented Priority Areas Some Challenge Addressed

Waiting time The average patient waiting time at the pharmacy at Kraaifontein Community Health Centre (CHC) in the Western Cape was reduced from 41 to 19 minutes over a 6 month period.

Ensuring medicine accessibility

Work of the Zenzele team in Ugu District in KwaZulu-Natal resulted in a 16% reduction in the number of parcels of chronic medicine which were not collected by patients at Umzinto Primary Healthcare Clinic (PHC).

Development of a referral system in Camdeboo Sub-District, Eastern Cape facilitated delivery of chronic diseases medications supplied by Midlands Hospital to feeder clinics, thus enabling a more client’s easier access to medications for chronic conditions.

Improving medicine supply management

At Cecilia Makiwane Hospital in the Eastern Cape, implementation of a batch management system resulted in a 3.1% (3.8 to 0.7%) reduction in expired stock as a percentage of expenditure The value of expired stock was reduced from 3.4% to less than 0.5% of stock held in 6 of 11 clinics in Sisonke district, KwaZulu-Natal

Examples of quality improvement activities implemented (cont’d)

Priority Areas Some Challenge Addressed

Ensuring compliance with standards

In KwaZulu-Natal compliance of prescriptions with standard treatment guidelines for non-steroidal anti-inflammatory agents was improved from 57 to 94% and 60 to 68% at two hospitals and from 37 to 67% at a CHC In the North West pharmacists worked with 10 primary health care facilities on the development of SOPs, distribution of reference manuals, and building capacity in good pharmacy practice including medicine supply management, which increased compliance with national core standards from 33 to 77%

Ensuring rational use of medicines

The average number of patients initiated on isoniazid preventive therapy at the Joe Morolong Memorial Hospital in North West increased from three to eight per month (a 167% increase in enrolment of patients on IPT) Eight months after completion of the PLDP, 45% of the facilities in the Frances Baard District were reporting ADEs, up from 26% (a 73% increase in number of facilities reporting ADEs)

Some time in the near future…

• Limpopo’s journey has begun • Workshop 1 held in June

2014….

• Western Cape…Leadership Development Program • pharmacist, facility

manager & doctor at PHCs

• Kwa-Zulu Natal • Sustaining PLDP projects

• Internal capacity to roll-out workshops • Incorporating approach

within the organisation – how we tackle our activities

• Sustainability • Partnerships with

universities

Watch this space……

MSH Remains True to its Founding Values:

Acknowledgements • PLDP Team • Senior Managers of the Department of Health • Guest Facilitators • Participants • Yourselves

• Management Sciences for Health, 2011. Managing access to medicines and other health technologies. Arlington, VA: Management Sciences for Health

• Management Sciences for Health, 2010. Health Systems in Action: An eHandbook for Leaders and Managers. Cambridge, MA: Management Sciences for Health.

References

~160 pharmacists and facility managers that carried out quality improvement initiatives as part of the Pharmaceutical Leadership Development Program (PLDP)