HEALTH COMMODITIES & SERVICES MANAGEMENT PROGRAM ANNUAL PUBLICATION

Transcription

1 arch ugust 2014 HH & V G PG PB publication of funded Health ommodities and ervices anagement Program mplemented by anagement ciences for Health H : nformed ecision aking in Kenya through use of H2 emorandums of nderstanding trengthen ollaboration and Health ervice elivery mprovement H assists Kenya s H to develop ssential edical ab ommodities ist

2 ontents 2 ommodity anagement 7/11 H pdates ommodity upply hain apping to support identification of gaps in ounties...1 emorandums of nderstanding trengthen ollaboration and Health ervice elivery mprovement...2 nformed ecision aking in Kenya through se of H2...3 H assists Kenya s H to develop ssential edical ab ommodities ist...5 mproving access to family planning information through development of a national family planning commodity dashboard...6 trengthening ommodity in Public and Private Hospitals in Kenya for Better Health utcomes...7 stablishment of ounty ommodity echnical Working Group s for ommodity anagement upport...8 e-activation of the Kenya ational edicines and herapeutics ommittee...10 upporting Forecasting and Quantification for better use of county resources in ombasa, Kenya...11 ommodity eporting ool trengthens ata ollection fforts n Kenya...12 Job id for the use f H2 for aboratory ommodity eporting...13 Profiles nterview with r Githuka...14 P gency designates the Kenya Pharmacy and Poisons Board (PPB) as a egional entre of xcellence in Pharmacovigilance...16 Voices From he Field...18 Picture peak...20 anaging for esults: upportive upervision Field Visit by Project anagement eam...22 Job id: ecording and eporting aboratory ommodities (HV rapid test kits)...23 over Page 12/13 W BF ditorial team Patrick Bourret, onstance rata, illian Gitau, Joseph wangi, ntony wangi, Josphat amoei, obert Kimbui harles uma, John himumbwa, Kusu dinda, Wambui Waithaka, Joseph ukoko, Victor umbi, ecilia uiva, amuel bugua, osalind Kirika, and Jospeh Warero esign & ayout: herry disa ditor: Yvonne tieno ounting pills using a pill counter Want to subscribe or submit articles to this newsletter? Have any questions, comments, feedback? Please l the ditor -Yvonne tieno on yotieno@msh.org ii

3 Word from the hief of Party Kenya s health sector vision is to improve the overall livelihood of Kenyans through an efficient and high-quality health care system based on quality standards. Health service provision in Kenya is constrained by a number of elements including shortage of staff, inadequate infrastructure, and lack of availability of essential medicines,and diagnostics. H works in partnership with the Government of Kenya, inistry of health, regional health management teams, implementing partners, donor agencies, faith-based organizations, communitybased organizations and the private sector to address the sector s priorities in health commodities and related services. he program supports country-led and country-owned interventions that result in better availability and use of quality health commodities; improved pharmaceutical sub-sector governance and services; and strengthened laboratory systems. his third issue of the ewsletter - H ecap, builds upon previous editions in bringing out the latest global best practices in commodity management, supply chain and health systems strengthening. t puts Kenya experiences into global perspective as well as bringing out issues pertaining to the unique county set up. he H/H program in is in its fourth, out of five years of award, and as such, its current focus is in tackling issues pertaining program sustainability and finalizing deliverables in partnership with H and others and it forms the main theme of this edition of the newsletter. t still maintains all its salient features such as highlighting national and regional activities to support alaria, eproductive Health, HV, pharmaceutical and laboratory services. he ultimate aim is to ensure robust systems are put in place at the exit of the program, to assure the country of sustained availability of high quality medicines for all Kenyans. Health systems rely on the continuous availability of safe and affordable medicines of assured quality. Without reliable access to medicines and coupled with their inappropriate use, patients are negatively impacted. H is providing technical assistance in improving the pharmaceutical subsector governance and service delivery; medicines quality assurance and pharmacovigilance and strengthening of pharmaceutical management information systems to support decision-making at operational, policy implementation and strategic planning levels. key milestone in this area is the appointment o f the Pharmacy and Poison Board (PPB) as a entre of excellence in Pharmacovigilance. For H, the goal has been, through technical support to PPB - promote appropriate medicine use and enhance patient safety through improved detection, management, monitoring and reporting of suspected adverse drug reactions and poor quality medicinal products, thenusing this data for improved decision-making. ther Highlights from this issue include various interventions to support access to commodities st the county including quantification, formation of ommodity technical working groups and signing of memorandum of understanding with counties, as well and orientation on the, use of H 2 in various counties. his issue also contains stories on and voices from the counties; the latest news in pharmaceutical management;; jokes; your favorite H puzzle and much much more. he H/H team is really optimistic that being an integral part of the inistry of health, H collaborative work will continue supporting and informing policies and laws as well as strengthen systems for better commodity management. his need is greater especially as the country continues to strengthen its pillars of the devolved system of government. ogether we can achieve Kenyans to constitutional right to access to quality healthcare. Happy eading to you all John himumbwa eam eader Health ommodities and ervices anagement (H) Program anagement ciences for Health 6thFloor, K Garden House, wing B. Bishops oad, 1stgong venue P. Box , airobi, Kenya : / mail: hcsmkenya@msh.org Website: isclaimer: he information provided in this ewsletter is not official. Government information and does not represent the views or position of the. gency for nternational evelopment or the. Government. iii

