Directorate of Pharmaceuticals & Medical Supplies Ministry of Health, Republic of South Sudan

1. Overview of Pharmaceutical and Medical Supplies2nd South Sudan Health Sector Summit Juba Bridge HotelAugust 20, 2014 Directorate of Pharmaceuticals & Medical Supplies Ministry of Health, Republic of South Sudan

2. Presentation Outline • Functions of DP&MS • Organizational structure of DP&MS • Updates on activities • Challenges • Way forward

3. Functions of DP&MS • The key functions of the directorate are to: • Procure medicines and medical supplies; • Ensure only high-quality medicines and medical supplies enter the public supply chain; • Manage medical stores, transport and storage of drugs; • Draw up policies on Pharmaceuticals in South Sudan.

4. Main Plans of The Directorate • Procure Medicines and Medical Supplies. • Transport Medicines and Medical Supplies to the counties. • Review and update the existing Pharmaceutical Management information system. • Establish an autonomous CMS. • Construct/renovate Medical stores ( Central. Regional and at the state). • Strengthen the Supply chain system.

5. Main Plans of The Directorate…Cont • Capacity building of Pharmaceutical staff. • Internship program for newly graduated Pharmacist in health facilities. • Build cold chain storage & transportation capacity - Cold rooms, refrigerated trucks, cold chain technician • Promote local production of Pharmaceuticals - Feasibility study/pilot

6. Minister of Health Republic of South Sudan Organogram of DP&E Undersecretary Ministry of Health DG Pharmaceutical & Medical Supplies Director Policy & Pharmacy Practice Director Quality Assurance Director Pharmaceutical Supplies Management Deputy Director Medical Store Administration Deputy Director Pharmacy Practice Deputy Director Quality Control Store Supervisor Quality Control Officer Procurement Officer Rational Medicines Use & Training Officer Senior Store Keeper Medical Supplies Logistician Junior Store Keeper Traditional Medicines Officer Pharmacovigilance Officer Pharmaceutical Management Information System Officer Drivers; Store assistants; Messengers; Cleaners Watchmen Record Assistant IT Specialist

8. Selection • Based on essential medicines concept: • Priority given to medicines that satisfy the priority health care needs of the population • Selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness • Standard Treatment Guidelines & Essential Medicine Lists • Selection done by MOH in conjunction with technical working groups, partners & donors • Relies on morbidity and consumption data from States/ health facilities • Recently updated list of pharmaceuticals & medical supplies for provision of basic package of health services • Guiding ongoing procurements

9. MOH Procurement • Sources of funding • Emergency Medicines Fund (EMF) • Donors (USAID, DFID & Norway) are procuring 1-year supply • Expected from Jan-Feb 2014) • Antimalarials arrived and received at CMS. • Procurement handled by third party (DELIVER) appointed by donors • MOH Procurements • First procurement received and will be distributed. • Second procurement expected in Feb/ April 2014 • Procurement guided by public procurement policy • Quality assurance built-in procurement process through rigorous specifications & technical evaluation process • GF,NGOs engaged in parallel procurements uncoordinated with MOH

10. MOH Distribution (1) • MOH through CMS handles: • Custom clearance • Receipt of supplies • Storage at CMS • Inventory control at CMS • Updating distribution plans and • Selection & contracting of transporters • Loading & dispatching supplies • Receipt of waybills (as proof of delivery at the County or hospital)

11. MOH Distribution (2) • Note: • CMS distribution cycle is quarterly; • CMS distribution list has 1,297 functional facilities • 47 hospitals, 250 PHCCs and 1,000 PHCUs • # of health facilities will increase during EMF to 1,401 • 53 hospitals, 286 PHCCs and 1,062 PHCUs • Emergency supplies • Anti-malarial distribution of 3-month supply to all counties done in August 2013 • Monthly/ weekly requests from Juba, Wau, & Malakal Teaching Hospitals and Sabah Pediatric Hospital • Uncoordinated requests from states, counties, communities, organized forces and other institutions are being supplied • Floods/ disaster affected areas (e.g. Warrap, Unity, & Jonglei states)

12. Transportation • Quarterly distribution • Push system implemented • Private transporters contracted to deliver : • To Counties level (PHCC & PHCU) • Direct to Hospitals • Emergency distribution • Occurs on case-by-case basis e.g. antimalarials

13. Rational Medicine Use Main Processes Key Considerations Diagnosis; Prescription Dispensing; Adherence Good dispensing practices Medicine information services Containing antimicrobial resistance Drug use evaluation Behaviour change strategies

14. Main Challenges (1) • Financial constraints • Delays in paying suppliers and transporters • Budget not enough for all health facilities, emergency and other uncoordinated orders • Poor infrastructure • Limited storage capacity & equipment at all levels • Transporters facing challenges with offloading due to lack of space • Delivery at county • Transporters ordered to deliver drugs at destinations other than what CMS specified • Drugs stuck at county

15. Main Challenges (2) • Ineffective pharmaceutical management information systems • Critical for transitioning to a pull system; • Inconsistent availability of PMIS tools • No feedback/ consumption reports from counties to CMS; • Ad hoc/ uncoordinated emergency ordering • Communication • No stable focal person at County level • Poor communication and coordination across the supply chain • Human resource constraints • No pharmaceutical training institute; few skilled personnel • Rampant irrational use of medicines

16. Recommendations/ Way Forward (1) • Allocate funds/ budget for regular County-to-health facility distribution • Put aside funds for emergency distributions (e.g. emergency orders, floods etc.) • Prioritize infrastructure improvements • Storage space & material handling equipment e.g. Forklifts, shelves • Strengthen PMIS • Print & disseminate PMIS tools • Send back the issue/ receipt vouchers once counties complete distribution to health facilities • Improve feedback of consumption/ morbidity data from facilities/ counties

17. Recommendations/ Way Forward (2) • Promote rational use of medicines • Supervise facilities to ensure drugs are rationally used • Update & train on standard treatment guidelines • Build capacity of pharmaceutical human resources • Deployment of pharmacy professionals to States • Assign focal persons for pharmaceutical supply management at county level • Train health workers on pharmaceutical management • Strengthen communication & coordination with key stakeholders in pharmaceutical supply management