National Performance Report on Medicines Management. The fourth National Performance Report on medicines management is here.

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1 This report covers the period from: Issue no. 4 January 2015 through March 2015 Tuesday, April 21, 2015 Published by: Data source: MMS data version 4.0 P.O. Box 7272 Executive Summary National Performance Report on Medicines Management The fourth National Performance Report on medicines management is here. This report: Is a management tool that provides information on the medicines management situation in the country and is produced quarterly Presents results from 98 districts implementing the supervision, performance assessment and recognition strategy (SPARS) Covers the period of January-March (QTR 3 of the financial year 2014/2015) The main objective of this report is to share performance assessment results in order to guide decision making processes at national and district levels. Other objectives include: To highlight the medicines availability situation To show progress in the five assessment components i.e. dispensing quality, prescribing quality, stock management quality, storage management quality, ordering and reporting quality as a result of medicines management supervisors (MMS) on- the- job training To assess progress at national level in order to identify districts that need follow-up, supervision and inspection General Remarks This quarter the number of districts reached through SPARS and reporting on medicines management reached 98 districts (approximately 88% of districts in the country (112 total districts). Average number of visits made per MMS increased from 0.9 to 2.9 visits whereas the average number of visits received per facility increased from 2.8 visits to 4.4 (target: 5 visits). The approach used by the MMS during visits is a combination of supervision, on the job training and performance assessment of the health facilities. This has resulted in great progress in the five assessment component areas as reflected in the spider graph from visit one with a total average score of to visit last with a total average score of (The maximum total average score is 25). Top Performing Facilities in districts reached Oyam is still the best performing district and has maintained this position with an average score of in the five assessment component areas in quarter 4 from 21.4 and 22.2 in the previous quarters.

2 83% of facilities scored above the 50% mark (12.5 out of 25 total average score).page 2 the district league table. Availability of the six tracer medicines on the day of visit- Trends 100% Availability of 6 tracer medicines on the day of visit (100% target) 80% 92% 100%100% 85% 87% 88% 88% 84% 84% 84% 86% 86% 85% 84% 87% 85% 86% 82% 77% 81% 60% 40% 20% 0% Average stock out days for facilities that were stocked out for at least one day TB had the highest average number of stock out days in the three months. This was more evident in Hospitals. Stock and Storage Management The correct use of the stock book is still poor (34%). The implementation of good stock and storage system that tracks movements, issues and provide the basis for quantification is important to ensuring EMHS availability, reduce expiry and maintain the quality of the commodities at the facility. Ordering, distribution and reporting Average lead time is still within the recommended time period (<60 days)- 44 days. Facilities stock management is based on a maximum stock level of 6 months and a minimum of 2 months. With a bi-monthly ordering and delivery cycle it is important for the facility to receive the next supplies no later than 2 month (60 days) after the last order has been received and a new order given Prescribing Quality Prescribing quality is still not improving at the same rate as the other assessment component areas as reflected in the spidograph. Specifically adherence to treatment guidelines for cough/cold, URTI, ARTI. Please note that the drastic drop in some graphs for the last visits is as result of limited number of visits with visit number 12 (nine visits) There is more information available in the report. Please share widely. For any clarifications, suggestions and enquiries in the report. Please contact , Belinda Blick (Technical Advisor Strategic Information Pharmacy Division)

3 Performance Report on SPARS This report covers from: January 2015 through March 2015 Version No April 2015 Region District Sub District Level Ownership IP MB MMS Facility ALL ALL ALL ALL ALL ALL ALL ALL ALL

4 Acknowledgement This report was made with Technical Assistance from the USAID/ Health Supply Chain Program Questions or clarifications? Send an to Content of this report 1. Overview 2. District League Table 3. Progress on SPARS indicators 4. Availability of medicines (Last Visit) 5. Stock Management 6. Store Conditions 7. Ordering and Reporting 8. Dispensing Quality 9. Prescribing Quality 10. Top score Facilities

5 Page 1 1. Overview Fact Box Visits made from: January 2015 to March 2015 Visits performed in this Period: 345 Period Total to date Average visits/medicines Management Supervisor/month: 2.9 Facilities certified in Good Pharmacy Practice (GPP) : 0 Facilities certified in Good Financial Practice (GFP) : 0 SPARS have started in: 98 districts in by Number of active MMS: 100 Visits performed: 9971 Facilities that have started SPARS supervision: 2291 Average number of visits done per facility: 4.4 Facilities GPP certified: 0 Facilities GFP certified: 0 Visit number Visit 1 Visit 2 Visit 3 Visit 4 Visit 5 Visit Last Total score average Number of visits

6 Page 2 2. District League table Total scores from last visit. Note: N - Total Visits, S - Score

7 Page 3 N - No. of visits, S - Score Based on 2292 last visits

8 Page 4 3. Progress on SPARS Indicators Dispensing time Packaging material Dispensing Dispensing equipment Services in dispensing area Patient care Labelling Rationing of antibiotic Correct use of prescription recording system Prescribing Rational prescribing Diarrhea management URTI,ARTI,cold,flu management Malaria management Stock management Store management Ordering & Reporting Stock card availability Correct filling of stock cards Physical count and stock card balance agree Stock book correctly used Cleanliness of pharmacy Hygiene of pharmacy Storage system Store conditions Store practices of medicines in the pharmacy Reorder level calculation Timeliness of orders and distribution Accuracy of HIMS report Filing systems

9 Page 5 4. Availability of medicines in health facilities 4A. Availability of 6 tracer medicines based on visits from January 2015 to March 2015 Based on 345 visits in this period

10 Page 6 4B. Availability of 8 other medicines based on visits from January 2015 to March 2015 Based on 345 visits in this period

11 Page 7 4C. Stock out days for 9 selected EMHS (Last Visit) Description: Average stock out days over the previous 3 months for facilities that have been out of stock at least 1 day..= Number of visits with observed stock out (T).= MoH Tracer Medicine Amoxicillin (T) 325 RDT kits 305 Artemisinin Combination Theraphy 330 1st line TB 89 Measle vaccine 189 Depo Provera 279 Oral Rehydration Salt 285 Gloves 288 Cotrimoxazole 326 Based on last 345 visits in this period

12 Page 8 5A. Stock card availability for selected medicines 5. Stock Management Based on 345 visits in this period 5B. Appropriate use of stock card system for basket of 15 EMHS Based on 345 visits in this period

13 6A.Storage handling 6. Store Conditions Page 9 Based on 345 visits in this period 6B. Handling of expired drugs Based on 345 visits Based on 9971 visits Based on 9971 total visits

14 Page Ordering, distribution and reporting from Health Facilities 7A. Order calculations - Is the facility calculating the right quantity to order? Visitis to 20 HC4 and 11 Hospitals 7B. Knowledge and application of VEN (Vital, Essential and Necessary) Based on visits to 339 different facilities Based on visits to 9433 different facilities Based on 345 visits in this period

15 Page 11 7D. Average lead time for HC4 and hospitals 44 days National Medical Store Health Facility Based on 20 visits in this period Based on 345 visits in this period Based on 345 visits in this period

16 Page Dispensing Quality Based on 345 visits in this period

17 9. Prescribing Quality Page 13

18 10.Top facilities Page 14 Based on visits to 80 Hospitals Based on visits to 150 HC4 Based on visits to 835 HC3 Based on visits to 1214 HC2

19 Page 15