This is a continuing activity from FY06 and FY07.

Dispensing, Rational Use and Site-level Inventory Management of Antiretroviral (ARV) Drugs and Related

Products

This activity focuses on facility-level stock management of essential HIV commodities, such as ARV and

opportunistic infection (OI) drugs, lab supplies, prevention of drug expiry by shifting stock among facilities,

and raising the current low standard of dispensing to acceptable levels. The activity is related to good

clinical and pharmacy practice and is a component of the rational use of drugs (rational prescribing, rational

dispensing, and rational use by the patient). Management Sciences for Health/Rational Pharmaceutical

Management Plus (MSH/RPM+) will continue to collaborate with the Drug Administration and Control

Authority (DACA), the Provisional Supplies and Logistics Department (PSLD) of the Ethiopian Ministry of

Health (MOH), the Partnership for Supply Chain Management (PSCMS), as well as new entities such as the

US President's Malaria Initiative(PMI), and the MSH Care and Support Program, and other relevant

organizations, to implement rational HIV commodity dispensing and use for ARV, OI drugs, malaria and

tuberculosis (TB) products, PMTCT supplies, laboratory reagents and test kits at ART facilities It will

support facilities in submitting monthly orders using facility-based data; in collaboration with DACA, Abt

Associates, and as part of the public-private partnership (PPP) effort, it will provide technical assistance

(TA) to Kenema (City Council), Red Cross, and selected private pharmacies in storing and dispensing ARV

and related commodities.

Improving Quality Assurance of ARV and Related Commodities

Quality assurance of ARV and other drugs plays a vital role in guaranteeing favorable treatment outcomes

and decreasing toxicity. This is a continuing activity from FY06 and FY07. MSH/RPM+ will continue to

provide TA to DACA by seconding Quality Control/Quality Assurance (QC/QA) pharmacists and supporting

regional activities to ensure the quality, safety, and efficacy of HIV/AIDS, TB, malaria, and OI drugs.

DACA's capacity to monitor and control the movement of counterfeit pharmaceuticals will be strengthened.

DACA's drug QC laboratory will be supported in the proper storage of reagents and chemicals, record-

keeping, and provision of reference books and standards, computers and accessories, TA in the

development of new standard operating procedures (SOP) and in managing an electronic database and

reporting system for their QC Laboratory. In collaboration with PSMCS, MSH/RPM+ will support DACA and

PHARMID's efforts in post-marketing surveillance of drugs, establishing six QC mini-labs at selected sites.

Strengthening Site-Level Pharmaceutical and Laboratory Information Management

This activity will assure that there are no treatment interruptions due to stock-outs of vital products, will

minimize expiry of expensive drugs. RPM+ has implemented pharmacy-based patient medication records

for more than 70,000 ART patients nationwide; some are computerized. Facilities have been provided with

over 50 computers and printers and 62 pharmacy data clerks have been deployed to hospitals and health

centers to ensure quality data entry and reporting. These activities will be maintained and further expanded

In FY08. RPM+ will support health facilities in preparing scheduled orders of HIV commodities, and will

support PSCMS in distributing these items from PHARMID regional stores to facilities. MSH/RPM+ will build

on the experience to date, scaling up inventory management, patient pharmacy records, and reporting at

facility level and ensuring that ART SOP and pharmacy-related formats and registers are available at all

ART/PMTCT sites. Routine commodity audit systems will be introduced at all ART sites. Target facilities will

be provided with computers and printers. Access to telephones and the Internet will continue to be

supported to facilitate reporting and track defaulters. In order to ensure ownership and use of data, data

managers will be recruited and deployed at regional health bureaus (RHB).

Facility-level data will be compiled, analyzed, and shared with relevant agencies for quantification and

redistribution. Monitoring of ARV drug management and use will be supported. In consultation with PSCMS

and other partners, MSH/RPM+ will continue to work on implementing an electronic tool to manage

information on laboratory commodities.

Strengthening Pharmacy Human Resource Capacity

This activity is part of an overall human resource (HR) capacity-building effort with local and US universities,

the Clinton HIV/AIDS Initiative (CHAI), and JHPIEGO. HR-related constraints are perhaps the greatest

challenge for the health system at present. In conjunction with the Ethiopian Pharmaceutical Association,

pre-service and in-service training will be provided to pharmacy personnel and students. To date RPM+ has

trained more than 1,400 pharmacy and allied professionals in HIV-product management and rational drug

use (RDU). Refresher trainings need to be conducted to update staff and address high staff turnover. ART

site staff will be trained in supply management, pharmaceutical care, and RDU, as well as basic computer

skills. Training will be followed by supportive supervision and mentoring. External short-term training in

relevant areas will be facilitated for selected participants. In collaboration with DACA, RPM+ will promote

public awareness and education by training media personnel to promote RDU, including containment of

antimicrobial resistance (AMR), adherence, awareness about counterfeits, etc., and providing up-to-date

specialty books and reference materials to health facilities. A critical task assigned to MSH/RPM+ by the

MOH during the plan year is the assessment of pharmaceutical HR needs and development requirements

of the pharmaceutical sector as outlined in the Pharmaceutical Sector Master Plan.

Provision of Technical Assistance and Coordination

RDU is a key element to maximize treatment options for chronic diseases such as HIV/AIDS. Monitoring

and minimizing adverse drug reactions (ADR) is instrumental in increasing adherence to treatment, which

supports the success of treatment. Clients will get improved pharmaceutical care, and the development of

viral or AMR will be minimized. TA will be provided in the following areas: 1) RDU; (2) establishing drug and

therapeutic committees (DTC) and drug information centers (DIC), in collaboration with DACA, PSLD, RHB,

CHAI's Hospital Improvement Initiative and others; (3) AMR containment; (4) ADR monitoring; and 5)

adherence monitoring and promotion through workshops, studies, and development of facility-level action

plans. Activities envisaged include collaboration with programs such as the new Care and Support Program

at health centers, at community and household levels with health extension workers, through HIV/TB drug

management, with PMI in management and rational use of malaria products; and by linkages with

stakeholders to conduct drug-related operational research. Working closely with DACA and PSLD, RPM+

will support improved governance in the pharmaceutical sector by providing TA in pharmaceutical policy,

regulation, and quality services in support of the national pharmaceutical and logistics master plans, and will

collaborate with the MOH, DACA, PSCMS, and the Implementation Support Team (IST) of the Logistics

Master Plan in the transformation of PSLD to the "New PSLD" and PHARMID to the new Agency.

Activity Narrative: This is a continuing activity from FY06 and FY07.