Impact of Training, Monitoring and Mentoring on Medicines Therapeutic Committees in Ghana presenter Kwesi Eghan Chinwe Owunna, Kwesi Eghan and Johannes Addison Presented at the International Conference on Improving Use of Medicines (ICIUM) Antalya, Turkey, November 14 - 18, 2011
Presentation • Medicine Use in Ghana • Background and design of study • Results • Key Lessons • Conclusion
Medicine Use in Ghana • National Drug Policy • Ghana has a robust processes for development and reviews of EML, STGS (6th edition) • Training on RUM and establishment of MTCs in several Health Facilities (primary care level) • Key Players-Ministry of Health (Dept of Pharmacy and Ghana National Drugs Program), WHO, Development Partners (e.g DFID) and MSH/SPS
Background to study • Ghana’s antimalaria drug policy (AMDP) changed in 2004 & 2007 to include the use of artemisinin- based combination therapy (ACT) for the treatment of uncomplicated malaria. • High circulation of Monotherapies. • Negative publicity on Amodiaquine -Artesunate (AS/AQ) due to (anecdotal?) reports on adverse drug effects. • Non compliance by health facilities to revised AMDP
Objectives • To improve health facility Medicines and therapeutics committee’s (MTC) understanding of the new National Anti malarial Drug Policy and • Show how supportive supervision using academic detailing can improve rational medicine use and compliance to AMDP at public health facilities.
Design • Before- and- after study with no control group. • post-intervention evaluation in two facilities at month 6
Drug and Therapeutics Committees (DTCs) Improve the Use of Medicines and Preserve Effectiveness of Antimalarials • Manage formulary • or essential medicines lists • develop and implement • monitor compliance • Identification of medicine • use problems • Indicator Studies • ABC Analysis DTCs • Training programs • In-service • Pre-service • Collaborations • With hospital departments • Infection control • Microbiology • Pharmacy • Hospital Management • Medicine Use • Interventions • compliance with treatment guidelines • drug use evaluations • support for • pharmacovigilance
Intervention • Trained in collaboration with MoH Pharmacy Department 155 MTC members from 48 facilities on rational medicine use and the new AMDP. • Conducted supportive supervisory visits at 20 of the 48 health facilities, mentored DTC members and facility prescribers to improve practices. • Supportive supervisory tools used focused on; • Process indicators • Impact and outcome indicators– quality of prescription - quality of care -adherence to documented treatment policies • Post visit one-on-one discussions (academic detailing) with prescribers, dispensers and group meeting with DTC members • Percentages of indicators related to AMDP compliance • Other parameters were measured website :www.sps.org
What key lessons can we learn from your work? • Training followed by regular supportive supervision is an effective way to improve adherence to treatment policies • Supportive supervision and monitoring has resource implications- time and money • For the intervention to be fully accepted by health workers, buy-in and full collaboration of the MOH (NMCP and pharmacy unit of GHS) is key
What specific studies should be included in a future research agenda on your topic? • Review the Long term impact of training and supportive supervision- especially use of ‘academic detailing’ and monitoring on health worker behaviors to improve RMU
Conclusion • Although training, supervisory visits, and mentoring can be resource-intensive, the survey showed that these interventions improve rational medicine and increased adherence to AMDP.