4 quality and effective laboratory service is a key part of a functional health care delivery system. aboratories provide the evidence base for accurate confirmatory diagnosis for individual patient care, improved management of disease and essential public health information for disease surveillance. iv

5 ommodity upply hain apping to support identification of gaps in ounties By avid oki and ichael aina health worker counting medication at a heath facility in Kisumu n ovember 2013, H conducted a health commodity supply chain mapping exercise across 13 counties in yanza, Western and oast egions of Kenya. his activity was designed to support the counties in strengthening their health commodity systems to meet the growing supply chain responsibilities that have come with the devolved government. he activity also included an end use verification exercise for movement of HV apid est Kits within and outside the facilities. eports detailing the findings, gaps and proposed interventions were prepared and disseminated to each county, and used by the counties as a basis for identification of interventions to address the gaps identified. he reports gave an overall impression of the state of Health commodity supply chains and have been used to inform dialogue among stakeholders at central and county levels on broad system-wide constraints and interventions. n overall report reflecting the findings across the thirteen counties was prepared and disseminated at central level to H counterparts and. his report was well received as it provided a basis for ongoing discussions aimed at identifying the optimal configuration of the supply chain under the new devolved government system. he exercise found that while eighty percent (80%) of facilities visited had tracer commodities in stock on the day of the visit, the procurement and distribution arrangements for the following quarter January to arch 2014 were still unclear in most counties. his highlighted a gap in the transition of supply chain management responsibilities from central to county level. H has enhanced its support to the county level to ensure the counties have the capacity to manage their new roles and prevent supply disruptions during the transitional phase. sing information from this exercise, H designed a county warehousing and distribution assessment tool to help counties assessing their readiness to manage the last mile of the supply chain - from the county store to health facilities. 1

6 emorandums of nderstanding trengthen ollaboration and Health ervice elivery mprovement By Joseph wangi and harles uma pharmacist dispensing medication in Kisumu istrict Hospital Pharmacy memorandum of understanding (o) is a written agreement between two or more parties. t states what actions the parties intend to take together and can be seen as a formal documentation of gentlemen s agreement. s are usually prepared in circumstances where parties involved do not consider it appropriate to have a legally binding agreement or where a legally binding agreement cannot be made. he Health ommodities and ervices anagement (H) Program is a -Kenya funded systems strengthening program with the mandate of improving health commodity management, Pharmaceutical Policy and ervice delivery as well as the laboratory supply chain both at national and peripheral level. ince its inception in 2011, the program has worked at the ational level and peripherally, at provincial, district and facility levels- through PHs, Hs and Hs- to implement interventions to improve overall commodity management and use. However, with the administrative changes brought about by the new constitution and the creation of 47 counties, the program had to refocus its support to selected priority counties to better focus and support activities in identified high need areas. n ovember 2013, the H program started working in these 13 priority counties, 10 of which are located in Western Kenya and 3 at the oast. o facilitate engagement and activity implementation, the program redeployed staffs that were previously coordinating project activities at provincial levels to be responsible for a cluster of counties in the focus regions. s the program started working at county level, it reengaged with county health management teams (Hs), outlining to the these teams the system strengthening technical assistance that the program was mandated to provide to them and what was expected from the teams. o help clarify the two-way approach (partnership) in which the program is to operate, it was found necessary to develop a guiding document. his is why s between H and county health management teams (H) were developed. hese s have since been signed by the ounties and H and are valid till arch hey provide details on what H and the counties are partnering to do in order to strengthen all aspects of health commodity management, pharmaceutical policy and service delivery and the laboratory supply chain. hey also specify what role each of the parties is to play in the collaboration. ther areas covered by the s include channels of communication, reporting and decision making mechanisms. ccording to H staffs working at the various counties, the s have led to a clearer understanding of the relationship that is envisioned between the H program and the counties and has facilitated smoother planning, activity implementation, monitoring and reporting of achievements and results. t is hoped that both H and Hs will continue to work together guided by this framework ultimately leading to improved delivery of health services and outcomes for the citizens in these counties. 2

