Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011

Details for Mechanism ID: 10525
Country/Region: Ethiopia
Year: 2010
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $3,000,000

The Strengthening Pharmaceutical Systems (SPS) Program is the follow-on to the Rational Pharmaceutical Management Plus (RPM Plus) Program, active in Ethiopia since 2004. SPS provides technical and material support to 400 ART sites in all areas of dispensing of medicines, including the maintenance of Pharmaceutical Management Information Systems (PMIS). SPS assists ART facilities and Ethiopian Government stakeholders to strengthen the rational use of medicines (RMU), including antiretrovirals (ARVs), medicines used for tuberculosis (TB), malaria, opportunistic infections (OIs), and other diseases.

The assistance being provided by SPS not only contributes towards meeting specific short-term program targets (e.g. antiretroviral therapy or ART uptake targets), but also plays an important part in assuring the sustainability of interventions by strengthening human resource (HR) capacity and introducing robust systems for patient-oriented pharmacy services in general. SPS strives to build institutional capacity and sustainability by providing technical assistance and resources to key pharmacy stakeholders, such as the Drug Administration and Control Authority (DACA), the Pharmaceutical Fund and Supply Agency (PFSA), schools of pharmacy, the Ethiopian Pharmaceutical Association (EPA), Ethiopian Druggists Association (EDA), Regional Health Bureaus (RHBs) and health facilities.

SPS support to DACA in the area of Pharmaceutical Good Governance will continue, as will support to strengthen its regulatory operations. The pharmacy professional associations will be supported to conduct their programs of Continuing Education and trainings on Pharmaceutical Ethics to pharmacists and druggists, including those in private practice.

Ethiopia is rapidly losing many of the cheap and effective antibiotics, including many of the drugs used by people living with HIV/AIDS (PLWHAPLWHAA) for the prevention and treatment of OIs, due to the development of microbial resistance. With the help of the National Antimicrobial Resistance (AMR) Committee that SPS helped establish, SPS will provide technical assistance to health facilities and stakeholder institutions to optimize the use of antibiotics and other infection prevention agents in a bid to contain resistance to these agents. SPS will continue to support DACA in its work to record and report Adverse Drug Reactions (ADR) and implement a national system for pharmacovigilance, while working with PFSA and health facilities on interventions to minimize medication errors and recognize and prevent ADRs.

The availability of medicines alone doesn't guarantee improvement in the health of a population; available medicines should be used rationally for this. SPS will continue its work to strengthen the capacity of health facilities, RHBs, PFSA and DACA to develop, disseminate, use, monitor and evaluate different tools that improve the rational use of medicines by prescribers, dispensers, regulatory and service-providing bodies. In collaboration with stakeholders, trainings in RMU will be provided to service providers, while 35 SPS staff on the ground throughout the regions will provide mentorship. Patient education materials on medicine use and the importance of adherence to treatment will be produced and disseminated to facilitate the job of dispensers and empower patients in the use of their medicines.

The Ministry of Health requires hospitals to have Drug Therapeutic Committees (DTCs) as part of their management structure, and DTCs are considered a key intervention in the World Health Organization Global Strategy for Containment of AMR. By establishing/strengthening DTCs, SPS plans to build the institutional capacity of facilities for the selection, prescribing and dispensing of medicines, and conduct medicine use reviews in order to optimize the use of medicines and contain their cost. The current outpatient and inpatient pharmacy services have been described as "unacceptable" by the MOH's Business Process Reengineering (BPR) reorganization. SPS will work to bring a fundamental change in patient-orientated pharmacy services by collaborating with DACA to introduce pharmacy service standards. Likewise, SPS will assist PFSA to prepare and implement clinical pharmacy/pharmaceutical care manuals and guidelines to improve treatment outcomes. For the same purpose, SPS will support health facilities to expand use of the current SPS-designed electronic and paper-based inventory and patient medication recording tool (AIDS Dispensing Tool, now updated as the Essential Drugs Dispensing Tool or ADT/EDT) for ART clients at hospitals and health centers, respectively.

SPS conducted several assessments on ARV adherence, AMR, private sector pharmacy initiatives, and pharmaceutical management. These findings have been disseminated to partners and stakeholders. In collaboration with key stakeholders, SPS is undertaking activities to address the gaps identified in the assessments. There is a mechanism for the sharing of resources, experiences, and information to bring synergy to the joint effort. To avoid duplications and leverage resources, SPS will collaborate with the existing USAID-funded MSH programs and with partners such as DELIVER, Johns Hopkins University, the United States Pharmacopeia (USP), ITECH, ICAP, CHAI and others. Cross-cutting activities include pharmaceutical management information systems to improve program outcomes, support to pharmacy training and curriculum review, AMR and infection prevention, and RMU and injection safety.

Funding for Health Systems Strengthening (OHSS): $3,000,000

This is a continuing activity from COP09, moved from ARV Drugs to Health Systems Strengthening. To promote rational drug use (RDU), Management Sciences for Health/Strengthening Pharmaceutical Systems (MSH/SPS) will provide tools to support good prescribing and dispensing practices. SPS will provide supportive supervision, training and mentoring to all antiretroviral treatment (ART) sites. SPS will give technical assistance and support to the Drug Administration and Control Authority (DACA), regional health bureaus (RHBs) and the Pharmaceutical Fund and Supply Agency (PFSA), to strengthen their capacity in implementing regulatory and service aspects of RDU, and will introduce Pharmaceutical Good Governance. To promote transparency and enhance pharmaceutical management and leadership skills; the Ethiopian Pharmacists and Druggists Associations (EPA and EDA) will receive support to conduct pre- and in-service training. SPS will support their continuing education programs, trainings on relevant topics and professional events such as workshops, meetings and public awareness campaigns. Schools of pharmacy will receive assistance to build their capacity to conduct trainings on RDU and pharmaceutical care.

SPS will support ART facilities to contain antimicrobial resistance (AMR) through interventions that discourage liberal use of antibiotics, promote adherence, ensure medicine safety/pharmacovigilance through quality assurance and rational use, and introduce pharmaceutical care to improve treatment outcomes. Patient- and product-related information, and inventory control and reporting at the dispensing level will be strengthened using manual and electronic pharmaceutical information tools, including the electronic dispensing tool (EDT), manual medication registers and reporting forms. Drug and therapeutic committees (DTCs) will be established and strengthened to ensure team work at facility level and introduce a system for the selection, procurement, prescribing and dispensing of medicines; providing information, patient education, medication use review, and disposal of expired medicines. DTCs will receive support through training, mentoring, supply of basic office equipment and reference materials.

Cross Cutting Budget Categories and Known Amounts Total: $1,267,200
Human Resources for Health $1,267,200