Grace Adeya, SPS/MSH February 23, 2011

2. Management of Medicines and Pharmaceutical Supplies for use in the prevention and treatment of Pre-eclampsia and Eclampsia Grace Adeya, SPS/MSH February 23, 2011

3. 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

4. Pharmaceutical Management Cycle

5. 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)

6. Selection: Who is making the purchasing decisions at the health facility level?

7. Procurement • Quantityneeded • Cost • Quality: packaging, cold chain • Shelf life • Supplier performance • Management information system (MIS) to monitor consumption • Medical Supplies e.g. BP machines

8. Procurement: Staff knowledge and use of essential data for quantification of requirements

9. The Procurement Cycle

10. Selection: Cost and Product versatility issues Source: MSH International Drug Price Indicator Guide

11. Distribution and Inventory Management • 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

12. Distribution: Storage Conditions

13. 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

14. USE: Respondents Knowledge of Recommended Treatment

15. USE: Product Availability

16. Management Support • Standard Operating Procedures • Financing • Information management (MIS) • Human resources • Preservice education • Continuing education • In-service education • Monitoring and supervision

17. 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

18. 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?

19. Thank you