7 nformed ecision aking in Kenya through se of H2 By om runga, Health ecords nformation fficer, Kisumu ast ounty; and Yvonne tieno r. ndrew yandigisi from the alaria ontrol nit discusses experiences to date and lessons learned in the implementation of H2 with workshop participants. (Photo credit: Yvonne tieno/h) n effective reporting system for health commodities is critical to ensure accountability, enable informed decision making, and provide timely access to information. o help improve reporting, the inistry of Health in 2010 approved the use of istrict Health nformation ystem (H2) to report on health service data at the subnational level. H2 is a free and open-source computer software typically used to monitor health indicators for a national health system. n health information systems, collecting and analysing data helps to improve health outcomes by enabling evidence-based decision making rather than basing decisions on intuition or broad estimates. H2 supports different facets of the information cycle including data collection, quality assurance, dissemination, reporting, and analysis. With support from the -funded Health ommodities and ervices anagement (H) program and other partners, Kenya s alaria ontrol nit transitioned its reporting system to H2 in ctober se of H2 improved reporting rates from approximately 45% to over 70% in the months after its implementation (Figure 1). Building on the experience of using H2 for malaria reporting, H worked with 13 county governments to promote reporting through H2 for family planning, HV, nutrition, and laboratory commodities. s of 30 pril 2014, H2 introduction and implementation had begun in 9 of the 13 focus counties. Following the introduction of H2 for commodity reporting in these nine target counties, facilitated an orientation workshop in early ay for service delivery partners to share lessons learned and to plan rollout to other counties. he Health nformation ystems unit of the inistry of Health and staff from the HV, B, malaria, reproductive health and family programs participated in the workshop. Participants heard how H2 improved Kenya s standing with Global Fund, going from a to an 2 rating. hrough better tracking of commodities with H2, donor confidence in the malaria program was restored and additional funding was secured. uring the workshop, participants agreed to continue rollout of H2 for commodity reporting to additional counties which is expected to further enhance and strengthen the management and use of health commodities and improve the use of data for decision making at all levels of the health system. ffective solutions like H2 can help improve accountability across the health system and should be scaled up. his will require identification of champions, training, and assigning roles and responsibilities at various levels for long-term sustainability. ltimately, solutions that help boost accountability improve access to medicines and bring Kenya one step closer to achieving its key global development goals. 3

8 4 P B Q F K F F V B V Y B K P P P P P Y X X H G Y Z G K Q W Z G K Q W Z G K Q W Z G H Z G W H K Z re you an inventory management maestro? hen finding the terms listed below in the grid to the right should be a breeze! he words may run across, down or at an angle and may read backwards or forwards. lock temperature FF cleanliness disposal label prescription patient fire safety issue store stock-out records bin card quantification procurement ax consumption-based delivery note lab stock card expiry date shelving

9 By amuel bugua H F H assists Kenya s H to develop ssential edical ab ommodities ist well equipped aboratory is key in improving laboratory diagnostic services ffective laboratory services support accurate medical diagnoses and evidence-based patient care and also help improve disease management and surveillance. ccording to an assessment conducted by Health ommodity upply hains and the Kenya edical upply gency, inappropriate use of resources, pharmaceutical waste, and medicines stock-outs continue to challenge Kenya s public health system spurred on by inadequate procurement practices, inappropriate medicines management, and poor quality of commodities including laboratory commodities. o address these challenges in laboratory commodity management, the inistry of Health with technical support from -funded Health ommodities and ervices anagement (H) program spearheaded the development of the Kenya ssential edical aboratory ommodity ist (K). he list defines and classifies the essential laboratory commodities and tests for the country s health system. he development of the K represents a major step forward in improving the quality of medical laboratory services and acts as a reference tool for procurement of laboratory commodities, health insurance plans, and other health financing strategies. he K helps support better procurement, storage, distribution, stock management, and record keeping by defining a smaller, predictable list of items. ince K prioritizes a range of items and guides procurement efforts, the overall effectiveness and efficiency of the supply chain has the potential to be improved. For supply chain K should be used as a basis for determining quantities of specific commodities as well as act as a basis for costing laboratory services. he list is also expected to lower prices, through economies of scale, promote multi-year procurements, and free up time for other critical procurement functions like quality assurance. osts of managing supplies will be lowered (e.g. storage requirements maybe reduced) through better planned delivery schedules and call down systems. nticipated ses and pplications of K: Healthcare financing and laboratory supply budgeting Health insurance schemes Pharmaceutical procurement, supply and distribution Healthcare workforce development aboratory regulation and monitoring (quality assurance) ppropriate use of laboratory tests (including supportive supervision activities) aboratory policy monitoring and operational research aboratory manufacturing standards he Kenya ssential edical aboratory ommodity ist booklet 5

