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Improving Medicine Supply Management in ILembe District, KZN HST Conference 4 May 2016 Lindiwe Mthiyane Ndwedwe CHC Sushila Reddy Stanger Hospital Ashina Rajkumar Sundumbili CHC Renal Govender Umphumulo Hospital Nhlakanipho Thela Montebello Hospital Sbonelo Mbatha Untunjambili Hospital Vani Naidoo District Office

Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

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Page 1: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Improving Medicine Supply Management in ILembe District,

KZN

HST Conference 4 May 2016

Lindiwe Mthiyane Ndwedwe CHC Sushila Reddy Stanger Hospital Ashina Rajkumar Sundumbili CHC Renal Govender Umphumulo Hospital Nhlakanipho Thela Montebello Hospital Sbonelo Mbatha Untunjambili Hospital Vani Naidoo District Office

Page 2: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Outline of Presentation

1 • Background

2 • Situation Prior to the Intervention

3 • Stakeholder Analysis and Engagement

4 • Challenge Model

5 • Monitoring and Evaluation Plan

6 • Key Interventions

7 • Results & Discussion

8 • Way Forward

9 • Acknowledgements

Page 3: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Background: ILembe 2014

1 Regional, 3 District Hospitals

2 Community Health Centre’s (CHC)

31 Primary Health Care(PHC) Clinics

662 413 Population

Page 4: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Background 2014 contd.

Sub District • Designated supervisory pharmacists in each sub-district (Khethimpilo)

PHC Support

• 6 institutional pharmacies with delegated support personnel to attached PHC clinics - Post Basic Pharmacy Assistant (PA) and supervising pharmacist

• Regular support visits to PHC clinics • Working relationships improving between PA /

Pharmacist and Operational Managers at PHC

• Pharmacists are actively involved at sub-district PHC meetings

Page 5: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Situation Prior to Intervention

End of June 2014

Lack of awareness of expired stock within the district

Expired stock was under reported and not adequately addressed

Quarterly & Monthly Performance reports consistently reflected high expired medicines with no specific interventions to eliminate the problem

Fruitless pharmacy expenditure continued

Weekly

There were weekly stock out reports despite concurrent expiring stock reports

Patients repeatedly sent home without the full quota of their medicines

Page 6: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Challenge Addressed

INCREASE STAFF AWARENESS

IMPROVE MEDICINE SUPPLY MANAGEMENT & MEDICINES AVAILABILITY

REDUCE FRUITLESS EXPENDITURE

• In 2014 the rand value of expired stock was very high every month although % expired stock was within provincial norm <1% of medicines expenditure

• Non commitment of staff members to improve stock management by reducing the expired stock

Page 7: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Situation at end of June 2014 as per District Quarterly Performance Report (Qtr. 1 of 2014-2015)

***Only closed stock was reported

Expired stock as a % of medicines expenditure at Hospitals and CHC

0.18 %

Expired stock as a % of medicines expenditure at PHC clinics

0.29%

Provincial Target <1 %

Page 8: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

ROOT CAUSE ANALYSIS DIAGRAM

POLICIES

PEOPLE ENVIRONMENT

Policies • Non adherence to Public Finance

Management Act(PFMA) • Medicine Supply Management

(MSM) SOP’s not implemented • Incorrect disposal of

Pharmaceuticals • Deviation from the Essential

Medicine Lists

Processes and Procedures • Monthly stock takes & expiry checks not done

correctly/ regularly • Procurement process- incorrect quantities

ordered ; expiry dates not checked on receipt • No implementation plans are made when

changes to policy/ protocols; no District PTC • No feedback to staff on expiry checks

People • Attitude • Skills • Honesty

Environment • Decisions taken to meet targets and deadlines.

Pressure to phase in new items with poor planning.

• Patients prioritized – more time spent dispensing than checking and monitoring stock

Expired stock accounted for 0.18% of medicine

expenditure at hospitals and CHC

Expired stock accounted for 0.29% of medicine

expenditure at PHC clinics

PROCESSES & PROCEDURES

Page 9: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Stakeholder Analysis

Pharmacy Managers &

Pharmacy Staff

Doctors and Nurses

Senior Management

Patients

Institutional and District PTC

Page 10: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Stakeholder Analysis Stakeholder Role How Engaged?

Pharmacists and Pharmacist Assistants

• Check expiry dates on receipt of stock • Conduct expiry checks in wards ,

consulting rooms • Comply with MSM policies • Provide support to PHC

• Regular departmental meetings

• Feedback reports on progress

Doctors • Adherence to STG • Co-operation when changes in STG

• District and institutional PTC Internal correspondence

Members of PTC ( district and institutional)

• Medicine utilisation reviews • Implementing plan for the phasing in of

new items • Adherence to STG

• Monthly PTC meetings / quarterly District PTC

Page 11: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Stakeholder Analysis Cont.

Stakeholder Role How engaged?

Patients • Correct use of medicines

• Inform pharmacy staff when medicine is in excess at home

• One on one counselling • Health education

sessions

Institutional Senior Management

• Support the project

Page 12: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

MISSION

To provide pharmaceutical services based on principles of rational drug use ; cost-effective quality care to all

stakeholders in ILembe

Re-order levels not maintained at facilities

Expiry checks not done when receiving stock

from depot/ supplier

Policies not implemented ( PFMA; EML, MSM)

Expiry checks done but not actioned

Staff attitude- commitment vs compliance

No planning for phasing in of new items

No District PTC

Review re-order levels quarterly

Implement & monitor 6 MSM SOP’s

Monthly Distribution plan for excess &

short dated stock in the district

Regular feedback to staff

Performance Management

Commenced with District PTC

Phasing in plans via PTC

Current Situation

Expired stock accounted for 0.18% of medicine expenditure at hospitals and CHC

Expired stock accounted for 0.29% of medicine expenditure at PHC clinics

VISION

Quality pharmaceutical services for a happy healthy ILembe

Measurable Result

Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.

Root Causes

Priority Actions

Page 13: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

M&E Plan Measurable Result : Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.

Indicator/s Definition Data Source (from which

source?)

Data Collection Method (how?)

Frequency of data

collection (how often?)

% expired medicine

Value of expired stock in ILembe district per quarter/ Total medicines expenditure per quarter for ILembe district

Board of survey from Plankmed; Open stock costing; PPSD expenditure reports report

Captured daily at point of discovery ; during stock takes

Daily At month end

Rand Value of expired medicines

Rand Value of expired stock ( open and closed) per quarter for ILembe

Board of survey from Plankmed; Open stock costing

Captured daily at point of discovery ; during stock takes

Daily

Page 14: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

M&E Plan contd. Measurable Result : Reduce expired stock ( open and closed) from 0.18% at hospitals/CHC & from 0.29% at PHC clinics, to < 0.1% of the ILembe District quarterly medicines expenditure , by the end of June 2015.

Indicator/s Definition Data Source (from which

source?)

Data Collection Method (how?)

Frequency of data

collection (how often?)

Rand Value of Relocated stock (short dated)

Rand value of short dated with < 6 months expiry that has been relocated to another facility

Time Expiry sheets; requisition from facility

Costing of requisition

Monthly

Rand Value of Relocated stock (excess stock)

Rand Value of excess stock that has good expiry but cannot be used up timeously by the facility and has been relocated to another facility

High Stock report from Plankmed; requisition from facility

Costing of requisition

Monthly

Page 15: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Key Interventions

Page 16: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

1. Identify areas where medicines are expiring

2. Monitor Programme needs

3. Encouraged Honest reporting of expired stock to detect the extent of the problem within the district

4. Proper documentation of expired medicines.

1. Regular monitoring of both open and closed stock.

2. Monitor phasing out of old stock when STG changes

3. Reinforced health care worker pledge to patients & need for accountability for expired medicines.

4. Records of both open and closed stock

4.

