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