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Assessment of Malaria Pharmaceutical

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Assessment of Malaria Pharmaceutical ASSESSMENT OF MALARIA PHARMACEUTICAL MANAGEMENT SYSTEMS IN GHANA Management Sciences for Health December 2009 Assessment of Malaria Pharmaceutical Management Systems in Ghana Daniel Kojo Arhinful Anthony Kusi Kwesi Eghan Chinwe Owunna Martha Embrey December 2009 Strengthening Pharmaceutical Systems Center for Pharmaceutical Management Management Sciences for Health 4301 N. Fairfax Drive, Suite 400 Arlington, VA 22203 USA Phone: 703.524.6575 Fax: 703.524.7898 E-mail: [email protected] This report is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of cooperative agreement number GHN-A-00-07-00002-00. The contents are the responsibility of Management Sciences for Health and do not necessarily reflect the views of USAID or the United States Government. About SPS The Strengthening Pharmaceutical Systems (SPS) Program strives to build capacity within developing countries to effectively manage all aspects of pharmaceutical systems and services. SPS focuses on improving governance in the pharmaceutical sector, strengthening pharmaceutical management systems and financing mechanisms, containing antimicrobial resistance, and enhancing access to and appropriate use of medicines. Recommended Citation This report may be reproduced if credit is given to SPS. Please use the following citation. Kojo Arhinful, D., Kusi, A., Eghan, K., Owunna, C., and Embrey, M. 2009. Assessment of Malaria Pharmaceutical Management Systems in Ghana. Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health. Strengthening Pharmaceutical Systems Center for Pharmaceutical Management Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA 22203 USA Telephone: 703.524.6575 Fax: 703.524.7898 E-mail: [email protected] Web: www.msh.org/sps ii CONTENTS Acronyms ........................................................................................................................................ v Executive Summary ...................................................................................................................... vii Background ..................................................................................................................................... 1 Malaria Policy Changes and Implementation Bottlenecks ......................................................... 1 The Private Pharmaceutical Sector in Ghana ............................................................................. 2 Assessment Methodology and Data Collection .......................................................................... 2 Results of Service and Product Assessment in Health Facilities .................................................... 7 Quality of Care at Private Drug Outlets ...................................................................................... 7 Client Care-seeking Practices ..................................................................................................... 8 Malaria Treatment Practices in the Public and Private Sectors .................................................. 9 Price of Medication ................................................................................................................... 10 Prescribing and Dispensing Analysis ....................................................................................... 10 Availability of Antimalarials and Supplies in the Public and Private Sectors .......................... 12 Results of Supply Chain Assessment in Health Facilities ............................................................ 15 Availability of Standard Treatment Guidelines, Antimalarial Drug Policy, and Essential Medicines List ........................................................................................................................... 16 Average Retail Prices of ITNs and Rapid Diagnostic Tests ..................................................... 16 Quantification Practices ............................................................................................................ 16 Procurement Practices ............................................................................................................... 18 Ordering from the Public Sector ............................................................................................... 19 Ordering from Private Wholesalers/Manufacturers .................................................................. 21 Storage ...................................................................................................................................... 22 Stock Management ................................................................................................................... 23 Causes of Stock-outs and Expiries ............................................................................................ 23 Quality Assurance System ........................................................................................................ 24 Pharmaceutical Management Information Systems ................................................................. 25 Monitoring and Evaluation ....................................................................................................... 25 Results of Regional Medical Stores Assessment .......................................................................... 27 Physical Condition of Stores..................................................................................................... 27 Storage Space and Conditions .................................................................................................. 28 Stock Management Techniques Used for Antimalarials .......................................................... 30 Availability of Tracer Drugs ..................................................................................................... 30 Causes of Stock-outs ................................................................................................................. 31 Information Technology ........................................................................................................... 31 Quantification and Forecasting ................................................................................................. 31 Preselection Criteria for Procurement ....................................................................................... 32 Ordering and Distribution ......................................................................................................... 32 Summary of Key Findings ............................................................................................................ 43 Access and Quality of Care of Antimalaria Medicines ............................................................ 43 Supply Chain Practices in Public and Private Medicine Outlets .............................................. 44 iii Supply Chain Practices in Regional Medical Stores ................................................................ 45 Recommendations ..................................................................................................................... 45 Appendix A. List of Health Facilities Visited by Region, District, and Type .............................. 47 Appendix B. Percentage of Facilities with Storage Conditions in the Pharmacy ......................... 49 Appendix C. Percentage of Facilities Using Stock Management Techniques Used for Antimalarials ................................................................................................................................. 51 Appendix D. Physical Problems with the Storage Facilities ........................................................ 53 Appendix E. Equipment Needed in the Order of Priority ............................................................. 55 Appendix G. Names and Distance to Nearest Wholesalers .......................................................... 59 iv ACRONYMS AS artesunate ACT artemisinin-based combination therapy AL artemether lumefantrine AQ amodiaquine ASH Ashanti region BA Brong-Ahafo region CMS Central Medical Stores CR Central region FEFO first expiry, first out GAR Greater Accra region GHC Ghanaian cedis ITNs insecticide-treated nets LCS licensed chemical seller MoH Ministry of Health NR Northern region PMI U.S. President’s Malaria Initiative PMIS pharmaceutical management information system RMS regional medical store SP sulfadoxine pyrimethamine SPS Strengthening Pharmaceutical Systems [Program] UE Upper East region USAID U.S. Agency for International Development UW Upper West region VR Volta region WHO World Health Organization v vi EXECUTIVE SUMMARY The Strengthening Pharmaceutical Systems (SPS) Program conducted this rapid assessment of the malaria pharmaceutical supply management and information systems in Ghana between January and February 2009 to provide evidence for— Addressing challenges in prescribing, dispensing, quantifying, and reporting practices related to antimalarial management in the private and public sectors Identifying key needs in the private sector supply chain to support strategies to promote artemisinin-based combination therapy (ACT) Evaluating inventory management and warehouse requirements (including infrastructure) needed at medical stores and outlets at regional, district, and facility levels to improve practices and minimize stock-outs, wastage, and leakage of ACTs Key
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