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An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal

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An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal Health Sector Support Programme (HSSP) Ministry of Health and Population (MoHP) - Nepal Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal Imprint Published by GTZ/GFA Consulting Group GmbH Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH - German Technical Cooperation - Health Sector Support Programme Department of Health Services Teku, Kathmandu, Nepal T +977 1 4261404 F +977 1 4261079 E [email protected] I www.gtz.de/nepal Author Pushkar Raj Silwal Editors Dr. Friedeger Stierle Professor Dr. Konrad Obermann Dr. Rajendra Kumar BC Dr. Ghan Shyam Gautam Photo GTZ Archive Design Kiirtistudio Print Hillside Press Kathmandu, November 2009 Disclaimer The views and ideas expressed herein are those of the author and do not necessarily imply or reflect the opinion of the companies or institutions involved. Contents Acknowledgements 7 Acronyms 8 Executive Summary 9 1. Introduction 12 2. Objectives 13 3. Methodology 13 3.1 Sampling ........................................................................................................................................................................................... 13 3.2 Data Collection ............................................................................................................................................................................. 14 3.3 Policy Review ................................................................................................................................................................................. 15 3.4 Limitations of the Study ......................................................................................................................................................... 16 3.5 Operational Definitions ............................................................................................................................................................ 16 4. Findings 16 4.1 Drug Stock-in Situation .......................................................................................................................................................... 16 4.2 Drug Availability Situation .................................................................................................................................................... 19 4.3 Quality of Drugs ........................................................................................................................................................................... 21 4.4 Drug Storage Situation ............................................................................................................................................................ 22 5. Discussion 24 6. Conclusion and Recommendation 25 Annexes 26 Annex I Details of ED Availability by ED Items Found in the 1st, 2nd and 3rd Visits ............................ 26 Annex II Description of the ED Manufacturing Companies by their GMP Statuses .................................... 28 Annex III Details of the ED Expiry Situation ........................................................................................................................ 29 Annex IV Drug Storage Situation .................................................................................................................................................. 32 Appendices 33 Appendix A Tools Used in the Study .......................................................................................................................................... 33 Assessment on Availability of ED in Health Facilities in Nepal Observation Sheet – STORE ROOM ................................................................................................................................... 33 Assessment on Availability of ED in Health Facilities in Nepal Observation Sheet – STORE ROOM / DISPENSARY ................................................................................................ 37 Assessment on Availability of ED in Health Facilities in Nepal Observation Sheet – STORAGE CONDITION ................................................................................................................. 41 Appendix B List of the ED for HP and SHP ........................................................................................................................... 45 Contents Figures and Tables Figure 1 Districts Selected for the Study ..................................................................................................................... 13 Figure 2 ED that were not Stocked-in in HF since Last 2 Years ................................................................. 17 Figure 3 Duration between Two Stock-ins of the ED (In Days) ..................................................................... 19 Figure 4 Availability of ED in HF ....................................................................................................................................... 20 Figure 5 Availability of ED (52 Categories) in 14 HF ........................................................................................... 21 Figure 6 Quality of ED by GMP Status of the Pharmaceutical Companies ............................................. 22 Figure 7 Drug Expiry Situation (In Percent) ................................................................................................................ 22 Table 1 HF Selected for the Study .................................................................................................................................. 14 Table 2 ED not Stocked-in in the HF over the Last 2 Years ......................................................................... 17 Table 3 Drug Stock-in Status of the HF by Stock-in Duration..................................................................... 18 Table 4 Availability of ED by Facility in Different Field Visits .................................................................... 19 Table 5 Percentage of ED Items Stored in Appropriate Condition by HF .............................................. 23 6 \ An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal Acknowledgements GOVERNMENT OF NEPAL MINISTRY OF HEALTH & POPULATION Ramshahpath, Kathmandu, Nepal Phone: 4262987, 4262590, 4262802, 4262706, 4262935, 4262862 5 November 2009 The Government of Nepal (GoN) introduced and Dr. Rajendra Kumar BC has been con- the policy of free health care services along ducted in order to assess availability of ED in with the provision of providing essential drugs health facilities (SHP and HP). It constitutes a (ED) to health facilities at free of cost. With timely and most valuable input into the this, Ministry of Health & Population ongoing discussion and ensures the availability (MoHP) has been struggling to provide of ED in these health facilities. So, the MoHP sufficient quantity of ED to these health would like to thank the study team. facilities. It has always been argued that governmental supplies of ED are not available The MoHP would like to appreciate the sufficiently throughout the year, and most of technical and financial support provided by the people who generally visited the sub-health GTZ/GFA Consulting Group GmbH, and posts (SHP) and health posts (SHP) may acknowledges the inputs of the Thematic Task remain deprived from getting the full course of Team members (Dr. Baburam Marasini, Mr. ED as and when necessary. Consequently, Yogendra Gauchan, Mr. Giri Raj Subedi, Mr. particularly poor and underprivileged people Parashu Ram Shrestha, and Dr. Rajendra have not able to access and utilize the required Kumar BC) to steer the whole process. amount of ED as anticipated. Although Suggestions and cooperation from Dr. MoHP is in operation with frequent monitor- Friedeger Stierle, Dr. Susanne Grimm, Profes- ing and supervision to the free health service sor Dr. Konrad Obermann, and Mr. Christian sites, there is no concrete studies yet con- Caspar have helped carrying out this study. ducted that guide policy makers to identify the Finally, the MoHP would like to thank all exact status of availability of ED in health those involved in the study. facilities particularly HP and SHP in Nepal. In this context, the ED availability in HP and SHP has intensively been debated among policy makers including its quality. The MoHP wants to stimulate debate and dialogue on this topic. The study by Mr. Pushkar Raj Silwal along with the backstopping team comprised of six Dr. Y. V. Pradhan people namely Mr. Parashu Ram Shrestha, Ms. Chief Rita Joshi, Mr. Ghanshyam Pokherel, Mr. Policy, Planning and International Satya Deo Prasad Yadav, Ms. Savitri Gurung Cooperation Division An Assessment on Availability of Essential Drugs in Health Facilities (HP and SHP) in Nepal / 7 Acronyms ASL Authorized Stock Level CDP Community Drug Programme DHO District Health Office DoHS Department of Health Services DPHO District Public Health Office ED Essential Drugs EHCS Essential Health Care Services EOP Emergency Order Point FCHV Female Community Health Volunteers FEFO First Expiry First Out FHCP Free Health Care Policy FHCS Free Health Care Service GoN Government of Nepal HF Health Facilities HFMOC Health Facility Management and Operation Committee HP Health Posts LMD Logistics Management Division MD Management Division MoHP Ministry of Health and Population ORS Oral
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