10 mproving access to family planning information through development of a national family planning commodity dashboard By Wambui Waithaka at any point in time and generate alternative views of the information e.g. trends, comparisons etc. his central access point of information will also be used for national and county planning. ach party had specific roles and responsibilities: H provided technical oversight over the dashboard development including guidelines and requirements while H developed the dashboard according to specifications from joint discussions with H and H. H would support hosting and maintenance of the dashboard onto a hosting site agreed to by H. Family planning improves maternal health Family Planning commodity security exists when people are able to choose, obtain, and use the family planning supplies they want. ccess to stock information at all levels is important to ensure there is reduction in the incidence and severity of stock-outs at national level and service delivery points. However in Kenya, it was noted that the system faced various challenges including, the absence of a central access point of all this information, lack of early warning systems for delayed procurements and the only information product funding and implementing partners received was the 2-pager monthly stock status report which, though useful, only presented a monthly snap-shot of the commodity status. Partners also required more information, for example facility/county data, which was not included in the monthly stock status report. pproach- evelopment of the FP ommodity ashboard o help address these challenges, funded Health ommodities and ervices anagement (H) program partnered with linton Health ccess nitiative (H), in consultation with the eproductive and aternal Health ervices nit (H) engaged in the development of a FP ommodity dashboard. he dashboard is an online information system meant to facilitate entry of certain commodity data elements, and make it possible for end users (inistry of Health and other partners) to access it he process commenced in ugust 2013, the dashboard was tested and demonstrated to the FP logistics echnical Working Group during their monthly meetings. he dashboard was officially used during the FP logistics WG meeting in ovember 2013, and the national stock status report auto-generated from the dashboard and circulated to stakeholders. ince then it has been updated at each monthly logistics WG meeting to reflect current national stock status and supply plans (procurement schedules). ses of the dashboard he dashboard link has been shared with all stakeholders and they are able to log in at any time to get up to date information in various views. hey are also able to compare consumption trends over certain periods and other analyses as required. urrently, only national stock data is uploaded onto the dashboard. nce commodity reporting from counties is available on H-2, this stock data will be uploaded automatically onto the dashboard, and county profiles will be created which county and sub-county managers can access for data reviews and subsequent decision making. t is envisioned that the dashboard will be used during the national and county quantification and planning processes. he dashboard has addressed the challenges listed in the context section: there is now a central access point of all this information, delays in procurements can be flagged early enough for action by funding partners. his ensures better stock status monitoring and improves commodity security. 6

11 H pdates trengthening ommodity anagement for improved health outcomes By Victor umbi edicines and herapuetic committees are key in improving appropriate use of medicines and technologies he scale-up of public health programs; and increased access to essential medicines and health technologies have improved treatment access in Kenya. However there is need for efficient systems to monitor medicine use in order to maximize outcomes and maintain cost-effectiveness. edicines and herapeutics ommittees (s), which are integral to improving medicine use and management at health facilities, are usually weak or non-functional. Functional s are mechanisms that ensure fundamental decisions on medicines management and use are made at all levels of care. hey provide a forum for pharmacists, clinicians and administrators to rationalize demands for quality medical products against financial constraints. Part of the mandate of the H/Health ommodities and ervices anagement Program is echnical support to improved medicine use practices at national and county level in targeted counties n the 26 th of pril 2014, he Hospital Pharmacists ssociation of Kenya (HPK), with technical support from the -funded H/H programconducted a one day orientation on edicines and herapeutics ommittees (s) for 36 pharmacists and senior pharmaceutical technologists from 12 counties. he H/H and HPK utilized a quality improvement approach that includes 2 targeted trainings, action plan development, and regular follow-up. he participants were drawn from various private and public hospitals in the country and included officials in charge of hospitals and in managerial positions. his collaboration is an example of public-private partnership where financial support for the workshop was provided by a private company. he capacity building approach is also utilizing the professional association (HPK) as a conduit for reaching the public and private practitioners. uring the training, each of the represented hospitals developed an action plan for establishing or strengthening their respective ommittees. H will continue providing technical support to the s in the implementation of the action plans and will carry out a follow up activity to review progress and delve deeper into the concepts of medicine use evaluations with this cohort of participants over the next year. he strengthened s are expected to lead to improvement of medicine use in hospitals, reduction of wastage of resources and improved patient outcomes. 7

