Building Capacity for Quality Pharmaceutical Services and Pharmaceutical Care

1. Building Capacity for Quality Pharmaceutical Services and Pharmaceutical Care Ndinda Kusu 1, Victor Sumbi1,Caroline Olwande2, Sarah Chuchu3, Fred Siyoi4 1Management Sciences for Health (MSH)/Health Commodities and Services Management Program 2National AIDS and STI Control Program; 3Ministry of Health/Pharmaceutical Services Unit; 4Pharmacy and Poisons Board

2. Background (1) • Access to quality health commodities is essential for the successful implementation of priority health programs • At inception most have poor or inadequate capacity for pharmaceutical management and pharmaceutical care. e.g. • ART was introduced in the public sector in 2003 but the Pharm. Systems were weak and needed to be strengthened to: • Ensure Pharmaceutical Supply and meet ART scale-up demands • Promote quality of care • Ensure continuity of care and sustainability of the ART program

3. Background (2) • Assessments done with support from the MSH/Rational Pharmaceutical Management (RPM) Plus Program at pilot sites revealed several gaps including: • inadequate human resource capacity, • lack of guidelines and policies, • Inadequate/paper-based pharmacy records that were inadequate to manage patients on chronic care effectively, • poor dispensing and medication-counseling practices, • crowding at dispensing windows that made confidential counseling impossible, and • lack of reference materials. • Recent assessments pre- and post-devolution show positive gains in pharmaceutical systems strengthening • However opportunities exist to do more and enhance quality pharmaceutical services and care in Kenya.

4. Interventions and Approaches • RPM Plus program and follow-on projects, Strengthening Pharmaceutical Systems (SPS) and Health Commodities and Services Management (HCSM), have worked with: • National AIDS and STI Control Program (NASCOP) to improve pharmaceutical care practices and support ART scale-up • Other Public Health Programs, MOH depts, Pharmaceutical Services Unit (PSU) and County Health Management teams strengthen pharmaceutical management and pharmaceutical care

5. Specific Interventions (1) • Capacity-building of health care workers in commodity management including: • the roll-out of various in-service training curricula • Support to KMTC and UON for curriculum review to ensure that graduating students are practice-ready for sustainability. • Implementation of electronic dispensing tools, initially the ADT, now the Electronic Dispensing and Inventory Tracking Tool (EDITT); • Design/development and dissemination of job-aids and tools • Infrastructural recommendations including setting up of private counseling booths to ensure patient-provider confidentiality. • Facilitated task-shifting by building capacity of other cadres (e.g. Nurses, Clinical Officers) to provide pharmaceutical services at PHC levels and underserved areas

6. Commodity Management Training Source: MSH Pioneer EpiVigil Course Graduates 2014 Photo from UoN Website

7. Specific Interventions (2) • Developed ART standard operating procedures (SOPs) and job aids for good pharmaceutical practices, including dispensing and medication use counseling. • Adapted general pharmaceutical SOPs, job aids and disseminated with Pharmaceutical services charter. • Supported PSK to develop PSK strategic and operational plan; and implementation of regional CPD trainings • Supported MOH depts., PSU and the National Medicines Therapeutics Committee (NMTC) to develop and disseminate: • Pharmaceutical services and MTC guidelines, training packages, essential medicines/commodity lists and standard clinical guidelines • Supported Pharmacy and Poisons Board to develop and implement: • the Pharmacovigilance (PV) system for promoting patient safety and Continuing Professional Development guidelines

9. Specific Interventions (3) • HCSM program supported several innovations including: • the PV electronic reporting system (http://www.pv.pharmacyboardkenya.org) • mobile App for Kenya standard clinical guidelines for the Android and iOS platforms, also accessible via the electronic platform http://kenyaclinicalguidelines.co.ke/) • DHIS 2 anchored Malaria Stock status monitoring tool • Support to Malaria Program to undertake bi-annual quality of care end-user verification surveys • Results show overall adherence to case management guidelines

11. Support to Bi-annual Quality of Care / EUV Surveys Improved adherence to Malaria guidelines

12. Specific Interventions (4) • To enhance oversight for commodity security, pharmaceutical management and pharmaceutical care at county level • HCSM supported establishment of county commodity TWGs and institutionalization in selected counties. • Capacity building for model facility MTCs to promote appropriate medicine use and curb AMR

13. Increased allocation with decreasing budgetary deficit- Busia County

14. Conclusion & Recommendations • Targeted assessments are critical for: • Identification of key gaps in pharmaceutical service delivery and • Generating recommendations for strategic planning and implementation of priority interventions. • Best practices and lessons learnt should be • disseminated and scaled up for system-wide impact and sustainability. • However, more efforts and resources are required to further: • mainstream and facilitate delivery of quality pharmaceutical services and pharmaceutical care across all health sectors and levels of care.

15. Acknowledgments • Ministry of Health- PSU, PPB, NASCOP, NMCP, NMTC • University of Nairobi • KMTC • Pharmaceutical Society of Kenya • Counties: CHMTS, Commodity TWGs, County Pharmacists • FBO and Private sector • USAID • MSH: RPM Plus, SPS and HCSM

16. Thank You