March 2013 - September 2013

Bi-Annual

HEALTH COMMODITIES & SERVICES MANAGEMENT PROGRAM ANNUAL PUBLICATION

A publication of USAID funded Health Commodities and Services Management Program ImplementedNewsletter by Management Sciences for Health

IN THIS ISSUE: • Kenyatta National Hospital Launches formulary • reporting goes electronic • HIV commodity logistics management information system Launched • Focus of Lab Commodity Management Practices Contents March 2013 - September 2013

Laboratory Interview on Lab commodities Managment...... 4 Supporting the Improvement of Malaria Case Management in Kenya ...... 6 Pharmacovigilance Reporting Goes Digital in Kenya ...... 7 Launch of KNH in pictures...... 8 Electronic tool for better HIV Treatment in Kenya...... 10 Launch of the Nutrition Service and Commodity Data Management System ...... 11 8/9 Assessment of Continuing Professional Development Programs for Pharmacy Professionals ...... 12 HCSM Updates Innovation in the use of electronic support tools for ADT project implementation support...... 14 Provincial General Hospital Kakamega Pioneers Medication Safety Self Assessment (MSSA) through Innovation Challenge Fund (INCH) ...... 15 KMTC Medical Training College (KMTC) Update ...... 16 Applying Pharmacoeconomics and Health Technology Assessment (HTA) to Essential Medicines Selection Workshop...... 17 REGIONAL UPDATES ...... 18/19 PICTURE SPEAK...... 20 Support to devolvement of health services...... 22 14 2 Commodities Word Search...... 22 Management Job Aid: Guidelines for Proper Storage of Health Commodities...... 23

10/11 NEWS BRIEFS

EditorialPatrick Bourret, Constance team Orata, Lillian Gitau, Cover Joseph Mwangi, Antony Mwangi, Peter Nguhiu, Josphat Samoei, Alex Muturi, Robert Kimbui Page Charles Ouma, Charles Njuguna Vivian Akinyi a data collector in the Malaria Quality of care survey interviews 23 Sherry Adisa year old Zuleka Hamisi and her 9 year old sister Mwanahamisi after receiving Design & Layout: treatment at Mswambweni District Hospital Editor: Yvonne Otieno

Want to subscribe or submit articles to this newsletter? Have any questions, comments, feedback ? Please emaill the Editor -Yvonne Otieno on [email protected] Dear Readers, It is now two and half years since the launch of the Health Commodities and Services Management program in Kenya. Since it’s inception, the Health Commodities and Services Management (HCSM) program has collaboratively worked with the Ministry of Health in strengthening commodity management, strengthening pharmaceutical services, and laboratory services. Strengthening systems that deliver quality health care commodities and services close to the family remain the focus of the Health commodities and Services Management program even as the country transitions into devolved system of governance. While the project is managed from Nairobi, it has senior staff embedded into county implementation support structures to ensure quick and seamless transitioning of systems from conceptualization to implementation, especially in line with the Constitution of Kenya. The project works collaboratively with regional county and national stakeholders that include, ministry of health, counties governments, development partners, non-governmental, faith-based and private sector organizations. In this second issue of the Newsletter we present a snap shot of some of the interventions implemented at the central and county level in strengthening supply chain management and commodity security, improving pharmaceutical service delivery, promoting medicines quality assurance and pharmacovigilance and strengtheing laboratoy system and service delivery Laboratory diagnosis and monitoring is an integral component of quality health service delivery. The provision of quality laboratory services is dependent on an uninterrupted supply of laboratory commodities, this is the focus of the first article where Edward Beja, shares his experience on skills transfer and of use of lab commodity tools. Another highlight of the last six months is the recent launch of the Kenyatta National Hospital (KNH) formulary. This is the first locally produced comprehensive hospital formulary and puts Kenyatta National Hospital at the forefront of providing quality health services in the country. The programme lauds the KNH team and is proud to be involved the development process. Another first is the launch of the electronic Pharmacovigilance reporting system that will make reporting on poor quality medicines and adverse drug reactions easier for health workers. Also featured are stories that show how innovation can help in ensuring continues access to medication to patients like Mzee Ahmed and his son who have been receiving Anti- retroviral for the past six years. Faith based organizations have contributed immensely to the health sector in Kenya and some of the interventions supporting their work are featured in the regional updates. These, are just a few of the stories documented in the newsletter and we hope that you will enjoy reading as well as testing your skills in the word search puzzle. Working collaboratively working with Ministry of health, HCSM will continue supporting and informing policies and laws as well as strengthening systems for better pharmaceutical and laboratory services and commodity management. This need is greater especially as the country transitions to the devolved system of governance. Together we can achieve Kenyans’ constitutional right to access to quality healthcare. Happy Reading to all, John Chimumbwa Chief of Party, Health Commodities and Services Management (HCSM) Program

Disclaimer: The information provided in this Newsletter is not official U.S Government information and does not represent the views or position of the U.S Agency for International Development or the U.S Government.”

3 March 2013 - September 2013

Laboratory Interview on Lab commodities Managment By Yvonne Otieno, Susan Gathuo and Samuel M Mbugua

Strengthening of the laboratory commodity management system has required a variety of approaches due to the complexity of the challenges. The Health Commodities and Services Management program has been implementing a comprehensive approach in building both the human and institutional capacity to manage laboratory commodities.

In collaboration with National laboratories services (NPHLS), Division of diagnostic and forensic services (DDFS), National blood Transfusion Services (NBTS) and other stakeholders. The program developed a laboratory commodity management curriculum that has been used to train 89 laboratory trainers of trainers (TOTs) staff. Edward Benja, one of the TOTs , shares his experience on knowledge transfer and of use of lab commodity tools.

Please tell us Commodities are stored within the recommended more about temperatures as per manufacturer’s instructions and this is yourself? monitored by a temperature chart/log. My name is A daily activity register is also used to record consumption Edward Benja. I of commodities on a daily basis at a particular user point. am the previous District Medical Laboratory Technologist for This tool is useful in compilation of the monthly consumption Kaloleni. My duties involve providing leadership in lab related report. activities within the region. Part of this work is laboratory commodity Management which entails establishment of good inventory practices at facilities. By the 5th of every month all facilities are How did you learn about Commodity management? required to submit reports to the District. The reports are then compiled and validated at the The pre-service curriculum at the institutions of learning district before submission to KEMSA by 10th provides basic learning from Diploma, Higher Diploma, Bachelor of Science, masters of Science and PhD but of every month using lab facility consumption commodity management is usually not covered. The first data recording and reporting (FCDRR). training I attended in commodity management was in 2009 under the SPS/MSH program where different departments including nursing officers, District Medical Laboratory How else do you support commodity management? Technologist and pharmacist were oriented on Commodity Besides mentoring the lab staff on use of lab tools; we also management. In 2011 I was selected to undertake a training provide them with job aids that assist them to effectively of trainers (TOT) on lab commodity management conducted manage their commodities at the facilities. This job aids by USAID funded Health Commodities and Services includes guidelines on proper storage of health commodities, Management program. good inventory management and quantification of Laboratory How do you support Laboratory Commodity commodities. management? Why is it important for the data to be accurate? As a Trainer of Trainers in Lab Commodity management, I In quantification, data is power; and proper and accurate focus on empowering lab staff by mentoring and training documentation gives you that power. This includes them on proper use of lab, how to order, receive, store and determining how much you need; how much you received, report on laboratory commodities. how much is in stock and how much was used or consumed. What are some of the tools used in lab commodity Accurate data reduces stock outs, expiries, wastages and management? encourages accountability. Some of the tools used include stock cards which is a key Is there any difference since you begun the trainings in inventory management tool. This is where all commodities Lab Commodity Management? receipt and issued are recorded. The tool also indicates the When inviting participants for commodity management stock on hand. training, alongside the invitation, we request the participants Another tool is the Expiry tracking chart which helps track to take photos of their facilities showing how the y store expiry dates of commodities. This tool is usually placed at a commodities and how they record their commodity usage. strategic point that is visible to all in the lab to know when a This gives a baseline so that the trainees can see the lab commodity is close to expiry and plan to take an action to difference on how they work before and after the training. avoid wastage. Initially when we started the training, the biggest challenge

4 March 2013 - September 2013

we faced was a lack of knowledge on how to use the tools. We realize that most facilities had the tools but the tools were stuffed up in shelves and quite a number of tools were lying around without being used.

In quantification, data is power; and proper and accurate documentation gives you that power. This includes determining how much you need; how much you received, how much is in stock and how much on when the activities will be achieved. The action plan is was used or consumed. Accurate made in duplicate – a copy for the participant and a copy data reduces stock outs, expiries, for the trainer. wastages and encourages After the training, we see marked differences with accountability, Edward Beja. more people using the commodity management tools. Some individuals still need support to improve on the During the training, a key output is an action plan use of the tools and we offer this through on the job developed by the participants. These action plans have training, mentorship and Supportive Supervision. During details on priority activities for improvement in commodity Supportive supervision we check on the progress made by management identified by the participant with timelines referring to the action plans developed by the participants during the training and offers any additional assistance.

THERE ARE MEDICINES WE CAN‛T SELL TO WHERE IS THIS WORLD COMING TO?! I THINK YOU UNLESS YOU HAVE A CLEARANCE FROM YOU SOLD ME AN EXPIRED MEDICINE. A DOCTOR TO CONSUME THEM.

I AM SORRY SIR BUT IT WILL BE IT IS PROCEDURE. OKAY. I ALREADY KNOW Script by Yvonne Otieno THE CURE FOR MY DISEASE. I and Art by DON‛T NEED A Bella Kilonzo DOCTOR. EXPIRED? ARE YOU SURE?

OF COURSE. LOOK AT THESE I AM POSITIVE ABOUT IT. I RASHES. IT ALL BEGAN SOON TOOK THE FIRST DOZE IN THE WE PLAYED OUR PART. BUT YOU AFTER I STARTED TAKING MORNING. I STARTED FEELING NEGLETED YOURS. YOU DIDN‛T WAIT A MINUTE. YOUR MEDICINE. ITCHY AFTER TAKING THE FOLLOW THE INSTRUCTIONS IT IS CLEARLY STATED SECOND DOZE AT LUNCH HOUR. THAT YOU OUGHT TO. AFTER THE THIRD DOZE THIS HERE, 1 X 1 NOT 1 X 3. EVENING...

SO AM I AT ANY MAYBE YOU HAVE RISK NOW? AN ALERGY TO SOMETHING. ARE JUST FOLLOW THE YOU SURE IT IS INSTTUCTIONS BECAUSE OF THE AND THE RASHES WILL MEDICINE? EVENTUALLY DISAPPEAR.

THAT IS A GOOD EXAMPLE I GLAD I NOW SEE YOUR WHY WE CAN‛T GIVE THOSE YOU NEVER I‛M OKAY. POINT. TOMORROW HIGH BLOOD PRESSURE DRUGS KNOW. I‛LL SEE MY DOCTOR. UNTIL WE ARE SURE IT MAYBE IT‛S A WON‛T CAUSE ANY CASE OF ANXIETY. HARM TO YOU. MAYBE YOU DON‛T NEED TO TAKE ANY DRUG.

CONTENTS ABOUT THE SUBJECT...

5 March 2013 - September 2013

Supporting the Improvement of Malaria Case Management in Kenya Alex Muturi and Robert Kimbui other malaria and treatment policy, and shares any related health recommendations with all stakeholders. systems support Kenya benefits from the survey due to activities in public improved malaria case management health facilities. which is one of the key interventions Adherence to the required to ensure the goal of reducing treatment policy malaria prevalence in Kenya. of 2010 at the facility level is key In round five of the survey, anti-malarial in ensuring better treatment for test negative patients case management. decreased from 52% to 20%. Such a decrease translates to to greater cost A key benefit of savings. the survey Physical count of commodities at Railway Health Centre, Mombasa is analysis National guideline recommendation County of trends for management of uncomplicated for selected malaria is that “All patients with In 2010, Kenya changed the malaria indicators fever or history of fever should be case management guidelines to that then inform interventions for tested for malaria and only patients advocate for testing of all suspected improvement in case management who test positive should be treated malaria cases before treatment with practices as well as results of for malaria” & “recommended first ACTs. Prior to that, the guidelines previous interventions. Some of the line treatment for uncomplicated allowed for treatment of fever as malaria key indicators observed include malaria in Kenya is artemether- in areas of high malaria transmission. availability of basic equipment and lumefantrine”. Since then, Kenya has made significant malaria diagnostics e.g. Microscopy USAID through HCSM has been improvement in case and Rapid providing support to the Division of management Diagnostic Test Malaria Control in building human and of malaria. The Kits, availability institutional capacity for prevention and improvement includes of anti-malarial treatment of malaria cases. The support an increase in Malaria drugs, availability includes training of health workers, diagnostics with better of national provision of job aids, tools and check case management malaria case lists for management of medicines practices observed management including dispensing to patients, countrywide – guidelines and dissemination of guidelines and other increasingly, only job aids, and materials among others. patients who exposure to in-service test positive for HCSM has also provided support to training and Malaria parasites the Division of Malaria Control on the supervision are treated with an malaria surveys through data collection among Antimalarial drug. and analysis, supervision of the others. process, printing and dissemination of This is according to the finalized reports for all five rounds results of round 5 Information of the Malaria Quality of care surveys of Malaria quality of from the conducted since January 2010 to care survey which survey is November 2012. Over the month of helps monitor the also used June 2013, round six of the nationwide out patient malaria by key survey which has 21 data collectors,10 case management stakeholders Team leaders visiting 172 facilities under the 2010 Dr. Soti of DOMC adreses participants during the in the launch of Malaria QoC report countrywide. There is also continued treatment policy in management support to the Division of Malaria Kenya. of malaria in the country Control to conduct such surveys, The survey which is part of a monitoring for example, the case management and regular monitoring of all the key process helps to assess national technical working group uses the data indicators to ensure that 2010 malaria level trends in the availability of anti- to monitor compliance to the treatment diagnostic and treatment policy is malarials, malaria diagnosis and guidelines as set in 2010 Diagnostic effective.

The survey is the product of collaboration between the Division of Malaria Control, USAID funded Health Commodities and Services management program, the Global Fund to fight AIDS, Tuberculosis and Malaria and Kenya Medical Research Institute /Welcome Trust research program.

6 March 2013 - September 2013 HCSM FOCUS Pharmacovigilance Reporting Goes Digital in Kenya By Yvonne Otieno and Kusu Ndinda

The Permanent Secretary in the Ministry of Information and Communication, Dr.Bitange Ndemo, said that he will ensure that Kenyans access this digital pharmacovigilance reporting system and report from their mobile phones free of charge

