Prepared by Dr. Sok Srun and Dr. Chroeng Sokhan

2. CAMBODIA EXPERIENCES ON MTP (MONITORING-TRAINING-PLANNING) TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPITAL Prepared by Dr. Sok Srun and Dr. Chroeng Sokhan

3. 1- Background • Previous indicator-based supervision and monitoring program in Cambodia did not show significant improvement. • Inappropriate prescribing practices in health facilities • Intervention to improve prescribing is uneasy to conduct, especially in private facilities • Interventions needs to be incorporated in the existing management system

4. 2- Objective • To discuss the problems of drug use in the health care system • To discuss the efforts in improving drug use carried out so far • To develop the innovative strategy for rational drug use in the health care system.

5. 3- Intervention Method (Stage 1) • Select 6 pilot hospitals • Assign 6 people of each hospital as Hospital MTP Teams • Training of MTP Teams on MTP process • Schedule the meeting to: • define problems on drugs use • develop an innovative strategy to improve drug use • define target • monitor the implementation and evaluate the achievements • National evaluation workshop • Wider implementation (Stage 2) if Stage 1 is successful

6. 4- Self-monitoring vs MTP Periodic evaluation at MOH Self- Monitoring strategy Indicator Indicator Indicator Indicator Indicator Indicator Indicator M T P M T P M T P M T P M T P MTP approach

7. 5- Stage 1 :Result: 1 Kandal RH: Reduction of AB use in normal delivery

8. 6-Stage 1:Result: 2 Kg Cham: Reduction AB use in post Cesarean and Post Scrotal Hernia surgery % of patients receiving antibiotics Reduction of the average medicine cost per patient from 15.3 to US$ 6.1 (US$ 2000/month)

9. 7-Intervention Method (Stage 2) • Select 7 pilot hospitals • Assign 6 people of each hospital as Hospital MTP Teams • Training of MTP Teams on MTP process • Schedule the meeting to: • define problems on drugs use • develop an innovative strategy to improve drug use • define target • monitor the implementation and evaluate the achievements • National evaluation workshop involving hospitals from Stage 1 • Nation-wide implementation if Stage 2 is successful

10. 8-Stage 2: Result 1 Siem Reap RH:AB use in Traumatology Ward

11. 9-Stage 2: Result: 2 OM Chhey RH: IV Fluid reduction in normal delivery

12. 10- Stage 2: Result 3 (Battambang) IV fluid reduction in the Maternityand the Trauma Ward AB Reduction in the Malaria Battambang

13. 5- Conclusion (1) • Flexible approach, not time-consuming, not costly to improve appropriate use of drugs in hospitals • MTP is good for solving sensitive problems • Encourage Hospital Technical Committees to initiate activities in improving appropriate use of drugs • A comprehensive approach, a combination of adult learning and managerial strategies. • Involving stakeholders in hospital, the “negative” consequences of rational drug use could be discussed accordingly

14. 5- Conclusion(2) • MTP can be implemented in both sector public and private. With the supports from PHDs, MTP can be used to solve drug use problems by themselves. • MTP can be extended nationwide. The “right people” should be selected from each hospitals. • If MTP imlementation is conducted with monitoring, supervision, and continuous training, MTP can reduce the health care cost. The community will participate and support this efforts • To reduce the prescribing problems and improve RUD for healthcare workers and patients.