In 06, RPM Plus focused on activities that included the strengthening of Therapeutics Committees (TC). A functional Therapeutics Committee serves as the foundation for the improvement of rational use of medicines at treatment facilities. To ensure sustainability of these committees, RPM+ is working with the regional TCs who are charged with the responsibility of addressing issues related to rational use of medicines in district hospitals located in their catchment areas. RPM+ is working with the following TCs: regional TCs of Oshana, Otjozondjupa, Omusati and Erongo regions and the district TCs in Onandjokwe Lutheran Hospital and Windhoek Central Hospital (WCH). These TCs will serve as best practice centers for the development of TCs in other regions in Namibia. Also in 06, RPM+ provided TA for the development of an adherence system. An assessment of current adherence practices is being conducted to determine factors that affect patient adherence and to determine strategies that health facilities have in place for the monitoring and improvement of adherence. This assessment will provide information for the development of national standards for monitoring and measuring adherence and for the implementation of interventions to improve adherence. The provision of infrastructure to treatment facilities will ensure that ARV medicines are stored and dispensed in a secure and safe environment. With 06 funding RPM+ developed the Therapeutics Information and Pharmacovigilance Center (TIPC) implementation plan. The MoHSS has nominated a TIPC implementation working group. In 06 RPM Plus conducted field supervisory visits for follow-up on the HIV/AIDS Pharmaceutical management training. Findings indicate that treatment facilities are in need of regular TA in the use of Standard Operating Procedures (SOPs), adherence monitoring and in quantification of ARV medicines need. 06 funds were also used to conduct an option analysis for the determination of interventions for reducing the cost of ARV medicines in the private sector. In continuation of support for the strengthening of policies and procedures of CMS/RMS for efficient procurement, storage and distribution of medicines, RPM+ in 06 provided CMS with a Closed Circuit Television (CCTV) surveillance system, supported the partitioning of the ARV warehouse, provided support for the implementation of the CMS SOPs and provided TA and support for the linking of the different medical stores and for the electronic ordering of medicines. Also in 06, RPM Plus continued to support the human capacity needs for pharmaceutical services by supporting ten (10) Pharmacists, a Quality Surveillance Laboratory Manager, a CMS Network Administrator and two (2) Pharmacists Assistants all managed by a local human resources company.

In 07 RPM+ will focus on support for the improvement in the quality of pharmaceutical care at the 34 treatment facilities and TA for the MoHSS decentralization plan for ART services to 13 health centers and clinics. 07 funding will provide: Support for the implementation of the pharmacy SOPs. The SOPs are currently in use in about 10 treatment facilities. The SOPs include a quantification workbook to assist facilities in the quantification of their ART medicines requirement. 07 funds will assist in the updating of the SOPs, printing of the final version, distribution to all the 34 facilities and the monitoring; Provide training in pharmaceutical management for treatment facilities in seven regions not covered in 06. These trainings will be provided to 30 pharmaceutical officers and will cover topics in stock-keeping, inventory control, store management, record keeping and reporting, SOPs and quantification. They will also address key knowledge of ARVs, OIs and Palliative care medicines including their side effects, adherence monitoring and appropriate dispensing practices; Provide TA and support for establishing a process for ongoing monitoring and supportive supervision of pharmaceutical services at treatment sites. 07 funds will ensure that all 34 treatment facilities have patient friendly ART dispensing practices. Patients attending the CDC Pharmacy and whose prescriptions contain ARVs, Cotrimoxazole Prophylaxis Therapy (CPT) and Isoniazid Prophylaxis Therapy (IPT) will receive their medicines at the same CDC Pharmacy. TA will ensure that prescriptions are monitored so that all patients qualifying for CPT and IPT according to the Namibia guidelines receive these medicines. This will support the provision of the Preventive Care Package of the USG; Provide TA for the strengthening of Therapeutics Committees to support projects aimed at improving rational use of medicines. Such projects may include reduction in patients waiting time to receive services, improvements in the reporting of side effects to ART medicines, hospital drug utilization reviews and application of the Monitoring-Training and Planning (MTP) model to improve functioning of TCs. RPM+ will be collaborating with URC on this activity to support their recommended interventions to improve injection safety practices;

Provide TA for the development and implementation of adherence monitoring and measurement strategies to assist in the finalization of the development of the national standards for monitoring and measuring adherence that were initiated in 06 and for the improvement in adherence to treatment including the training of expert patients and community counselors in 34 treatment facilities to provide adherence counseling; Provide TA and to reduce cost of ART treatment in the private sector. An option analysis was conducted in 06 and the results of that analysis and subsequent discussions with stakeholders including medical aid (health insurance) schemes will provide direction for the required interventions will reduce cost of ART provision in the private sector; Provide support for Health care workers to enhance professional training networking; Support mid-level Pharmaceutical officers and the development of continuing professional development materials in pharmaceutical management; Support will be provided for retention of ten (10) Pharmacists and the hiring of a drug information Pharmacist to support the TIPC center. Also bridge funding will be provided for five (5) newly qualified Pharmacist Assistants until MoHSS is able to absorb them. RPM+ plans to support the rollout of the Integrated Management of Adolescent and Adult Illness (IMAI) with the recruitment of mid- level pharmaceutical officers for 5 selected district hospitals. All staff will continue to be provided through Potentia, a local human resources company; Support the MoHSS decentralization plan for ART services using the IMAI model to 13 health centers and clinics. To improve outcome with chronic disease management, stabilized patients must be able to access care closest to their homes. This approach is in line with one of the key recommendations of the Namibia Cabinet, better health care in the rural areas by ensuring equal treatment in respects to medicines and equipment. For the decentralization of ART services, the critical pharmaceutical management issues will include aspects related to distribution systems as well as to the rational use of ARV, OIs and palliative care medicines. Support to ART decentralization among other things will involve the following: a) Advocacy for the adoption of a policy to allow nurses to repeat ART prescriptions, for stabilized patients b) Training of Nurses, health center and Clinics officers in pharmaceutical management topics and training of Community counselors, support groups and CBOs on: how to store medicines, need for adherence, Patient Information Leaflets (PIL) on medicines in local languages, how to recognize mild and transient side effects and when to seek medical attention with moderate to severe side effects

In FY06 RPM Plus provided support and training to the ART Logistics Pharmacist of MoHSS. This ART Logistics Pharmacist position was created at the initiative of RPM+ in 2005 to serve as the lead person for the ART Commodity Tracking System (ACTS). The ACTS collects ART medicines consumption data from treatment facility and therefore provides national information on consumption of these medicines. The consumption information is also utilized for the projection of national ARV medicines needs using the RPM Plus quantification tool called Quantimed. Skill transfer for the use of Quantimed was successfully completed in 2006 with minimal technical assistance provided to the ART logistics Pharmacist.

The MOHSS Pharmacy Management Information System (PMIS) Task force activities were supported by RPM Plus in FY06. Those activities included the field testing of the PMIS indicators and the incorporation of comments for the final adoption. This is in preparation for training and implementation of the indicators. RPM Plus also provided needed hardware to assist with data collection in relation to the activities of PMIS.

Consumption data for the ARV, opportunistic infection (OI) and palliative care medicines are required to inform policy makers and the ART program on the reach of the ART services. Funding is requested in COP07 to continue support for the routine and seamless transmission of ART consumption data from the treatment facilities to the national level. High volume facilities will use the ARV Dispensing tools for the tracking of these data and the smaller facilities will be supported to use the monthly consumption reporting forms in the SOPs for the reporting of their ART medicines consumption.

Support the roll out of the ART Commodities Tracking System (ACTS)- The ACTS includes the ARV Dispensing Tool and the National Database for the collation of national ARV consumption data. Currently the ARV dispensing tool is being used in 4 treatment facilities. RPM+ plans to increase the use of the ARV dispensing tool to another 6 higher volume facilities. These facilities will be using the ARV Dispensing tool to track consumption of ARVs and OI medicines in their facilities, complete the MoHSS ART monthly report and generate daily refill list to trigger defaulter tracing. The ARV Dispensing Tool will collate data that will feed into the national database that will be managed by the Supply Chain Management System (SCMS).