Monitoring and reporting of adverse drug reactions (ADRs) the PPB to strengthen and implement an integrated and poor-quality human medicines has gone digital in Kenya. pharmacovigilance system in collaboration with WHO, among other organizations,”said Dr.NdindaKusu, the Deputy Chief of Medical experts and patients can now detect, assess, and Party at the HCSM program in Kenya. report unpleasant reactionsto pharmaceutical products in real time to the Pharmacy and Poisons Board’s (PPB) By the time of launching the e-reporting system, the PPB National Pharmacovigilance Centre. The goal is to ensure and had received over 6000 reports and over 370 reports. This enhance . influx of information has resulted in quarantining, recalling, or withdrawing some medicines; changes in labeling; line The Board began establishing a process of monitoring and inspections for continuous Good Manufacturing Practices; reporting ADRs in 2004, and the National Pharmacovigilance and, in one case, the closure of a pharmaceutical company System was officially launched on June 9, 2009. that was not meeting regulatory requirements. However, since then, reporting has been done manually Dr. Pandit using printed forms—a yellow form for reporting suspected said that Post the launch of the PV e-reporting ADRs and a pink form for reporting suspected poor-quality negotiations medicines. system the PPB has received additional were 1690 ADR reports and 119 poor quality “This was a tedious process because we had to make underwayto medicine reports. Of these reports, sure that the forms are printed, then transported to various have an health care facilities throughout the country, ensuring every application for 648 ADR reports and 57 poor quality department within the facility has these forms, then feedback the system on medicine reports were received via the collected using the same process,” said Dr. Jayesh Pandit, mobile phones, e-reporting system. More health care who heads the Department of Pharmacovigilance at the particularly providers are now shifting to use the PPB. “Moreover, when reports come back to the National Nokia, Android, Pharmacovigilance Centre, we then have to manually enter Apple, and less tedious and innovative e-reporting them into the WHO recommended database, which all added Black Berry system. to our costs and loss of time,” says Dr. Pandit. platforms. The new digital system, which was launched on April 23, The Permanent Secretary in the Ministry of Information and 2013, does not require paperwork at all. The application can Communication, Dr. Bitange Ndemo, said that he will ensure be downloaded either on a computer or a smart phone, or that Kenyans access this digital pharmacovigilance reporting the report can be made directly to the PPB on their website system and report from their mobile phones free of charge. (http://www.pv.pharmacyboardkenya.org). It is believed “There is no single medicine in the world that is 100 percent that the digital system will make reporting easier, more safe,” said Dr. Pandit. “It is not possible to know everything cost effective, and prompt, and will serve to build its own about a particular medicine just through clinical trials. That is database for future reference. why pharmacovigilance becomes an important process for The system is based on an open-share Linux software further monitoring of all drugs in the market.” platform, designed by the PPB and developed in Kenya By launching the system, Kenya becomes the first country by Intellisoft Consulting, a local IT firm with financial and in Africa and in the world to use a digital reporting tool for technical support from the Health Commodities and Services pharmacovigilance based on mobile technology. Management Program implemented by Management Sciences for Health (MSH), with funding from USAID. “In general, the USAID, through the Health Commodities and Service Management program at MSH, has been supporting

7 HCSM Updates March 2013 - September 2013 Launch of KNH Formulary in pictures By KNH Communications

Unveiling the Kenyatta National Hospital (KNH) Formulary

Kenyatta National Hospital has unveiled a new Formulary at Formulary (BNF) which at times have not addressed an event that was held at the hospital administration grounds information requirements of local institutions. on 6th September 2013. This is the first locally produced Speaking on behalf of United States Agency for International comprehensive hospital formulary and puts Kenyatta National Development who funded the development of the formulary, Hospital at the forefront of providing quality health services in the country. The KNH formulary consists of a list of all medicines used at KNH and guidelines on their prescribing, dispensing and medicine information to be provided to patients. The formulary is intended to promote safe, efficacious, rational and cost effective supply and use of pharmaceuticals. While presiding over the launch, Dr. Rachael Nyamai (Consultant Pediatrician) who represented the Principal Secretary, Ministry of Health, applauded KNH’s efforts in setting global standard in health care services. “These initiatives are important to steer the Hospital to compete both locally and internationally” Said Dr. Nyamai. Appreciating the contribution made by various partners in the development of the formulary, Dr. Nyamai added that Kenya Dr. John Chimumbwa ,Chief of Party Health Commodities and Services requires both public and private sector in order to realize Management (HCSM) program addressing guests at the launch universal healthcare and Vision 2030. Dr. John Chimumbwa ,Chief of Party Health Commodities and “With the support of the private sector and non-governmental Services Management program said that USAID’s funding organizations, Kenya can make strides to be the regional to support the development of the formulary “is part ofta provider of choice for specialized health care,” said Dr. broader U.S. Government commitment to strengthen the Nyamai. Kenya to to improve access to quality health Mr. Carylus Odiango, Deputy Director (FA) representing the services for all Kenyans.” acting KNH CEO. KNH CEO’s, stated that the realization of He also lauded the KNH Management and the hospital’s the formulary has indeed reinforced the Hospitals position in Medicines and Therapeutics Committee for their stewardship policy formulation in the health sector. ‘The team has given of the process that has culminated in-the launch of the us a medicine reference document that reflects our national formulary. commitment to quality healthcare’, said Mr. Odiango. “This event firmly entrenches the hospital as a leader in the Traditionally, African countries have relied on borrowed East African region in the provision of quality health care to its formularies from other countries e.g. the British National clientele,” Dr. Chimumbwa, Chief of Party, HCSM.

8 March 2013 - September 2013

Dr Thomas M. Mutie, Senior Asst Director, (KNH), Dr. Enoch Omonge, Chairman, Formulary Review Sub-committee (KNH),- Dr. William Sigilai, ` Chairman. Medicine & Therapeutics Committee (KNH), Mr. Carylus Odiango, Representing the Acting KNH Chief Executive Officer, Prof. Anastasia Guantai, AZ Dean School of Pharmacy, College of Health Sciences, Dr. Rachel Nyamai,Rep. Principal Secretary, Ministry of Health,- Dr. John Chimumbwa, Chief of Party, HCSM, Dr. Sarah Chuchu, Deputy Chief Pharmacist, Ministry of Health

Kenyatta National Hospital is a National Refferal and Teaching hospital that attends over 700,000 patients annually, with over 2,500 inpatients at any given time. The launch of the Formulary will help in improving patient care as it provides current, evidence-based and impartial medicine to all the health providers at the institution. Copies of the formulary will be distributed by the KNH pharmacy to all clinical departments and wards in the hospital while electronic versions in PDF form will also be made available.

Kenyatta National Hospital Choir choir entertains guests at the launch

Members of the KNH Medicines and Therapeutics Committee and key guests during the launch of the formulary

Images by Yvonne Otieno/MSH

9 NEWS BRIEFS March 2013 - September 2013 Electronic tool for better HIV Treatment in Kenya By Yvonne Otieno wife runs a food kiosk. Our son Juma is in school and plays and studies like other children. Our last born is two months old and he was born negative,” says Ahmed. “I owe our lives to ARVs and following instructions given by doctors,“he adds.

Antiretroviral drugs (ARV’s) work to boost the immunity of HIV patients and reduce the risk of opportunistic infections – it’s a complex, life- long treatment that must be strictly adhered to. Missing a routine doctor`s appointment, or failure to adhere to the treatment plan, can impact both the Mzee Ahmend and his son individual and the community. Incorrect dosing or missing as little as one dose “I have encouraged four of my friends to get tested and they puts a patient at-risk of developing agreed. They are now living happy with full drug resistance, which means the knowledge of their HIV status and faithfully virus becomes resistant to certain getting Anti-retrovial treatment,’ says Mzee antiretroviral drugs. If detected early, Ahmed who has brought his six year old most types of drug resistance can be son to Port Reitz Hospital to collect his Anti managed by changing drugs. If it is retroviral drugs. not detected early, the drug-resistant virus will continue to multiply, thereby His son is the fourth born in a family of causing a patient’s health to fail and five children. Mzee Ahmed, his wife increasing the risk of infection to others. and his son Juma are positive while Ahmed’s younger brother was born negative.

