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Improving Access to Essential Medicines through Public-Private Initiatives:

Improving Access to Essential Medicines through Public-Private Initiatives:. The Case of the Catholic Pharmaceutical Service in Ghana. ABSTRACT. Background. Demographic Profile Population 18,912,079 Sex: Male: 49.5% Female: 50.5% Locality: Rural: 56.2% Urban: 43.8%

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Improving Access to Essential Medicines through Public-Private Initiatives:

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  1. Improving Access to Essential Medicines through Public-Private Initiatives: The Case of the Catholic Pharmaceutical Service in Ghana

  2. ABSTRACT

  3. Background Demographic Profile Population 18,912,079 Sex: Male: 49.5% Female: 50.5% Locality: Rural: 56.2% Urban: 43.8% Growth Rate: 2.7% Health Status U5 Mortality Rate 107.6/1000 Infant Mortality Rate 56.7/1000 Maternal Mortality Rate 214/100,000 Life Expectancy 58years HIV Prevalence 3.8% Population Per Health Facility By Provider Ghana is a tropical country situated in the West Coast of Africa and located between latitudes 4 ˚ & 11˚ North of the equator

  4. Background • Strategies to Enhance Access to Medicines (SEAM) is an initiative created by MSH to improve access to medicines in developing countries. The initiative is funded by Bill and Melinda Gates Foundation • SEAM country programs are developing and testing various models of public-private collaborations to improve access to medicines in the countries participating in the program and also to identify models that can be deployed in other countries facing similar access problems • In Ghana, the Catholic Health Service was identified as one of the two private sector institutions to implement a SEAM Program

  5. Background • Faith-Based organizations provide 40% of all health services in Ghana • The Catholic Health Service, the largest body provides 75% of mission sector health delivery • Services are delivered through 31 hospitals, 66 clinics & maternity homes, 4 drug supply depots, situated mostly in rural areas in 18 autonomous dioceses throughout Ghana • Access problems identified • Availability - drugs out of stock 35% of time • Affordability - Nearly a fifth of daily wage required to treat adult malaria in mission sector • Rational use - average of 5 items on a prescription

  6. Project Objectives • Improve capacity of Catholic Pharmaceutical Service to achieve better pricing and more reliable supply service • Improve quality of prescribing and dispensing services by promoting the rational use of drugs

  7. Organized meetings with Bishops, Administrators, and Hospital managers to get buy-in and consensus agreement on approaches for pooled procurement, MIS and Rational Drug Use Established a pooled procurement model for procuring and delivering medicines to facilities, re-engineered existing structures, carried out a tender for 20 drugs, and trained facilities in inventory management Interventions

  8. Interventions • Trained a team of 4 health professionals from each of 5 hospital on promoting RDU at health facility level using Drugs and Therapeutic Committees, in a ‘learn and do’ cyclic approach Catholic Health Service DTC Design ‘Learn & do’ Cyclic Approach Adapting training Material – Local & Int’l Experts Selection of Facilities and DTC team Training ( 2-days) Implementation And Follow-up in Health Facility (8 weeks)

  9. Results Pre-Intervention Results for Access dimensions of Availability, Affordability and Quality of Service AVAILABILITY AFFORDABILITY RATIONAL USE Post-Intervention Evaluation of Access Dimensions is scheduled for Oct 2004 – Jan 2005:

  10. Key Milestones • Procurement of 20 essential drugs by tender using quantities from 29 facilities yielded on average 20% savings in price • Five facilities piloting the DTC program established DTCs in their facilities after first module training • The effects of these milestones on availability, affordability and rational use of medicines will be determined in a post intervention evaluation scheduled for Oct 2004 - Jan 2005

  11. Implications • Building Capacity and Structures for sustainable implementation of Program • Maintenance, sustainability vrs staff attrition • Providing Technical Assistance vrs Capital Investments • Ownership of program and commitment of implementing partner

  12. Implications • Pooled Procurement Systems • Ability to enforce requirements of tender contracts • Supplier’s Delivery of Goods on schedule vrs Client’s Payment for Goods on time • Timely information flow for forecasting, procurement, payment and delivery decisions • Prequalification of suppliers • DTC Program • Training • Skill development vrs information dissemination • Credible Expert Trainers, local/international • Providing support for institutional work

  13. Conclusions • The project has demonstrated that where there is commitment, appropriate leadership, and ownership, group purchasing program can be implemented to make great savings • The ‘learn and do’ cyclic approach to DTC training has ensured that skills are acquired and maintained through real field experience within the environment of the practitioner • Linking the implementation of pooled procurement with DTC programs strengthens institutional capacity for sustainability

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