INTERVENTIONS METHODS

Page 17: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Key Interventions

M & E

1. High stock reports & expiry checks done monthly

2. Improved monthly & quarterly pharmacy reports

CLINICAL STAFF/PERSONNEL

1.Engaged with stakeholders (nursing; pharmacy; doctors; district PTC)

2. Rational prescribing in accordance with EML

(changing prescribing trends)

BUDGET IMPACT

1.Relocated stock, reduce fruitless expenditure

(sub-districtdistrict KZN)

PROCEDURES

1. Re-order levels adjusted

2. Changed costing of expired stock (include both open and closed stock)

Page 18: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Monitoring of Closed and Open Stock

Page 19: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Examples of Phasing Out Plans

Item to be phased out Item to be phased in Plan

Cefixime no longer in STI guidelines –PHC EML 2014

Ceftriaxone Use all existing stock of cefixime Redistribute excess to other institutions in district

Doxycycline no longer on STI Guidelines ( PHC EML 2014)

Azithromycin Relocate existing stock of doxycycline to hospital and CHC in district

Gliclazide 80mg tablets ( PHC EML 2014)

Glimepiride tablets Newly diagnosed out patients to be prioritised. Reserve stock of gliclazide for chronics whilst awareness and education increases.

Page 20: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Engaging with nurses at PHC

Page 21: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Patient Counselling & Education

Page 22: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Results /Findings

Page 23: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

HOSPITALS & CHC - Rand Value of Expired Stock & % Expired Stock ( Qtr1 and Qtr2 of 2014-2015)

Institution

Quarter 1 Quarter 2

Expired stock

Value(R)

Total Medicine

Expenditure

% of Expired

stock

Expired Stock

Value(R)

Total medicine expenditure

% Expired

stock

Ndwedwe CHC

R 0 R2 539 089 0% R365 R3 277 441 0.01%

Montebello Hospital

R0 R1 768 544 0% R0 R3 341 558 0.61%

Sundumbili CHC

R9 165 R3 396 234 0.27% R1 210 R6 470 894 0.02%

Stanger Hospital

R1 046 R 10 039 587 0.01% R0 R19 787 294 0%

Umphumulo Hospital

R10 414 R 2 382 568 0.44% R0 R2 630 874 0%

Untunjambili Hospital

R 17 691 R1 234 216 1.43% R6 597 R2 857 148 0.36%

ILembe District

R 38 316 R21 360 238 0.18% R28 494 R38 385 209 0.07%

Page 24: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

HOSPITALS & CHC - Rand Value of Expired Stock & % Expired Stock ( Qtr3 and Qtr4 of 2014-2015)

Institution

Quarter 3 Quarter 4

Expired stock

value(R)

Total Medicine Expenditure

% of expired

stock

Expired stock

value(R)

Total medicine expenditure

% Expired

stock

Ndwedwe CHC

R2 791 R2 603 065 0.17% R10 393 R1 630 964 0.64%

Montebello Hospital

R12 367 R 1930 712 0.64% R7 394 R2 614 675 0.28%

Sundumbili CHC

R6 903 R6 857 212 0.08% R2 550 R8 188 635 0.03%

Stanger Hospital

R7 189 R13 759 854 0.05% R2 935 R15 659 676 0.02%

Umphumulo Hospital

R681 R3 302 302 0.02% R2 662 R5 400 448 0.05%

Untunjambili Hospital

R5 430 R1 844 835 0.32% R2 476 R1 705 875 0.15%

ILembe District

R35 361 R30 297 980 0.12% R28 410 R35 200 273 0.1%

Page 25: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

HOSPITALS & CHC - Rand Value of Expired Stock & % Expired Stock ( Qtr1 of 2015-2016)

Institution Quarter 1

Expired stock value(R)

Total medicine expenditure

% of expired stock

Ndwedwe CHC R 10 603 R3 507 743 0.3%

Montebello Hospital R 10 591 R 3 245 899 0.33%

Sundumbili CHC R4 680 R 6 262 336 0.07%

Stanger Hospital R4 250 R13 845 249 0.03%

Umphumulo Hospital R2 167 R 2 136 473 0.1%

Untunjambili Hospital

R15 916 R 1 586 074 1%

ILembe District R 48 207 R30 583 774 0.16%

Page 26: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

Pe

rce

nta

ge E

xpir

ed

Sto

ck

Institutions

QTR1

QTR2

QTR3

QTR4

QTR1 (2015-2016)

