Improving Access to Essential Medicines

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

• Faith-Based organizations in Ghana
• Provides 40 of all health services in Ghana
• Catholic Health Service, the largest body
  provides 75 of mission sector health delivery
• Catholic Health Services
• Delivered through 31 hospitals, 66 clinics
  maternity homes, 4 drug supply depots,
• Situated mostly in rural areas in 18 autonomous
  dioceses
• 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

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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

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Key Interventions

• Advocacy to get buy-in and consensus agreement on
  approaches for interventions
• Baseline Survey on access dimensions of
  availability, affordability, quality of services
• Re-engineered existing structures for pooled
  procurement system
• Restricted competitive bidding as a means of
  procurement
• Training in inventory management for facilities
  committed to pooled procurement

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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 Intl
Experts
Selection of Facilities and DTC team
Training ( 2-days)
Implementation And Follow-up in Health
Facility (8 weeks)
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Key Milestones

• Procurement of essential drugs by tender has been
  instituted.
• First Tender for 20 items yielded an average of
  20 savings on price
• DTC established in five facilities
• Has specific mandate to promote the rational use
  of drugs

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Lessons

• Consensus building on implementation approaches
  critical for success
• Prequalifying suppliers assures quality of
  products supplied
• Procurement by tender provides significant
  savings
• Learn and do cyclic approach to delivering DTC
  training effective in imparting skills to
  overburdened health professionals

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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

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Implications

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

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Future Studies

• How to build capacity for sustainable
  implementation of programs
• Ensuring equitable pricing of essential medicines
  
• The effectiveness of DTCs as a vehicle for
  promoting RDU