“My wife was the first to discover her status. After giving This is the message that Juma shares with his friends. birth, my wife started feeling unwell and when she came to “I tell friends that it is better to learn your status and get hospital she was admitted. She received some counseling treatment if found positive. For the past six years, we have and was tested and the results were positive for HIV. Juma come for medication sometimes after a month of two months was also tested and found to be positive, says Ahmed’ for refills and never have we missed any drugs.” “After learning my wife’s status, it took me awhile to get Dr. Dominic Miruka Nyamwega, pharmacist at Port Rietz tested but I eventually got the courage to get tested. The test credits the availability of drugs to the use of an electronic was positive and I was also put on Antiretroviral treatment,” Antiretrovirals Dispensing Tool (ADT) – easy-to-use electronic explains Mzee Ahmed pharmacy management software, which has helped in This was six years ago. The two were immediately put on effectively managing HIV medications. antiretroviral treatment. Mzee Juma says that by the time he The dispensing tool allows pharmacy staff to keep track of learnt of his wife status, there was still a lot of stigma and fear patient information, and records on the antiretroviral drugs of HIV. prescribed and dispensed. Keeping track of medication Though his wife and son get their medication in Port Rietz consumption allows staff to accurately forecast the amount hospital but Mzee Siadi gets his medication from Bomu of medicines needed. In order to effectively treat the virus, Medical Centre, Mkomani area which is 3 km from Port Reitz. health providers must maintain an uninterrupted supply This is not a rare occurrence as many seek treatment far of antiretroviral drugs and medicines to treat related away from their homes to escape the stigma that can be opportunistic infections associated with being HIV-positive – the good news is that As at end of June 2013, 619, 669 patients were on ARTs. they always get their ARVs whether in Port Rietz or Mkomani. Total adults on ART were 561,774 and total of 57,895 children Mzee Ahmed explains that when they were put on were on ARTs. antiretroviral treatment, he and his wife were given Mzee Ahmed and his son are just two of the over 600,000 instructions on when to take the drugs and given patients who present their card and prescription at the appointments on when to come for refills. pharmacy window. The healthcare workers then confirm “I didn’t not expect that we would still be alive this long. My patient’s biographical information and match the drugs on the wife and I still live normal lives, I am a mechanic while my prescription, with the drug history stored in the dispensing Continues on Pg 11

10 March 2013 - September 2013

Launch of the Nutrition Service and Commodity Data Management System By Cecilia Muiva & Yvonne Otieno

Nutrition is a major determinant of good status of the HIV-positive population, since a standardised Nutrition logistics health, especially among people living nutrition indicators are tracked. These can management information system (LMIS) with HIV & AIDS (PLWHA) in developing only be compiled from routine data collection was lacking to monitor usage and assist countries. The Kenyan Constitution and the and reporting by health facilities on both in determining national commodity Kenya recognise nutrition as nutrition service and nutrition commodity requirements and resupply to health important in disease prevention, disease usage. Indeed this vital role of capturing facilities. management and maintenance of health. nutrition data was emphasised by Dr. Francis To address this challenge, NASCOP and The Kenya Health Policy (KHP) 2012- Kimani, the Director of Medical Services its partners, with technical assistance 2030 aims to ensure significant reduction (DMS) during the launch of the Nutrition and support from USAID-funded MSH/ in overall ill-health in Kenya in line with service and commodity data management HCSM and Nutrition HIV Program (NHP), the country’s Vision 2030 and the Kenya system, held in Nairobi in February. This developed a harmonized data collection and Constitution, 2010. The KHP Objectives 2, workshop invited Ministry of Health officials reporting system accompanied by service 4 and 6 are relevant to Nutrition services i.e and regional MoH and stakeholders for and LMIS tools, which will ensure that the halt and reverse the rising burden of non- sensitization on the new Nutrition data protocol to be followed for providing HIV communicable conditions, provide essential management system. Dr. Kimani lauded the nutrition services and managing nutrition healthcare and strengthen collaboration with launch of the Nutrition data management commodities is harmonized across facilities health-related sectors. In the KHP, nutrition is system which aims to provide standardized and supply chains. These will reduce identified as one of the 8 social determinants monitoring and reporting for nutrition duplication of supply chain activities and of health (preventive and promotive), with the services beyond HIV care and treatment. tie in with the other existing commodity strategy being to ensure adequate nutrition He noted that antiretroviral medicines given and service data management initiatives. for the whole population through avoiding without the proper food cause gastric NASCOP, NHP and MSH/HCSM also and managing over or under nutrition. discomfort among other complications in developed sensitization materials that have a patient on Antiretroviral therapy. Good been used to sensitize health care workers. The Kenya Health Demographic Survey nutrition however assists the HIV-positive (KDHS) 2008/9 shows that 5.8% of The National AIDS & STI Control Program patient who requires chronic care to maintain children are wasted and 29.6% are (NASCOP) noted that there is need good health. He noted “Proper feeding can stunted in growth; while for women, to sensitize the health workers and help reduce the disease burden, proper 12.3% are thin and wasted while 18% stakeholders at the various levels on how to prescription of clinical nutrition can help save are overweight and 7% are obese. fill the LMIS tools and submit reports to the money which could be used to focus on national level using the identified reporting other development areas.” channels. NASCOP therefore presented a People living with HIV & AIDS require good One of the major challenges facing the proposed rollout plan that progressing from nutrition as part of their care and treatment. Nutrition program has been the lack of a this launch will see the regional and facility This requires the ministries of health to harmonised data collection and reporting staff sensitization, provision of reporting formulate relevant policies and guidelines system. This especially affected the tools, and initiation of reporting across the and ensure provision of therapeutic and management of nutrition commodities country. supplementary feeds. To monitor nutrition

Continued from Pg 10

software. A patient’s next appointment is then entered and dispensary workers input the drug name and batch number dispensed. This exercise is replicated in over 320 sites that have the antiretroviral therapy dispensing tool. Dr. Bob Agwata, Chief Pharmacist at Coast Provincial General Hospital which has over 4000 active patients on ARVs says the tool increases the quality of patient care, it catches errors in prescriptions or patient information, and immediately flags health workers when patients have missed their appointment or are in danger of running out of drugs. “Before the antiretroviral dispensing tool, we used a Daily Activity Register – a thick book in which workers would log Dr. Rafida using the Anti Retroviral Dispesning tool at Coast General dispensing information. With the register there was no way Hopistal to keep track of patients who had missed their appointments * Mzee Ahmed and his sons names have been changed for privacy or were at-risk of running out of medicine. Monthly reports purposes would take hours, instead of minutes – as they do using the dispensing tool,” explains Dr. Rafida of Coast Provincial General Hospital

11 NEWS BRIEFS March 2013 - September 2013 Findings of the Assessment of Continuing Professional Development Programs for Pharmacy Professionals in Kenya By Charles Ouma and Yvonne Otieno

Continuing Professional The survey was conducted in March 2012 by The Pharmacy Development (CPD) and Poisons Board (PPB) with technical assistance from is an internationally the USAID funded Health Commodities and Services accepted approach that Management (HCSM) Program implemented by MSH. provides professionals What are some of the key findings of the survey? with the necessary knowledge, skills and The study found that most practitioners perceive CPD ethical attitudes to positively and over 80% undertake some form of CPD remain current and activities. Only 0.6% of the respondents indicated that competent in their they see no benefit of CPD. However, perception of what practice. constitutes CPD was varied. The top reason for undertaking CPD was for skills improvement and career development. In Kenya, the Ministry of Health has mandated For most respondents distance to CPD venues and lack regulatory boards of information on what CPD activities are available were and professional cited as the major constraints. Increased access to online associations carry out or technology based learning methods and availability of continuing education an enhanced range of topics that meet practice needs programs for their respective professionals to build capacity were highlighted as some of the factors that could motivate of all cadres of health care workers and enhance delivery practitioners to undertake CPD. Furthermore, over 90% of of quality healthcare in the country. For the pharmacy the respondents suggested some form of sanctions for non- profession, the requirement to undertake CPD is stipulated in compliance with CPD requirements. the Kenya National [Sessional paper No. 4 of 2012] with the program being administered by the Pharmacy and Poisons Board (PPB), Kenya’s regulatory authority. Why the survey? The Pharmacy and Poisons Board developed the first edition of CPD guidelines in 2006 and thereafter adopted it for use by pharmacy professionals. However, implementation was constrained by a number of challenges which hindered roll- out and scale-up of CPD activities including lack of proper enforcement due to legislation limitations, practitioners’ needs not being met by available programs, and lack of adequate and timely information on available CPD programs. This baseline assessment was therefore undertaken to Priscah Akinyi receiving medication at the Pharmacy evaluate the status of CPD for the pharmacy professionals with the aim of supporting revision of the guidelines and Who will benefit? development of strategies to scale-up CPD and strengthen The survey, which is the only one of its kind to be conducted its implementation. in Kenya in recent times, has culminated in the development The objectives of the assessment included collection of of a report which is currently being disseminated to all baseline information on implementation of CPD programs stakeholders including pharmacy practitioners in all sectors, in Kenya among pharmacy professionals; identifying their professional associations and potential CPD providers. challenges hindering the implementation of CPD programs; This report is vital in addressing gaps in the implementation and obtaining information to support plans and strategies for of CPD programs and has been a vital resource in the on- scaling up the implementation of CPD programs. going review of the current CPD guidelines to address key implementation issues including – The survey was also aimed at establishing the appropriate means of documenting, participation and awarding of CPD • accreditation of CPD programs and providers; points while also determining the scope of the supervisory • defining what activities qualify for CPD; and regulatory framework for implementation of CPD programs. • points allocation criteria and required thresholds; • requirements for monitoring and evaluation (M&E) framework.

