Improving Access to Essential Medicines through PublicPrivate Initiatives:

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Improving Access to Essential Medicines through
Public-Private Initiatives

• The Case of the
• Catholic Pharmaceutical Service
• in Ghana

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ABSTRACT
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Background
Demographic Profile Population 18,912,079 Sex M
ale 49.5 Female 50.5 Locality Rural 56.2
Urban 43.8 Growth Rate 2.7
Health Status U5 Mortality Rate 107.6/1000 Infant
Mortality Rate 56.7/1000 Maternal Mortality
Rate 214/100,000 Life Expectancy 58years HIV
Prevalence 3.8
Population Per Health Facility By Provider
Ghana is a tropical country situated in the West
Coast of Africa and located between latitudes 4
11 North of the equator
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Background

• Strategies to Enhance Access to Medicines (SEAM)
  is an initiative created by MSH to improve access
  to medicines in developing countries. The
  initiative is funded by Bill and Melinda Gates
  Foundation
• SEAM country programs are developing and testing
  various models of public-private collaborations
  to improve access to medicines in the countries
  participating in the program and also to identify
  models that can be deployed in other countries
  facing similar access problems
• In Ghana, the Catholic Health Service was
  identified as one of the two private sector
  institutions to implement a SEAM Program

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Background

• Faith-Based organizations provide 40 of all
  health services in Ghana
• The Catholic Health Service, the largest body
  provides 75 of mission sector health delivery
• Services are delivered through 31 hospitals, 66
  clinics maternity homes, 4 drug supply depots,
  situated mostly in rural areas in 18 autonomous
  dioceses throughout Ghana
• Access problems identified
• Availability - drugs out of stock 35 of time
• Affordability - Nearly a fifth of daily wage
  required to treat adult malaria in mission sector
• Rational use - average of 5 items on a
  prescription

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Project Objectives

• Improve capacity of Catholic Pharmaceutical
  Service to achieve better pricing and more
  reliable supply service
• Improve quality of prescribing and dispensing
  services by promoting the rational use of drugs

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Interventions

• Organized meetings with Bishops, Administrators,
  and Hospital managers to get buy-in and consensus
  agreement on approaches for pooled procurement,
  MIS and Rational Drug Use
• Established a pooled procurement model for
  procuring and delivering medicines to facilities,
  re-engineered existing structures, carried out a
  tender for 20 drugs, and trained facilities in
  inventory management

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Interventions

• Trained a team of 4 health professionals from
  each of 5 hospital on promoting RDU at health
  facility level using Drugs and Therapeutic
  Committees, in a learn and do cyclic approach

Catholic Health Service DTC Design Learn do
Cyclic Approach
Adapting training Material Local Intl
Experts
Selection of Facilities and DTC team
Training ( 2-days)
Implementation And Follow-up in Health
Facility (8 weeks)
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Results
Pre-Intervention Results for Access dimensions of
Availability, Affordability and Quality of
Service
AVAILABILITY
AFFORDABILITY
RATIONAL USE
Post-Intervention Evaluation of Access Dimensions
is scheduled for Oct 2004 Jan 2005
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Key Milestones

• Procurement of 20 essential drugs by tender using
  quantities from 29 facilities yielded on average
  20 savings in price
• Five facilities piloting the DTC program
  established DTCs in their facilities after first
  module training
• The effects of these milestones on availability,
  affordability and rational use of medicines will
  be determined in a post intervention evaluation
  scheduled for Oct 2004 - Jan 2005

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Implications

• Building Capacity and Structures for sustainable
  implementation of Program
• Maintenance, sustainability vrs staff attrition
• Providing Technical Assistance vrs Capital
  Investments
• Ownership of program and commitment of
  implementing partner

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Implications

• Pooled Procurement Systems
• Ability to enforce requirements of tender
  contracts
• Suppliers Delivery of Goods on schedule vrs
  Clients Payment for Goods on time
• Timely information flow for forecasting,
  procurement, payment and delivery decisions
• Prequalification of suppliers
• DTC Program
• Training
• Skill development vrs information dissemination
• Credible Expert Trainers, local/international
• Providing support for institutional work

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Conclusions

• The project has demonstrated that where there is
  commitment, appropriate leadership, and
  ownership, group purchasing program can be
  implemented to make great savings
• The learn and do cyclic approach to DTC
  training has ensured that skills are acquired and
  maintained through real field experience within
  the environment of the practitioner
• Linking the implementation of pooled procurement
  with DTC programs strengthens institutional
  capacity for sustainability