HOSPITALS & CHC - % Expired Stock ( Qtr1 of 2014-2015 to Qtr 1 of 2015-2016)

Page 27: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

R 0

R 10 000

R 20 000

R 30 000

R 40 000

R 50 000

R 60 000

QTR1

QTR2

QTR3

QTR4

QTR1 (2015-2016)

HOSPITALS & CHC - Rand Value of Expired Stock ( Qtr1 of 2014-2015 to Qtr 1 of 2015-2016)

Institutions

Ran

d V

alu

e o

f Ex

pir

ed

Sto

ck

Page 28: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

PHC - Rand Value of Expired Stock & % Expired Stock (Qtr1 and Qtr2 of 2014-2015)

Institution Quarter 1 Quarter 2

Expired stock

value(R)

Total Medicine Expenditure

% of expired

stock

Expired stock

value(R)

Total medicine expenditure

% Expired

stock

Ndwedwe CHC(3)

R 0 R368 239 0% R0 R281 625 0.%

Montebello Hospital (3)

R0 R823 652 0% R8741 R425 760 2.05%

Sundumbili CHC (7)

R11 592 R1 667 256 0.7% R17 161 R1 228 044 1.4%

Stanger Hospital (9)

R6125 R 5 309 722 0.12% R6 145 R4 498 642 0.14%

Umphumulo Hospital (7)

R269 R 1 190 171 0.02% R0 R644 246 0%

Untunjambili Hospital (2)

R 9743 R311 156 3.13% R4 382 R173 867 2.52%

ILembe District (31)

R 27 729 R9 670 196 0.29% R36 429 R7 252 184 0.5%

Page 29: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

PHC - Rand Value of Expired Stock & % Expired Stock (Qtr3 and Qtr4 of 2014-2015)

Institution Quarter 3 Quarter 4

Expired stock

value(R)

Total Medicine Expenditure

% of expired

stock

Expired stock

value(R)

Total medicine expenditure

% Expired

stock

Ndwedwe CHC(3)

R0 R371 061 0% R0 R328 473 0%

Montebello Hospital (3)

R23 779 R693 036 3.4% R4 330 R 440 355 0.9%

Sundumbili CHC (7)

R 5 625 R1 483 339 0.3% R 1 761 R 1 408 521 0.13%

Stanger Hospital (9)

R 839 R 6 660 773 0.01% R21 325 R 4 703 996 0.45%

Umphumulo Hospital (7)

R2 005 R728 053 0.23% R3 105 R1 179 527 0.26%

Untunjambili Hospital (2)

R 2 189 R 182 732 1.2% R 14 364 R 269 412 12.9%

ILembe District (31)

R 34 437 R 10 118 994 0.34% R44 885 R 8 330 284 0.54%

Page 30: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

PHC - Rand Value of Expired Stock & % Expired Stock ( Qtr1 of 2015-2016)

Institution Quarter 1

Expired stock value(R)

Total medicine expenditure

% of expired stock

Ndwedwe CHC R 2 357 R 979 214 0.24%

Montebello Hospital R 12 146 R 468 474 2.6%

Sundumbili CHC R 1 744 R 3 410 081 0.05%

Stanger Hospital R 6 114 R 4 530 628 0.13%

Umphumulo Hospital R 1 852 R 1 478 152 0.13%

Untunjambili Hospital R 3 945 R 185 390 2.13%

ILembe District R 28 158 R 11 051 932 0.25%

Page 31: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

Pe

rce

nta

ge E

xpir

ed

Sto

ck

( n)= no of PHC clinics attached to mother institution

QTR1

QTR2

QTR3

QTR4

QTR1 (2015-2016)

Institutions

PHC - % Expired Stock ( Qtr1 of 2014-2015 to Qtr 1 of 2015-2016)