12 March 2013 - September 2013 TB UPDATES By Charles Njuguna

While the spread of tuberculosis (TB) has decreased in the past few years in Kenya, the disease continues to be a public health problem. The USAID-funded HCSM program is working at all levels of the healthcare system to improve the supply chain management system in relation to TB commodities while also building local capacity of TB program staff. Charles Njuguna, HCSM Senior Technical Advisor on TB Commodities, explains the work the program has been implementing.

What is the current status of TB in building local capacity has been an integral data acquisition has resulted in reliable Kenya? aspect of the HCSM approach to program information for decision making which has support. TB program staff has been translated into optimal supply and reduced Currently there are 264 cases of TB per equipped with quantification and supply wastage. 100, 000. Such a case detection rate is management skills. Design of a simple 83% above the WHO recommended rate of Improved skills in pharmacovigilance electronic tool for generation of stock 75%. Although this presents a slight drop (patient and medicines safety) have resulted status report has made it possible for the from in 2011, Kenya remains among the 22 in improved quality of care given to the staff to generate regular reporting on their countries that carry 80% of the global TB patients. own. HCSM has ensured that commodity disease burden. management is being mainstreamed into What are some of the challenges facing The emergence of Multi-Drug Resistant the existing government pharmaceutical the implementation of TB programs (MDR) TB continues to pose a major threat management system as well, while locally? to the gains made in the fight against TB data collection is currently undergoing Challenges encountered include lack of in Kenya. To date about 600 patients have mainstreaming into the existing government sufficient funds to bridge the financial gap cumulatively been diagnosed with MDR- system. for commodities. Although HCSM and TB and currently there are 401 patients on Information for Decision Making DLTLD have worked together aggressively treatment. in mobilizing resources, gaps still remain Up to date information is critical for Success in the fight against TB is forcing the program to run without buffer commodities supply planning. HCSM dependent on many factors ranging from stocks. This has called for a delicate has supported the review of the Logistics intensified case finding, supported by high pipeline monitoring with health facilities Management Information Systems (LMIS) quality treatment and laboratory services running with sufficient stocks most of the to improve TB commodity data capturing at and access to quality medicines. time. health facilities and at the national level. The What role does HCSM as program play in support has involved reviewing, printing and Imparting commodity management skills helping to control the spread of TB? distribution of tools used to collect data at at the service delivery points is also Health Commodities and Services various levels while also making sure LMIS challenging given the large number of Management (HCSM) program is can integrate TB/HIV data and avoid the facilities which can mean enormous cost collaborating with the Division of Leprosy multiplicity of tools used at service delivery implications. HCSM has been addressing TB and Lung Diseases (DLTLD) in Kenya points. HCSM has also supported the this challenge through leveraging resources to ensure access to quality pharmaceutical initiative to have all TB medicines managed with other implementing partners but to a and laboratory commodities for TB, MDR- by pharmacists who by law are the limited extent. This remains one area that TB and TB/HIV. custodians of medicines within healthcare cannot be ignored if quality of TB services systems. is to be maintained. Supply Chain Planning Quality of Care In your opinion, how far has Kenya come To ensure the flow of commodities remains in controlling the spread of TB and what uninterrupted, HCSM has provided At the patients’ level, HCSM has more can we do? support for pipeline monitoring. This supported efforts to improve the quality involves generating monthly stock status of care given to TB patients by initiating Kenya as a country has come a long way reports which highlight what is stocked pharmacovigilance activities. Staff from in TB control. Government and partner at the warehouses and the periphery. MDR-TB treatment services providing efforts have ensured that TB prevalence has This information is given to decision facilities have been trained on identifying fallen from a high of 322 to 264 in 100,000 making institutions such as procurement and reporting adverse drug reactions in the last five years. Treatment coverage and distribution agencies to ensure (ADRs). This was done in partnership with has remained above 90% with cure rate commodities are delivered at all levels. the Pharmacy and Poisons Board who also of at least 80%. However, if the fight is to HCSM has also supported DLTLD in provided tools for reporting ADRs. be sustained, more resources need to be conducting national quantification and allocated to TB commodities. Currently, the What do you consider to be some of the supply planning as well as coordinating government provides resources for first-line local achievements in TB control? partner and donor forums for resource TB medicines while second-line, pediatric mobilization to meet any financial gaps. Some of the achievements from these and TB/HIV prophylaxis medicines are efforts have been uninterrupted supply being procured by donors. To ensure sustainability of these efforts, of medicines to the patients. Improved

13 CASE FILES March 2013 - September 2013 Innovation in the use of electronic support tools for ADT project implementation support By Joseph Warero and Caroline Olwande

Introduction

The National AIDS and STIs Control Programme (NASCOP) was established in 1987 to spearhead the Ministry of Health’s interventions on the fight against HIV/AIDS. NASCOP therefore operates as a division within the Ministries of Health and is mainly involved with technical co-ordination of HIV and AIDS programmes in Kenya. NASCOP contributes to the bulk of the implementation of the Kenya National HIV and AIDS Strategic Plan III (KNASP III).

Over NASCOP’s formative years, challenges on data availability, quality and reliability were experienced. NASCOP realized that use of paper-based systems was a significant constraint to scale up of the ART program and encouraged development of innovative solutions to improve gathering and supporting of facility level ART-related information. To this end, Management Sciences for Health/Rational Pharmaceutical Management Plus (RPM+) program developed the ARV Dispensing Tool (ADT) just after the start of the ART program in 2004. This was rolled out to health facilities to support the automated collection, analysis and use of antiretroviral medicine consumption data and related patient data. Over the years and through various programs (RPM+, SPS and now HCSM), MSH continued to provide technical assistance to improve pharmaceutical management systems in support of ART.

The Challenge: to the customers through a custom interface that made it possible for support to be provided. As of June 2013, over 309 health facilities were using the ADT 2. The growth in the number of health facilities using tool with the support being predominantly provided by HCSM ADT provided an administrative and supervision with the support of regional champions and a partner network. challenge. In order to effectively capture and assist The challenges that came up with the scale up of ADT to over in reporting of any problems that a facility has with 309 health facilities were: ADT tool, so that follow up and problem resolution tracking can be done effectively, a help desk 1. The need for timely maintenance and support to ensure that software was acquired. The help desk software the facilities were up and running within the shortest time generates a work ticket for reference and serves possible after experiencing a problem in order to prevent as a data repository and knowledge base on all data backlog, maintain integrity of patient data and provide problems reported in the use of the tool, directory continued accountability of the ARV commodities. listing of the health facility using ADT including the 2. Incident management - The need to monitor, log and resources stationed at those facilities as well as respond to support requests from end users for ease of the names of implementing partners serving that tracking and problem resolution assignment. the facility. help desk software runs on the cloud using a Software as a Service Model meaning that 3. Bridging of the information gap that existed when a key HCSM does not have to take on the additional tasks resource at the health facility responsible for the usage and required for maintenance, upgrades and hosting of administration of ADT had been transferred or had left the the online application. health facility 3. The challenge of knowledge gap occasioned by Interventions the often high staff turnover at the facilities was addressed through the development of video 1. The first problem wasaddressed through the identification learning tutorials that captured the ADT functionality of suitable remote support software that made it possible and basic troubleshooting methods in the event to remotely access a health facility’s computer and proceed of common problems occurring. The video to resolve the technical support issue that needed to be editing software made it possible to record and addressed. This meant that the HCSM staff did not have to demonstrate ADT usage through direct computer travel for miles and days on end in order to reach a facility screen capture and incorporate voice instruction and resolve the technical support issue that had been to it as well. The video tutorials serve as tool that a experienced. The software that was acquired was easy to health facility running ADT could utilize to refresh implement and install and provided the much needed relief and orient new users in a more in-depth manner and complement the user manuals in place.

The Implementation:

HCSM is currently conducting a mainstreaming exercise to hand over the ADT Support tool to NASCOP. Mainstreaming is a process through which the management, support and administration of ADT software is being integrated as part of the conventional NASCOP activities The timely acquisitions and use of the above electronic tools are making it possible to effectively communicate to NASCOP on the methodology and processes that HCSM has used over the years to provide support to the ADT sites and what is now possible for NASCOP moving forward

14 March 2013 - September 2013

Provincial General Hospital Kakamega Pioneers Medication Safety Self Assessment (MSSA) through Innovation Challenge Fund (INCH) By Dr.Bernard Wambulwa, Dr. Johnson Masese, Dr. Patrick Boruett and Dr.Roseline Atieno

Introduction: Safe and appropriate use of medications is a primary aim of an effective health system. It has however been documented that medication errors occur in all health care systems. In an effort to improve medication safety, The Provincial General Hospital , Kakamega through the Medicine Therapeutic Committee (MTC) recently conducted a medication safety self assessment (MSSA) on medication use processes at the hospital. The objective of was to conduct a medication use process assessment using a standardized tool to examine current practices as a baseline, identify opportunities for improvement and document processes. It covered the entire medication use process in the hospital.

About the MSSA was spearheaded by a multidisciplinary team including nurses, pharmacists and clinicians through the MTC. Dissemination was done within the facility The medication use process is affected by to the hospital leadership, middle level managers and front line staff. We had numerous interrelated steps ranging from selection, opportunity to share findings in a oral presentation by Dr. Wambulwa at the 10th procurement, storage, prescribing, dispensing, HOPAK (Hospital Pharmacist Association of Kenya ) symposium in August this administration and use of medicines. Medication year. errors occur when human and system factors interact with the complex process to produce an unintended and potentially harmful outcome. The Findings: MSSA is a proactive rapid diagnostic tool which The self assessment revealed the strengths as well as areas of improvement in takes a systematic approach to know the baseline, the current medication use processes throughout the entire system. It presents guide implementation and monitor progress as a strong foundation to efforts to improving medication safety in the hospital. part of continued quality Significant priority intervention requires minimum improvement efforts. resource inputs to safeguarding processes in the It allows hospitals to facility. Potential areas for improvement are in handling examining the entire of patient information, access to drug information, medication use process medication storage practices, labeling of medications, pinpoint specific areas enhancement of the newly implemented computerized of strength, areas of system, staff education, patient education and a culture improvement in their of learning. A number of challenges can be addressed medication management through increased involvement of pharmacy staff systems including inbuilt within the hospital. This will require establishment of a safeguards and is best done multidisciplinary team to spearhead implementation of by a multidisciplinary team recommendations and monitor progress in efforts to with hospital leadership improve medication safety for sustainability. mandate. The innovation adapted to the local context self assessment practices Lessons Learnt: that have successfully been applied in the US, Canada, The application of a systems approach was an ‘eye Spain and Australia. This The multidisciplinary data analysis team opener’ to understanding the ‘medication journey’ at includes 10 key elements the hospital including the interaction between various and 18 core characteristics. The 10 key elements of actors and processes. safe medication practices include Patient information; Drug information; Communication of drug orders and The multidisciplinary approach brought together diverse players and other drug information; Drug labeling, packaging and insights which enriched the assessment process. Medication safety can be nomenclature; Drug standardization, storage and improved through simple changes and adjustments to current practices. A distribution; Medication delivery, device acquisition, multidisciplinary team to spearhead medication safety at PGH Kakamega use and monitoring; Environmental factors, workflow has been formed. This team can support scale up of efforts to improve and staffing patterns; Staff competency & education; medication safety arising from the innovation. Patient Education and; Quality processes & risk management. Conclusion: Implementation MSSA is a potentially useful approach to improving medication safety at our health facilities by taking a systems approach to diagnose and address Implementation milestones included sensitization of challenges within the system. It is also useful in identifying best practices to hospital leadership, adaptations of the assessment bench-marking. The underlying system faults can be gradually addressed for tools, data collection, data analysis and dissemination enduring changes and significant error reduction. of findings and proposed recommendations. This

Acknowledgements:

Management and staff of the Kakamega Provincial General Hospital for their support to this project under the leadership of Dr. Roseline Atieno, Medical Superintendent

Institute of Safe Medication Practices (ISMP) USA for allowing us to adapt their ISMP Medication Safety Self Assessment® tools to our local setting.

This was made possible with funding from inaugural MSH Center for Pharmaceutical Management Innovation Challenge Fund (INCH) awarded to three field proposals as part of an effort to strengthen pharmaceutical systems across the health sector globally, The INCH Fund builds on existing work to strengthen medicines quality and pharmaco- vigilance being implemented by MSH in Kenya through Health Commodities and Service Management (HCSM) program an Associate Award funded by USAID.

15 PROGRAM UPDATE March 2013 - September 2013 MSH/HCSM Collaboration with the KMTC Medical Training College (KMTC): Update By Ndinda Kusu (MSH/HCSM) and Jacinta Mukonzo (KMTC) Assessment of pharmaceutical services in Kenya has revealed concurrently across the Nairobi, Mombasa, Machakos and Nyeri inadequate training and skills among health care providers. In KMTC campuses from 23rd – 25th July 2013. particular, the lack of pre-service training on pharmaceutical Results: The total number of participants trained was 273 and management is a significant weakness. the breakdown is as follows: Nairobi (113), Nyeri (59), Mombasa The Kenya Medical Training College, department of pharmacy (45) and Machakos (56).The mean score for the pre-test was in collaboration with Management Sciences for Health/Health 66.1% and the post-test mean score was 77.4%. Most students Commodities and Services Management Program developed proposed that this course content be included in the diploma and implemented a three-day training course on commodity curriculum and extended from 3 to 5-days. management. The main aim of the course was to equip the final year qualifying class of pharmaceutical technologists from KMTC Conclusions and Next Steps with the necessary knowledge, skills and attitudes to enable Students responded positively to this course and it has them to effectively manage medicines and health commodities in been recommended that it be institutionalized in the diploma primary health care settings. curriculum. The training improved students’ knowledge and skills on effective management of health commodities based on post The training objectives were as follows: test gains results. Pre-service curriculum for pharmaceutical a. Describe the key aspects of health commodity management cadres should include key topics of pharmaceutical management b. Describe Standard operating Procedures for health so as to equip future health workers with the appropriate and commodity management relevant knowledge and skills. c. Discuss the concept of pharmacovigilance and its role in medicine safety ASSESSMENT OF KNOWLEDGE GAIN d. Undertake a site visit to a model health facility to apply KMTC Campus % Average Pre-Test % Average Post-Test knowledge and skills Score Score Nyeri 65.3 75.6 Approach: The 3-day curriculum was fully implemented at the end of the diploma course and by the KMTC faculty using the Mombasa 62.9 70.8 MSH/HCSM supported curricula, references, tools and job aids. Machakos 69 86 This course incorporated classroom learning, exercises, case studies, and practicum. A before and after training assessment Nairobi 67 77 using scored pre- and post-training tests and a post-training Mean Score 66.1 77.4 course evaluation was applied. Four trainings were held

Participant 1 - Eugene Saina Kimutai (Nyeri Participant 2 - George Amania Campus) “The training was educative to us since we are “The training was good and very helpful. I learnt joining the pharmacy profession. Our mandate how to handle pharmaceutical products and as pharmaceutical technologists is handling of management of commodities. I learnt how to report health commodities thus the training came in very adverse drug reactions and poor quality medicines. handy. The most striking thing was to learn how I observed that it is not easy to differentiate a counterfeit drugs are killer substances that many counterfeit medicine from a genuine one. I had never unsuspecting consumers are being exposed to. I known that counterfeit drugs have such far reaching consequences in leant how to make dispensing an effective process. The practicum was healthcare. I learnt on the importance of proper counseling of patients a very good experience to see an application of what we had learnt in during the dispensing process. I thank the facilitators for their tireless the presentations.” effort and MSH/HCSM for the reference materials and for making this training successful.”

