Pharmaceutical Management for Micronutrients and Anemia … · 2021. 3. 10. · THE PROBLEM –...
Transcript of Pharmaceutical Management for Micronutrients and Anemia … · 2021. 3. 10. · THE PROBLEM –...
Pharmaceutical Management for Micronutrients and Anemia-Reduction
Medicines
Academy for Educational Development A2Z/India: Suneel Muttoo, Prakash Kotecha, Sumitro Roy;
A2Z/Uganda: Alfred Boyo, Milly Namaalwa
A2Z/USA: Linda Tawfik, Tina Sanghvi, Zo Rambeloson, Verónica Lee
&
Management Sciences for Health Vim Dias, Grace Adeya, Helena Walkowiak, Abaasi Kabogo
Supply –Side Considerations
Sumitro Roy, Alive & Thrive
Asia Regional Meeting 3 May 2012, Dhaka, Bangladesh
Presentation Outline
• Intervention Site- Uganda & India
• Problem
• Aims
• Methods
• Results
• Global and Country-level Implications
THE PROBLEM – INDIA, JHARKHAND STATE
Estimated rural population1
24
million
Any anemia in pregnant women2
70%
Any ante-natal care (ANC) checkup2
55 %
3 or more ANC checkups2 28%
Received or purchased IFA2 46%
Prenatal IFA supplementation consumed for 90+ days2
11%
Sources: 1Registrar General of India, Dec., 2006 2NFHS 2005-06, Jharkhand State Report, May 2008
THE PROBLEM: UGANDA
Population1 28.5 million
Anemia in pregnant women2 64%
Any ANC checkup2 94.5%
2-3 ANC checkups2 41.7%
4+ ANC checkups2 47.2%
Prenatal iron supplementation consumed for 90+ days2 0.70%
Source: 1Uganda Bureau of Statistics; 2UDHS 2006
The Problem: % of Women Reporting Difficulty in IFA Supply Availability versus Access or Cost of IFA
25 25
4137
4
53
2531
0
20
40
60
80
100
Supply Access Cost Supply Access Cost Supply Access Cost
Uttar Pradesh, India Jharkhand, India Uganda
% W
om
en w
ith infa
nts
<6 m
onth
s
Supply: Tablets not available/stockout Access: Site too far away/no transport Cost: Too expensive
Aims
• Improve program impact
• Transfer knowledge and develop toolkit
Methods
• Selected large-scale A2Z program sites in India, Uganda, and Cambodia
• Determined conceptual framework
• Collaborated with stakeholders and engaged international pharmaceutical experts to conduct assessment
• Selected interventions by analyzing
options • Implemented interventions • Monitored and evaluated results
Pharmaceutical Management Cycle
Selection
Management Support
Distribution
Procurement Use
Policy and Legal Framework
Providers
know
protocols but
counseling is
absent
Poor IFA quality,
use of mebendazole
vs albendazole
No
standard
schedules,
low priority
of anemia-
reduction
products Poor forecasting
skills, inaccurate target population
denominators,
no buffer stocks
Determine Framework & Conduct Assessments
Select Interventions
India/Jharkhand State
• Advocate National, State, District levels
• Change to a demand-based system Estimate needs based on population based
• Develop systems & procedures Procurement, forecasting, inventory control,
distribution, HMIS, appropriate use
• Build capacity Train service providers (quantification, counseling, and HMIS use) Develop job aids
• Monitor stocks at all levels
Uganda/12 Districts
• Advocate National & District levels
• Build Capacity Train service providers in 12 districts
(quantification, counseling, and HMIS use)
Develop job aids • Develop National Guidelines and
Tools for Anemia Reduction
Village Health Teams Manual, Supplies Monitoring Checklist
• Monitor stocks at all levels
Results: India and Uganda
India/Jharkhand State
• State procurement of IFA increased 8 fold from 2005/6 - 2008/9
• Deworming medicine selected and procurement increased
• State level MOH logistics staff increased
• Number of service providers trained in supplies management and counseling increased
• Stock outs of IFA and deworming medicines at district and health sub-center levels decreased
Uganda/12 Districts
• National Medical Stores committed to stock combined IFA (at national level)
• Number of service providers trained in supplies management and counseling increased
• Days of stock out for ferrous sulphate (200mg) and folic acid (500 micro g) reduced
• Days of stock out for deworming medicines (albendazole or mebendazole) reduced
Results: Trend in IFA Procurement (L) Jharkhand State, India 2005/06-2008/09
Micronutrient Drug Procurement IFA (L): Jharkhand
22500000
63631800
35 million
281 million
0
50000000
100000000
150000000
200000000
250000000
300000000
2005-06 2006-07 2007-08 2008-09
Financial Year
Tab
lets
Results: Trends in procurement of Mebendazole & Albendazole Jharkhand State, India 2005/06 - 2008/09
Trend in Procurement of ALBENDAZOLE,
Jharkhand 2005/06-2008/09
0 0
7,599,100
276,000
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
2005-06 2006-07 2007-08 2008-09
Table
ts p
rocure
d
Financial Year
Trend in Procurement of MEBENDAZOLE,
Jharkhand 2005/06-2008/09
2,850,000
2,000,000
460,000
00
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2005-06 2006-07 2007-08 2008-09
Table
ts p
rocure
d
Financial Year
Results: IFA Stock outs, % of Year Health Sub-center & Dumka District Warehouse Jharkhand State, India, 2007-08 and 2008-09
Results: Deworming Medicines Stock outs, % of Year Health Sub-centers, Dumka District Jharkhand State, India, 2007-08 to 2008-09
Results: IFA, Ferrous, Folic Acid, Albendazole, Mebendazole, Stock outs, % of Year, Uganda, 2007 and 2008
% of Days of Stock Out per Year
Uganda-6 Districts
51%
66%58%
30%
18%
53%43% 40%
24%
10%
0%
20%
40%
60%
80%
100%
IFA Ferrous sulphate
(200mg)
Folic Acid (5 mg) Albendazole Mebendazole
% o
f d
ays o
f sto
ck o
ut
2007 2008
Conclusion
• Selection of Quality IFA Tabs–Composition & Packaging
• Estimate based on population- Accuracy of denominators
• Advocacy at National, Divisional, District level to prioritize procurement & supply of Anemia reduction products
• Strengthen systems & procedures- Forecasting, Procurement, inventory control, distribution, HIMS at all levels
• Build the capacity of staffs at all level
• Monitor stock at all levels of supply & distribution- Assess status of stock out
Conclusions: Global and Country Implications
• A systematic strategy can lead to improved availability of anemia-reduction products at service delivery points within one year
• The strategy includes stakeholder collaboration, assessments, options analysis, interventions, monitoring and evaluation
• Scaling-up the supply side of proven interventions is key to sustainable reductions in morbidity and mortality from micronutrient deficiencies
• Strengthening pharmaceutical management systems requires investment and a long-term sustainability strategy
Thank You
A2Z—the USAID Micronutrient and Child Blindness Project—is managed by the Academy for Educational Development (AED) and funded
by the United States Agency for International Development (USAID), Health, Infectious Disease and Nutrition (HIDN) Office of the Bureau of
Global Health, Cooperative Agreement, Leadership with Associate Awards, GHS-A-00-05-00012-00. The information provided does not
represent the views or positions of the U.S. Agency for International Development or the U.S. Government.