Page 32: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

R 0

R 5 000

R 10 000

R 15 000

R 20 000

R 25 000

R 30 000

R 35 000

R 40 000 QTR1

QTR2

QTR3

QTR4

QTR1 (2015-2016)

n= number of PHC clinics attached to mother institution

PHC - Rand Value of Expired Stock ( Qtr1 of 2014-2015 to Qtr 1 of 2015-2016)

Institutions

Ran

d V

alu

e o

f Ex

pir

ed

Sto

ck

Page 33: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Rand Value of Excess Stock & Short Dated Stock Relocated (2014-2015)

INSTITUTION & PHC CLINICS

VALUE OF EXCESS STOCK (Rands)

VALUE OF SHORT DATED STOCK (Rands)

TOTAL VALUE OF STOCK RELOCATED ( Rands)

Stanger + 9 PHC R56 489 R46 158 R102 647 Sundumbili + 7 PHC R58 144 R32 37 R90 511 Ndwedwe CHC + 3 PHC R19 493 R893 R20 386 Montebello + 3 PHC R17 977 R16 580 R34 557 Umphumulo + 7 PHC R6 546 R16 853 R23 399 Untunjambili + 2 PHC R408 916 R71 260 R480 176

ILEMBE R567 565 R184 111 R751 676

Page 34: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Best Practices

Page 35: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done
Page 36: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Best Practices • Select excess or short dated items for district focus

• Circulate excess/ short dated lists before PPSD orders are due

• Plan and manage phasing in of new items due to STG changes

• Encourage honest reporting to give true reflection of challenges.

Page 37: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Limitations Challenge Impact

Transport – Insufficient Vehicles due to combined trips with other health care workers to PHC

Some trips to clinics have to be cancelled if no vehicles available ; little or no pharmacy support or reduced time spent at PHC

Lack of Full time PAs at Clinics Roving PAs have limited time for adequate stock monitoring.

No Electronic System to monitor expiry dates (Plankmed does not contain expiry date trackers)

Short dated stock has to be identified manually ( time consuming and less effective as electronic)

Board of Survey Committees not sustained at clinics and all institutions

Non compliance with regulation for destruction and disposal of expired stock (PFMA)

Lack of commitment of Stakeholders MSM policies not fully implemented

Page 38: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Progress in ILembe

Before 2012

2012-2013

2013-2014

2014-2015 2015-2016

PHC reported nil, all hospitals/CHC not reporting

PA’s visiting clinics; PHC values for expired stock still added on to hospital values

reporting improving; awareness increasing

MSM Training , SOPs, Project commences; start to identify what items expiring and why; open or closed stock

Now we know: • Where ? • What ? • Why ? • Open or closed ? • What class ? • EML/non EML ? • Excess vs short

dated ?

Page 39: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Scaling up interventions within the district

• Closer monitoring is still required in clinics

• Monthly reports (Pharmacy Managers District Pharmacy Manager)

• Regular feedback to stakeholders

• Improve participation of nurses

Page 40: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Sustaining the project

Phased implementation of

MSM policies; STG/EML changes

and consistent monitoring thereof

Policy must be institutionalized and awareness

campaigns broadened

Design interventions to

target therapeutic classes with high

expiries

Ongoing communication with relevant stakeholders with regards to rational medicines prescribing,

and medicines management

Roll out project to other districts

Page 41: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Acknowledgements

• Provincial Pharmaceutical Services

• MSH / SIAPS

• Institutional Senior Management

• District & Institutional PTC members

• Operational Managers & PHC Supervisors

• Pharmacy & Nursing Staff

• Fellow Pharmaceutical Leadership & Development Programme (PLDP) participants and colleagues

Page 42: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Acknowledgements • This project was carried out as part of the

Pharmaceutical Leadership Development Program (PLDP) facilitated by the USAID funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS)

• This presentation is in memory of our team member and Pharmacy Manager, Mr. N. Thela who passed away tragically on 17 April 2016

Page 43: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Inspiration

Page 44: Medicine Supply Management in ILembe District, KZN...31 Primary Health Care(PHC) Clinics 662 413 Population . ... Re-order levels not maintained at facilities Expiry checks not done

Thank You