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Agenda

Assessments of the Supply Chain and Forecasting and Quantification of Essential Medicines and Consumables for the MOHS, Sierra Leone, May 2009 PHYLLIS OCRAN CONSULTANT. Agenda. Scope of Work and Objectives Capacity Building Assessments

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Agenda

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  1. Assessments of the Supply Chain and Forecasting and Quantification of Essential Medicines and Consumables for the MOHS, Sierra Leone, May 2009 PHYLLIS OCRANCONSULTANT

  2. Agenda • Scope of Work and Objectives • Capacity Building • Assessments • Essential Medicines and Medical Consumables Quantification • Training Proposal • Logistics Cycle • Challenges • Recommendations

  3. Scope of Work and Objectives • To assess the strengths and Limitations of the current Supply Chain and training needs of the health personnel involved with the supply chain at the districts and central levels. • Forecast the requirements of Essential Medicines and Medical Consumables needed to support the expansion of the Sierra Leone RCH/MOHS Program for the period 2009-2010

  4. Capacity Building Exercise • Strengthening capacity within the MOHS in: • Supply Chain Assessment using Tools • Collection of Logistics and Morbidity data from the field • Reviewing the basic logistic concepts • Data compilation, verification, validation, aggregation, Inputting and analysis of the data • Using forecasting methodologies • Preparing the forecast • Preparing reports on stock status, commodity requirements and estimating Cost

  5. Assessments

  6. Strengths • Policy, Protocols and Guidelines have been established for key intervention areas in Health Systems- • Revised health services cost recovery policy guidelines • Guidelines for the donations of Medicines, Medical Supplies and equipment to Sierra Leone 2004 • The Pharmacy and Drugs Act, 2001, • Public Procurement Act 2004 • Public Procurement Regulations 2006

  7. Strengths Con’t • National Standard Treatment Guidelines • Essential Medicines List etc., • Existence of a National Drug Regulatory Authority in Sierra Leone. • Provision of technical assistance, essential commodities and logistical support by Stakeholders, UN agencies and other NGO’s (UNICEF, World Bank, ADB, EU, UNFPA, MSF, GFATM and others).

  8. Strengths Con’t • Some logistic records in the system -Stock cards -Daily activity registers -Store ledgers -Monthly drug consumption/issuing form Claim forms General requisition/issue note (GRIN), waybill)

  9. Essential Medicines Distribution

  10. Challenges • Lack of technical expertise on some district council’s procurement process. • Often times most drugs procured by council on behalf of the government when delivered has few months shelf life remaining, and this has resulted in a lot of expiries and wastage. • Large influx and availability of sub standard drugs • Lots of expiries because of unstandardized and unfavorable cost recovery mechanisms.

  11. Challenges Con’t • Lots of stock outs throughout the Health Facilities – • Budgetary allocations for essential drugs are often times not adequate. • Drugs Procured inadequate to meet the needs of the general populace.

  12. Challenges Con’t • There are different donors of drugs at the districts and each donor has its own reporting format • This causes some facilities which are the beneficiaries to be significantly overstocked, which can result in expiration, damage, and waste, whilst some facilities lack the medicines expiring elsewhere.

  13. Challenges Con’t • Lack of trained personnel handling the essential medicines. • Low moral of some health workers who are working and are not yet on government payroll • Volunteers serving for long periods expected incentives which were not forthcoming

  14. Challenges Con’t • Logistics management information system (LMIS) is nonexistent for the essential medicines • Poor clinical recordings on patient morbidity • Lack of accurate record keeping and good documentation • Lack of reporting on drug usage

  15. Stock Status Analysis as at May 2009

  16. Quantification

  17. Scope and Purpose • Forecast the requirements of essential medicines and medical consumables needed to support the expansion of the Sierra Leone RCH/MOHS Program for the period 2009-2010 • For the morbidity method, the categories were: -Pregnancy related conditions -Under fives presenting conditions -PHUs presenting conditions -Hospitals (in and out patient) presenting conditions

  18. Assumptions • Total Population of Sierra Leone = 5,400,000 • Pregnancy related Conditions = 5% = 270,000 • Under Fives = 17% = 918,000 • PHUs and Hospitals (out patient and In patients)adjusted for 60% reporting (DPI) • STGs used

  19. Forecasting Methodologies Three forecasting methodologies were considered: • Consumption method (logistics data) • Morbidity method (Demographic/morbidity/service data: no. of patients with health conditions). • Adjusted Consumption method (Logistics data adjusted)

  20. Quantification Results • Essential Medicines • Medical Consumables

  21. Cost Estimates for Commodities

  22. Quantification Challenges • Absence of Logistics data in most health facilities • Inaccurate Logistics data in most health facilities • Poor reporting on most health conditions

  23. Training Proposal • Two days sensitization workshop per group. The groups are: • District Council members especially the procurement Officers • District Medical Officers and Medical Superintendents • Hospital Administrators • Monitoring and Evaluation Officers • DHMT members • Pharmacy Board

  24. Training Proposal con’t • Three to five days training (# of trainings based on 25–30 participants) 10 people national level,1–2 pharmacist from District Hospitals, 1 Pharmacist from District medical Stores, 1 storekeeper from each District Store, 1 In charge of the CHP, MCHP,CHC per districts. 2 hospital midwives in charges. • Ten months of three to five day trainings of all staff throughout the system (919 RCH facilities and CMS, Pharmacy Board etc)

  25. The Logistics Cycle

  26. Recommendations • The MOHS should strive towards having a centralized system for procurement and drug distribution. It could be two agencies operating it on a not for profit basis, one of the agencies can be government owned and the other could be owned by civil society.

  27. Recommendations Con’t • The MOHS should strengthen its procedures for management of essential medicines including procedures for issuing to health facilities, storage, distribution systems, procurement and a system for monitoring facility stock levels of the medicines.

  28. Recommendations Con’t • The MOHS should seek technical assistance to design and implement a Logistics Management System for the Essential Medicines and train all Healthcare Workers managing the essential medicines throughout the supply chain. .

  29. Recommendations Con’t • The MOHS should explore the options of having a scheduled delivery system for the essential drugs and medical consumables. The system would deliver directly from the Central level to the DMS and hospital stores and then to the PHU’s.

  30. Recommendations Con’t • The MOHS should conduct a multi-year forecasts which will be reviewed biannually to enable medium term planning for financing and procuring essential medicines and medical consumables.

  31. Looking across the horizon, the vision spreads so far away. • Old saying…….. • A journey of thousand miles starts with the first step…… • …The MOHS, Sierra Leone is past the second step • THANK YOU

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