Support for the data collection activities of the PMIS task force- Additional requirement for the efficiency of the data collection processes will be provided and may include computer hardware, data processing software and a database for the storing of aggregate information. The PMIS taskforce is currently being supported by RPM+ to develop MoHSS PMIS tools and system. In COP07 RPM+ will also support the PMIS task force to develop indicators for monitoring the implementation of the National Medicines Policy Implementation Master plan. Supplementary hard wares and soft wares to the ones procured in COP06 are therefore required. The additional procurement of these hard wares and soft wares is estimated to cost about USD $60,000. COP07 funding will also be used to provide TA to the PMIS taskforce for the development of the indicators.

In FY06 RPM Plus continued to provide TA and support for the strengthening of the pharmaceutical policy environment through the design, development and advocacy for the implementation plan for the Therapeutics Information and Pharmacovigilance Center (TIPC). The TIPC implementation workgroup was set up by MoHSS. RPM Plus collaborated with the Spanish Cooperation, Medicos Del Mundo, in this activity. Discussions for the merging of the ITECH HIV call center initiative into the TIPC was held with ITECH and was well received. RPM Plus in FY05 and FY06 provided TA and support for the development of a registration database for the registration unit of the Pharmaceutical Control and Inspection (PC&I) SubActivity Narrative In 07 activities will be for strengthening of the pharmaceutical policy environment to support the scale up and decentralization of ART services with the following activities: 1. Support to committees charged with guidelines development for HIV/AIDS and other medicines. The selection of medicines for inclusion or deletion from national essential medicines lists are usually conducted by special groups with technical knowledge in the disease areas concerned. For the HIV/AIDS area, selection of ARV medicines is carried out by the Technical Advisory Committee (TAC), such committee and others require knowledge on critical appraisal skills and pharmacoeconomics in order to understand the comparative advantages of the choice they will be making. RPM Plus will support TAC and other essential medicines list HIV/AIDS related committees with knowledge in critical appraisal skills and pharmacoeconomics; 2. Provide TA for Policy on selection of medicines for inclusion into the Palliative care medicines list and the Home based care (HBC) kits. Currently some medicines including pain management Opiates like Codeine and Morphine, antidepressants like Amitriptyline and anti-diarrhea like Loperamide are not within the prescription rights of Nurses. Policy is needed for the selection of medicines for the Palliative care essential medicines list, HBC kits and increasing the prescriptions rights of Nurses to include all medicines in the World Health Organization (WHO) recommended palliative care essential medicines list. RPM Plus bring MoHSS policy makers, opinion leaders and stakeholders together and advocate for policy change to improve access to these medicines in line with the MoHSS decentralization objective and the strengthening of the continuum of care. This activity will result in greater access to medicines and improvement in care provided by all partners working in the areas of HBC and Palliative care; 3. Provide TA and support for the update, printing and distribution of the Essential Medicines List. The Namibia Essential Medicines List (EML) is currently not updated and does not contain such medicines like ARVs and the new TB and Malaria medicines; 4. Provide TA for the implementation of the Medicines Information, Pharmacovigilance and ADR systems and for the continued support to the Therapeutics Information and Pharmacovigilance Center (TIPC). RPM Plus will support the TIPC with the recruitment of a Drug Information Pharmacist, the development of the ADR forms and local training in pharmacovigilance and adverse drug reaction reporting 5. Provide TA and support for the Development and printing of a National Formulary; 6. Strengthen Medicines Control Council (MCC) secretariat. The MCC currently requires further strengthening and support with exposure in critical areas of medicines control. There is also lack of knowledge of the use of pharmacovigilance and post-marketing information for regulatory purposes. RPM Plus will provide TA and support for the training of MCC members in pharmacovigilance and use of post-marketing information for regulatory purposes; 7. Provide TA for the development of an updated National Medicines Policy implementation Master-plan. Support will be provided to ensure that an implementation master-plan is developed from the revised NMP division.