Establishing Effective Hospital Drug and Therapeutics Committees: a situational analysis

1. Establishing Effective Hospital Drug and Therapeutics Committees: a situational analysis Ndhlovu C E, Simoyi T National Drug and Therapeutics Policy Advisory Committee, Ministry of Health and Child Welfare, Harare, Zimbabwe

3. Background/Introduction • Not much is known about the existence and operations of hospital drug and therapeutics committees(HDTCs) in the developing world. The Zimbabwe National Drug Policy(ZNDP) was formulated in 1987 and the current edition was published in 1995. One of its objectives was “to encourage health workers to participate in collaborative management of drugs in their institutions in order to promote the rational use of drugs”. • At national level, there is the National Drug and Therapeutics Policy Advisory Committee(NDTPAC) which was established in 1992 and has been active since its inception. At the local level, however, not much seems to be taking place on a formal basis. As a follow up to ICIUM 1997, the NDTPAC established a subcommittee for the Establishment and Organization of Drug and Therapeutics Committees(DTCs) in Zimbabwe1. In 1998, 8 hospitals were chosen as pilot centres for the establishment of formal hospital drug and therapeutics committees. 2 were at central level, 3 at provincial level and 2 were church-related district hospitals and 1 was a privately run hospital.

4. Objectives • To determine the fate of the subcommittee which had been set up by the NDTPAC for the process of establishing HDTCs countrywide. • To find out if the 8 pilot hospital drug and therapeutics committees which were set up in 1998 were still functional. • If they had folded up, to find out why they were no longer functional.

5. Methods • Data about the whereabouts of the original members of the subcommittee of the NDTAPC was obtained through verbal communication with members of the Department of Pharmacy Services in the Ministry of Health and Child Welfare. This data could be also be cross-checked with the pilot centres. The current doctors-in-charge of the hospitals that were pilot centres were contacted by phone and using a standardised questionnaire, data about how much the doctor new about the previous HDTC as well as its fate was obtained. Two of the centres had to be contacted by email as it proved very difficult to get through, by telephone, to the hospitals during the final data collection period which was set to be at the end of February just to make the information as up to date as possible. The demographic data about each hospital was obtained from Ministry of Health and Child welfare databases. The medical superintendent or district medical officer was the key informant.

6. Results • The Subcommittee of the NDTPAC:The original Subcommittee of the NDTPAC for the establishment and organisation of DTCs consisted of 10 members: 3 clinicians and lecturers, 2 Clinical Pharmacologists and 5 Pharmacists. 8 of these members were based in Harare i.e at central administrative level. Only one was based at a Provincial level, this being a Principal Pharmacist. 6 were employed via the University whereas only 3 were Ministry of Health and Child Welfare employees. One was a Pharmacist with the army. Currently this subcommittee is not active. Only half (5) of its members are still based in the country and of these, 3 are employed by the University, I by the MOHCW and the last one is in the private sector. 4 are working outside the country. Only one of this original group is still a member of the NDTPAC.

7. Membership by Speciality

8. Membership by Primary Employer

9. Hospital Size • Hospital size by number of beds

11. Discussion • With the high staff attrition rate especially with regards to pharmacists, it was suspected that none of the pilot centres would still be functional. This was confirmed by finding only one pilot centre still active since 1998. It was interesting to note that this particular hospital had never had a pharmacist and was currently using a nurse aide as their “pharmacy technician”. Their remaining functional is most likely to be explained by having a doctor in charge who has attended a national rational drug use course and who has remained in charge from as early as 1998. • 75% of the doctors asked were aware of the original pilot activities and seemed to blame the demise of the committees to the loss of the original founder members. The NDTPAC itself no longer has within its membership anyone formally trained in the setting up of hospital drug and therapeutics committees. The two resource persons that they originally hoped would spearhead this activity are both now based in the UK and hence not available to implement and help monitor activities on the ground.

12. Conclusions/Recommendations • Most hospitals do regularly hold some administrative level meetings at which drug issues are discussed e.g Medicine division monthly meetings at central hospitals. Such meetings are not formal HDTCs but do carry out some of the objectives of a hospital drug and therapeutics committee such as discussing drug stockouts and observed drug use problems. If their pharmacy issues were well documented, monitored and evaluated, there would not be a need to introduce yet another meeting to already stressed out staff. In view of the high staff turnover at our hospitals, setting up of formal hospital drug and therapeutics committees is proving to be difficult. Hence it is recommended that the objectives of the HDTCs be carried out and monitored via existing regular meetings such as division meetings which are usually attended by the administrators of hospitals. The administrators would ,therefore, collate and feedback all the information from the various divisions so that rational use of drugs can be achieved. Reference: 1. Establishing an Effective Drug and Therapeutics Committee: A practical manual developed in Zimbabwe, October 1999, National Drug and Therapeutics Policy Advisory Committee(draft document)