Transcript EDM STRATEGY FOR WORKING WITH COUNTRIES-TANZANIA Rose Shija EDM NPO TANZANIA Indicators for Tanzania  Population 34.5 million  GNP/Capita  Per $260 capita health expenditure $9  Pharmaceutical annual expenditure.

EDM STRATEGY FOR
WORKING WITH
COUNTRIES-TANZANIA
Rose Shija EDM NPO TANZANIA
Indicators for Tanzania
 Population
34.5 million
 GNP/Capita
 Per
$260
capita health expenditure $9
 Pharmaceutical
annual expenditure per capita
public+private $2
 Allocated
public expenditure per capita-
Pharm $1.30 (02/03)
 Infant
 <5
mortality 102
mortality 154
 Maternal
 Access to
mortality
530
health facilities 93% (1 hr)
 Population
/ health facility
 Immunization
coverage 83%
7,431
Why monitor and evaluate:
Evidence-based planning
1. Assess and Monitor
3. Implement
2. Plan
Monitoring and assessing the
pharmaceutical situation in
Tanzania is important so as to
know more about current
levels of access to essential
drugs that are of good quality,
efficacious and are being used
rationally so efforts to
improve access can be targeted
most effectively.
Objectives of Level II survey

To collect baseline information on the pharmaceutical
sector in Tanzania from the facility to the central level
that can inform prioritisation of plans and
interventions.

To monitor the outcomes of the implementation of
various components of the NDP and the
Pharmaceutical Master Plan to see if the objectives are
achieved.
Survey Methodology

Study Design: Prospective and retrospective
cross-sectional survey including face to face
interviews

Survey Area: 4 randomly selected regions (Dar
es salaam, Kilimanjaro, Mwanza and Mbeya)

Randomly selected per region:
5 public health facilities with pharmacies
5 private pharmacies
1 central/district warehouse
75 households (15 around each HF = 300)
WHO Medicines Strategy
2000-2003
Four strategic objectives:
1. Access - selection, affordability, financing,
supply strategies
2. Rational use - health professionals and
consumers, public and private
3. Quality and safety - standards, effective drug
regulation, information
4. National drug policy - framework for collective
action
Access
Availability of key drugs for treating the top ten
diseases (list of 15 drugs) shows that on the
average 87% of key drugs are available in the
public Health facilities.
Affordability On average 51% and 86% of the
lowest daily government salary (or 4-7 hours of
work) was spent to purchase drugs for
mild/moderate pneumonia from private
pharmacies for children and adult patients
respectively
Stock-out duration The average stock-out
duration for key drugs is 28 days (Median 21.2,
Access interventions

Interventions to look at pricing mechanisms of
pharmaceuticals
 Further strengthening of the Medical Store
Department and its zonal warehouses
 Continuing education in drug management for
all pharmaceutical staff in health facilities
Rational use of medicines
Prescribing indicators
 Average number of drugs per encounter: 1.8
 Percentage of encounters with an antibiotic
prescribed: 42%
 Percentage of encounters with an injection
prescribed: 14%
 Percentage of drugs prescribed from EDL:
98.5%
Rational use of medicines
(cont)
Patient care indicators
 Percentage of prescribed drugs dispensed: 80%
 Percentage of drugs adequately labelled: 76%
 Patients’ knowledge of correct dosage: 80%
 Availability of copy of EDL or STG: 25%
Rational use interventions

Revision of Standard treatment guidelines,
developed with end-users, with active
dissemination and follow-up
 Revision of Essential Medicines lists, linked to
treatment guidelines and used for training and
supply
 Support to Hospital Drugs and Therapeutic
Committees
 Training in RDU
Quality and safety

Of the 83% of key essential medicines for the
top 10 diseases which were on the shelves in
public health facility pharmacies, 13% were
expired

11 basic minimum criteria for adequate storage
of medicines were met by 82% of warehouses
and 64% of public pharmacies
Quality interventions -HF

Drug management training includes good
storage practice
Quality interventions TFDA
(cont)

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Update existing guidelines, procedures, forms
and develop new ones, including SOP´s for
inspection, ADR monitoring and drug
advertising and promotion
Purchase and network computers
Create website
Provide dissolution apparatus
Purchase reference standards
Post-marketing surveillance of drugs
Quality interventions (cont)

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Train staff locally in drug registration, drug information
development and dissemination and monitoring of
promotion materials
Train staff abroad in QC Laboratory management,
validation of analytical methods, and developing
reference standards
Train inspectors in GMP
Organize workshop on GMP and GDP for
manufacturers, importers and wholesalers
Organize workshop for drug regulators for the lab,
police and customs and prosecutors
Consumer education campaign using radio/TV spots,
posters and brochures
Future priorities

Continue support strengthening of health
systems and human resources

Monitor impact- re assess and adjust
plans according to needs and
performance