Participant 3 – Beneah Abuti Masimba Participant 4 – Joy Nkirote Gatobu

“The training was very good and I felt favoured “The training was indeed a great idea. I enjoyed to have been given the opportunity to attend the session on procurement most and I realised it. The component of performing a root cause that there are many areas that I can actually analysis made the greatest impact in my thinking. specilaise in besides dispensing like ensuring good Monitoring and evaluation struck me as the procurement practices are followed in my place of backborne of all work and it should be incoporated work. An isolated training besides class work has in the curriculum. I am confident that my carrer is more impact. The training has simply exceeded my on course.” expectations.” Participant 5- Simon Kyalo

“I had never really thought of the counterfeits seriously. We all have to be involved in tackling the monster. If we have SOPs at our places of work, there would be more efficiency and uniformity of work. I would like to thank the sponsors and facilitators for the great opportunity.”

16 March 2013 - September 2013

Applying Pharmacoeconomics and Health Technology Assessment (HTA) to Essential Medicines By Ndinda Kusu (MSH/HCSM) and Prof Anastasia Guantai (UON)

New medicines have the potential to greatly improve health University of Nairobi lecturers, Ministry of Health, SIAPS and HCSM outcomes, but health care programs across the globe are technical staff, all of whom have extensive experience working with faced with challenges to make evidence-based decisions on a variety of initiatives to help apply pharmacoeconomics principles selection of medicines to ensure the value for money. Selection of and HTA to essential medicines selection, pricing regulation, essential medicines should be based on the evaluation of clinical reimbursement, and clinical trials. outcomes, costs, and cost-effectiveness. With the challenges of The workshop targeted 23 participants representing the following the global economic situation and the clamor for universal health institutions and groups: Academics from pre-service and post- coverage, developing countries are increasingly faced with the graduate pharmacy and medical schools, Ministry of Health, need to develop explicit criteria for priority setting in health and National Medicines and Therapeutics Committee (NMTC), Kenya also to build capacity of regulators, academics, and other health Medical Supplies Agency, Kenya Medical Research Institute, care professionals who are involved in making evidence-based Pharmacy and Poisons Board, National Quality Control Laboratory, decisions on essential medicines selection, pricing regulation, County health management teams, Facility Medicines and reimbursement, and review of clinical trials. Therapeutics Committees and the private sector as shown in the The University of Nairobi (UON) in partnership with the United table below: States Agency for International Development (USAID)-funded Health Commodities and Services Management (HCSM) and Category Organizations Represented Number of Systems for Improved Access to Pharmaceuticals and Services Participants (SIAPS) program and University of Washington conducted a four- Agencies/ Pharmacy and Poisons Board 5 Parastatals day training of trainers’ (ToT) workshop to develop sustainable Kenya Medical Supplies Agency skills in pharmacoeconomics principles and Health Technology Assessment ( HTA) as they relate to essential medicines selection. National Quality Control Laboratory This TOT which adopted the continuous quality improvement Kenya Medical Research Institute Monitoring-Training-Planning (MTP) approach provided an Academia University of Nairobi 7 opportunity to empower academics, regulators, and health care Kenyatta University professionals to apply knowledge and skills acquired become in Jomo Kenyatta University of their own settings. Agriculture and Technology

The objectives of the workshop were as follows: MOH National Medicines and Therapeutics 3 Committee • To provide basic concepts, terminology, and methods of pharmacoeconomics and health technology assessment Department of Pharmacy Facility Medicines Kenyatta National Hospital 4 • To gain an understanding of evidence-based approach to and Therapeutic economic evaluation Committees Moi Teaching and Referral Hospital • To develop an understanding of basic calculations of costs, Priority Health National AIDS and STI Control 1 health outcomes, and cost-effectiveness Programs Programme County Machakos County 2 • To gain an understanding of how to interpret and understand Representatives the results of pharmacoeconomic studies and HTA reports Kisumu County • To develop practical skills in the use of basic cost- Private Sector Gertrude’s Children Hospital 1 effectiveness tools and measures to help in the selection of Total Participants 23 medicines, pricing regulation, and formulary decisions

• To understand the impact of new health technology on the During the workshop, action plans will be developed for activity essential medicines budget implementation and follow-up support. The mid to long-term goal • To understand the key principles, process and methods of is to incorporate pharmacoeconomics and HTA principles into Health Technology Assessment (HTA) in low-resource settings pre-service and post graduate training courses in pharmacy and medical schools. The workshop facilitators are drawn from renowned faculties of the University of Washington—partners of the SIAPS program,

17 REGIONAL UPDATES March 2013 - September 2013 Support to Faith based organizations The Catholic Church in Kenya is one of the key partners of the government in provision of health care services. As at June this year, a check on the Kenya list of health facilities showed that 393 facilities in the country were run by the Catholic Church accounting to about 5% of all operational facilities at the time. Through its facilities, the church provides much needed services especially to underprivileged communities. Many of their facilities are located in remote areas thus providing populations in need with accessible health services even where terrain proves daunting. Recognizing the role played by the Church in healthcare and also as aresponse to the call to strengthen health systems across all sectors including public, private and faith based sectors, the USAID funded Health Commodities and Services Management program (HCSM) continues to engage with various catholic dioceses in capacity building initiatives.

RiftValleyBy Joseph Mwangi In Rift valley regionthis year, increased availability of commodities as well as the project has worked with proper utilization of the same. three dioceses namely Nakuru, With time, and informed by the interaction with Eldoret and Ngong. In the HCSM and with champions that the project has process, over 30 staffs have been mentored in the various regions of the country, sensitized on good inventory health facility staffs have continued to show management practices as well innovation in improving inventory management as on how to conduct supportive practices including having inventory records in supervision towards improving place and ensuring commodities are placed on the management of health shelves and pallets to maintain quality. commodities. It is expected that this together with other ongoing initiatives will ultimately lead to Mombasa NyanzaBy Josphat Samoei By Antony Mwangi

Group photograph with the healthstaff Kenya Catholic Council of Bishops (KCCB) Health Facilities Staff in a In Nyanza region there are three dioceses namely; Kisumu, kisii discussion during the Orientation on Commodity Management and Homa bay, Support was initiated in kisumu diocese which HCSM is funded to strengthen commodity management, encompasses Siaya and Kisumu County FBO facilities. A two day pharmaceutical services and the Laboratory Supply Chain training on commodity management, appropriate medicine use and across all sectors in Kenya i.e. public, private and Faith Based Pharmacovigilance was held at Ukweli Pastoral centre in kisumu Organizations (FBO). on 24th and 25th June 2013. During the training graced by Bishop of kisumu Diocese, Bishop Okoth, 26 healthcare workers from the 14 To strengthen support to the FBOs countrywide, a structured faith based organizations were trained. engagement approach was adopted with the HCSM Regional Team holding a joint meeting with KEC Health Stakeholders that Dr Owuor thanked the MSH/HCSM for selecting the FBO in the resulted in drafting of joint implementation plans. facilities support sensitization package with its unique challenges. He encouraged participants to utilize the training resources provided to On 25th – 26th July, 2013, KEC Mombasa Catholic Diocese them and follow up on action plans established at the end. jointly held an Orientation meeting on to equip the staff with the necessary knowledge and skills towards good inventory “For a long time commodities have not been properly managed management and dispensing of health commodities, by the health workers leading to poor service delivery and financial appropriate use and also enhancing patient safety through losses which would serve the less fortunate in society hence the need Pharmacovigilance. The expected outcomes of the course are to have proper management,” said Dr. Owuor. enforcement of good commodity management practices which Bishop Okoth highlighted the huge challenges of disease burden and enhances accountability, appropriate use and even availability resource constraints in providing quality health care. He advised the of commodities, reduced expiry of commodities, improved health workers present to be true to their calling by providing quality commodity reporting rates and improved e reporting on adverse and cost effective services by being “accountable in management of drug reactions. essential medical supplies.”

