NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

The activities in this area will focus on strengthening the pharmaceutical management for HIV/AIDS

commodities at facilities in line with the Ministry of Health's (MoH) policy to integrate HIV/AIDS

pharmaceuticals into the Ministry's supply system and the rational use of ART drugs. It will address the

capabilities in monitoring the system, and will involve training of service providers, development of Standard

Operating Procedures (SOP's), facilitating their implementation at the facility level, and the introduction of

management tools. In addition, technical assistance (TA) to the MoH for reviewing, updating and

disseminating essential drugs list and standard treatment guidelines will be provided.

Background

With FY 2008 Emergency Plan (EP) funding, MSH/SPS will support the MoH scale up plans for counseling

and testing, ART, and PMTCT services by facilitating the integration of HIV/AIDS medicines into the general

supply chain to improve overall pharmaceutical management for HIV/AIDS programs. Current support in

pharmaceutical management addresses each HIV/AIDS area individually and there is need to consolidate

these efforts under the umbrella of the National Drug Policy in terms of drug selection, procurement,

distribution, and rational use.

Experiences, lessons learned, and tools from other countries supported by MSH within the region will be

drawn on to strengthen the pharmaceutical management of HIV/AIDS commodities in Malawi.

The procurement of all medicines and medical supplies in Malawi is done in accordance with the Malawi

National Drug List and the Essential Health Package. The National Drug Committee is charged with the

responsibility of selecting drugs and reviewing the Essential drug list and standard treatment guidelines

(STG). MSH/SPS will work with the MoH to update the Malawi Essential Drug List as well as STG with

HIV/AIDS medicines, to provide a facilitative policy environment for HIV/AIDS commodities integration into

routine supply chain systems, and their rational use at facility levels.

The expected results include improved ART dispensing and management of ART patients at facility levels

and improved management of ART drugs. Also, it is expected that the HIV/AIDS unit will have the capacity

to quantify HIV drugs for the country.

With EP funding, MSH/SPS will increase the number of ART service providers trained in proper

management of ART drugs using updated training materials that are incorporated in the national training

materials for all health workers, as well as increase the capacity at the facility and CMS level to estimate

more accurately HIV/AIDS commodities requirements and promote the rational use of ART drugs.

MSH/SPS will work closely with the DELIVER Project and the MoH (the new HIV/AIDS M and E unit) to

ensure a seamless complementarity of assistance and training between the two projects. This activity

focuses on pharmaceutical management and rational drug use while the JSI - Deliver project focus is on

logistics and information systems.

Activity 1: Review and Dissemination of EDL

MSH/SPS will support the updating and dissemination of the Malawi Essential Drugs List (MEDL) and

Malawi Standard Treatment Guidelines (MSTG) to incorporate the new drugs being used for treatment of

HIV/AIDS, opportunistic infections, and in PMTCT. This will be a wraparound initiative with the Presidential

Malaria Initiative (PMI), as the review and dissemination will include the new Malaria drugs (i.e. ACT) into

the MEDL and MSTG. The EP funds for this activity will be used to support 3 review workshops of the

National Drug Committee, and dissemination of guidelines through training of 1325 health workers on the

proper use of the guidelines.

Activity 2: Incorporate HIV Pharmaceuticals into Pharmaceutical Training Curricula

This activity will support the incorporation of a management for HIV/AIDS medicines module in the pre-

service pharmaceutical training curriculum for all health workers. The revised curricula will address issues of

pharmaceutical management of HIV/AIDS medicines. These would include prevention of adverse drug

reactions, the promotion of drug safety including rational use, preventing medication errors, and minimizing

factors that contribute to therapeutic ineffectiveness. Examples include non adherence, poor quality drugs,

drug interactions, and microbial resistance. These topics will be covered during pre-service training not only

of health workers directly involved in ART, but other health staff working in primary health care settings. The

activity will initially target the Malawi College of Health Sciences and CHAM (private sector hospitals)

training schools.

Activity 3: Pharmaceutical Management of ART Drugs

With EP funding, MSH will build capacity of health workers in the pharmaceutical management of ART

commodities to improve management of ART drugs and supplies and the quality of care provided at facility

level. Building capacity of health workers involved in managing ART at facility level as well as Central

Medical Stores in pharmaceutical management of HIV drugs will involve training through a Monitoring,

Training, and Planning (MTP) approach. The training will be given to 340 health workers (at least two from

each ART site) from public sector as well as the private sector through the Malawi Business Coalition for

HIV/AIDS and will focus on adherence monitoring, rational use, recognizing suspected adverse drug

interactions and how to report them, and drug interactions. In facilities where both ART services and malaria

Activity Narrative: treatment are provided, deliberate effort will be made to link the pharmaceutical management of ART and

antimalarials trainings.

Activity 4: Strengthening ART Pharmaceutical Care Management Procedures at the Facilities that Provide

ART services Including Central Medical Stores.

The activity will primarily involve:

(i) Introduction of SOPs for ART management in both public and private sector (e.g. CHAM Hospitals).

These SOPs will ensure standardized drug management procedures in all facilities that are providing ART

and will focus on stock management, dispensing, medication counseling, ADR reporting, medication errors,

and side effects management.

(ii) Introduction of the ART dispensing tool in the district hospitals to promote good medicines and patient

management as well as dispensing leading to improved care and treatment of HIV/AIDS patients. The

manual management of data on patient profiles and treatment regimens is a challenge as the number of

patients enrolled in the ARV program progressively increases. There are currently 100,000 patients enrolled

in the program. The ART dispensing tool will be used in conjunction with existing software in the district

hospitals. Additional funding will be needed/leveraged to procure hardware to support those district

hospitals that will need new hardware.

(iii) Coordinate with Deliver/USAID and national stakeholders for policy decisions leading to the

development of an ART inventory management system at CMS to track ART consumption at facility level,

identification, and installation of inventory management software for CMS that can accommodate the ART

management information system.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18515

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18515 18515.08 U.S. Agency for Management 7872 7872.08 MSH - SPS $500,000

International Sciences for

Development Health

Table 3.3.15: