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