18 March 2013 - September 2013

Central Selection and Quantification of Health Commodities for Kiambu County: By Constance Orata Two Clinical Pharmacists from Thika L5 and Kiambu District Hospitals led the Medicines and Therapeutics Committee (MTC) of clinicians and consultants in compiling a Kiambu County Formulary; based on the current Kenya Essential Medicines List 2010 and taking into account formularies from the various hospitals in the county. At the end of the two days workshop, the MTC secretariat had a draft Kiambu County Formulary which they shared with the various hospitals for review and feedback. The secretariat has planned another workshop to finalize this document. Meanwhile, the Pharmacists, Commodity Nurses and Lab Managers compiled consumption data for EMMS and Dr Hillary Kagwa and Dr Glory Kinya, both Pharmacists from Laboratory reagents for all facilities according to their Gatundu District Hospital various levels and sub counties. These teams had already spent about one month prior to this workshop, collecting th th On 8 and 9 August 2013, Kiambu County Commodity the relevant source data from health facilities. The lab team Managers comprising District and hospital Pharmacists, had the additional task of ensuring that reagents for all the Medical Lab Managers and Commodity Nurses participated machine types found in the various hospitals are included in a two day Selection and Quantification workshop to and well described on the list. provide annual estimates of all the Essential Medicines and Medical Supplies (EMMS)and Laboratory reagents needed HCSM provided both operational and technical support for to offer healthcare services through their public (GoK) health this exercise, which was further boosted by the presence facilities. They were led by their Interim County Pharmacist. of the County Health Director and the County Health Administration Officer.

Eastern Mwea Mission hospital launches standard treatment guidelines By Lillian Gitau

Over the last year, HCSM has been providing technical On the 24th of May the hospital officially launched the support for the development of institutional Standard guidelines with the publishing of a few seed copies. Treatment Guidelines (STGs). Development of the guidelines was through collaboration the working with Mwea Mission Hospital through their Medicines & Therapeutics Committee (MTC). Speaking during the launch, Sister Josephine Ndege the Chief Executive Officer of the hospital said that the launch of the guidelines marked a great step in inspiring service delivery for the community. “The regular and consistent use of these guidelines by the clinicians in Our Lady of Lourdes Mission Hospital in Mwea is expected to improve rational use of available drugs and contribute to the realization of vision 2030; that is creating an enabling environment Sister Josephine Ndege, CEO of the hospital receives copies of the for the provision of sustainable quality health care that institutional Standard Treatment Guidelines from Lillian Gatubu of HCSM is cost effective and accessible to all Kenyans’ said Sister Ndege.

19 PICTURE SPEAK March 2013 - September 2013

Consultation during the data review Data analysis in Webuye

A guest reading the Standard Treatement Guidelines during the Celebration at the launch of Starndard Treatment Guidelines in launch in Mwea Mwea

It was all song and dance by the faculty during the launch event

20 March 2013 - September 2013

Guest at the launch of the Pharmacovigilance Electronic Reporting System launch

Tom Arunga - District Health Information Officer during a supportive Availability and completeness of Antimalarial drug management supervision at Nyalenda Hospital, Kisumu records are part of the activities observed. USAID throgh HCSM helps in providing stock cards to record usage of drugs

David Omondi a student at the University of Nairobi getting tested for HCSM staff engaging Kenya Episcol Conference heakth workers at Malaria using the malaria Rapid test Kits meeting on Commodity management held in early May

21 March 2013 - September 2013

Support to devolvement of health services By Eric Wakaria of Health Cabinet Secretary and Principal Secretary on the current status of the laboratory services, the Laboratory sub- sector strategic direction and challenges, as an important component of health services in Kenya. A county Interim Laboratory Coordinators’ Orientation and Consultative Forum was held on 28th to 30th August, 2013 bringing together the National and County Laboratory sub sector leadership in order to deliberate the major National and County Laboratory functions and anticipated challenges associated with their implementation as well as to identify and establish the Laboratory county coordinators during the consultative meeting linkages and working relationships that will enable both levels to deliver their health mandates in a smooth interdependent Strengthening Public Health Laboratory System project manner. All the 47 county laboratory coordinators and various (SPHLS) is supporting the Laboratory leadership to translate implementing partners supporting the laboratory sector the Ministry of Health requirements for devolution. The attended the forum which was officiated by the Director of project provided technical assistance in preparation of a Medical Services (DMS). The DMS emphasized on the need for laboratory brief to fully appraise the newly appointed Ministry implementation of quality standards to ensure proper diagnosis. Expansion of infection and prevention control program in Kenya

SPHLS continues to support the Ministry of Health to ensure the safety of Healthcare workers, patients and communities as well as to ensure quality specimen for diagnosis and patient management. An integrated strategy has been employed to train HCWs in biosafety and safe phlebotomy practices. Follow up to track progress in applying knowledge & skills gained during the trainings have been carried out. There has been demonstrated proficiency in drawing of blood, decrease in specimen rejection and improved supply of safe phlebotomy supplies. The chart below depicts some of the improvements made in blood collection procedures.

Word Search Jokes D F N IZ YLG YT A NDSMY C O TH M V L L C T LTU A Y O Examination A young guy comes to a doctor. After F I RN N I E O I IOT A T IR The words and phrases below are all relevant to reporting. examination the doctor says: E S H A E GR V R L I C H D U T Can you nd them in the grid? Z P T D E I I M X I V K M J P C The words may run across, - So, we will have to cut one of your down or diagonally and may lungs. E N L O S P P L S C I O D U R A read backwards or forwards. E C BZTZ G O C A T N S S E S The guy is astonished and tells: N L I K P K N N C F Y H E T T N activity losses - But doctor, my lungs have always been K C Z R T U B P I H S A S M S A client record-keeping great, I have never had any problems daily RHF with them. S B A NAL R A P A N ST E I R health facility summarize K E SMA EMV R DOLL N G T logistics CDRR - I see it myself. But your liver have no quantity consumption room anymore. Y T I D O M M O C A C O L T E D reporting period data Y L H T N OU EMF N D P S R A stock on hand lab Q U A N T T Y SI E ECHRH T adjustments monthly commodity register N O IT MPU S N O C BRE R A DAR stock balance R OE RCD K E E I NP G B G U KEMSA transaction

22 March 2013 - September 2013

Job Aid: Guidelines for Reporting on Adverse Drug Reaction

23 “For me the worst thing is a patient to come in for treatment and not get

medication.” Esther Wahome, Nurse Nairobi

Health Commodities and Services Management is a national level USAID-funded program with a 5 year Implementation period (April 1, 2011-March 31, 2016). The program is anchored on USAID Kenya’s objective of strengthening health systems for sustainable delivery of quality services and has three outcome areas - strengthened Ministry of Health commodity management, strengthened pharmaceutical services and strengthened laboratory services