12 H pdates stablishment of ounty ommodity echnical Working Groups for ommodity anagement upport By harles uma and onstance rata t is critical within any health system to ensure patients receive quality service and effective medicines he scale-up of public health programs; and increased access to essential medicines and health technologies have improved treatment access in Kenya. However there is need for efficient systems to monitor medicine use in order to maximize outcomes and maintain cost-effectiveness. edicines and herapeutics ommittees (s), which are integral to improving medicine use and management at health facilities, are usually weak or non-functional. ccess to required health commodities and their proper management and use are important factors in the delivery of quality health services and the achievement of desired health outcomes. n Kenya and in most developing countries, access to the required health commodities, in adequate quantities, in the required form(s) and at an affordable cost has been a long standing challenge. Procurement and distribution of health commodities in the country have been the responsibility of the central government with these functions delivered through the Kenya edical upplies gency (K). With Kenya transitioning to a devolved system of government, county governments are now responsible for managing the health system in their areas of jurisdiction including the procurement of health commodities for their facilities. despite the huge responsibility placed on the county health management teams to provide stewardship within the county health system there have been no established structures or committees responsible for providing oversight for commodity management n its support to thirteen counties to improve commodity management, pharmaceutical and laboratory service delivery, the Health ommodities and ervices anagement (H) program has worked with the ounty Health anagement eams to establish county health commodity security committees. his committees serve as organs within the counties to provide leadership and stewardship in these areas. efinition and mportance of a ommodity ecurity WG he ounty Health ommodities ecurity echnical Working Group, popularly referred to as ommodity WGs, are a mechanism for systematically integrating commodity management operations/functions at county level in order to improve access and management of health commodities. ne of the aims of the ommodity WG aims to advocate for and strategize on system strengthening initiatives to increase efficiency and effectiveness of the supply chain for increased availability, accessibility and affordability of health commodities for example HV, alaria and family planning products within county health systems o achieve its goal, the ommodity WG employs good governance practicesthat ensure accountability, responsiveness and participation of all stakeholders involved in commodity management support. ince health commodities do not fall under a single concerted effort by the different disciplines handling commodities is observed. he commodity WG presents an avenue for the different cadres within the H, as awell ass 8

13 H pdates other stakeholders to meet and deliberate on commodity security with the backing of senior management and finance managers. he Kisumu ounty ommodity WG is an example of how the ommodity WGs are working in other priority counties. he WG was constituted on 28th Jan 2014 with the formal adoption of its terms of reference (os) and appointment of members by the ounty irector of Health. ubsequently the WG would then take leadership and provide oversight for activities and initiatives aimed at improving commodity management and security in the county. dvising the ounty irector of Health on priority issues related to commodity management and security, Planning and implementation of interventions to improve availability, use and efficient management of health commodities and pearheading human and institutional capacity building for commodity management are among some of the Key responsibilities of the WG, apacity building in forecasting and quantification and conducting actual quantification exercises. his is aimed at enabling the county to accurately determine requirements for health commodities and budget for the procurement of the same. he report from the quantification exercise will be used to advocate for funding for the procurement of health commodities from the county administration. upport upervision in targeting selected facilities to assess practices and provide on-the-job training to improve commodity management rientation of county and facility staff on the use of electronic platforms for commodity data reporting- he istrict Health nformation ystem 2 (H2) and the Health ommodity anagement Platform (HP). his initiative was necessitated by the overall poor commodity reporting rates achieved through use of manual collation and report transmission mechanisms. ther responsibilities include the evaluation of supply chain systems for all health commodities and with institution of corrective measures where required as well as acting as a forum for collaboration with other stakeholders involved in commodity management support in the county. he WG has a membership of eleven, with the county pharmacist as the chairperson and the ounty edical aboratory echnologist serving as the secretary. t draws its membership from H units/divisions such as Pharmacy, aboratory, on-pharmaceuticals/edical upplies, Priority programs, nutrition and health records. t also incorporates membership from partners working in the county drawn from H/H, K, PHPlus, P and F who are co-opted to attend meetings and participate in activities as necessary. he WG holds monthly meetings, slated for the first Wednesday of the month with minutes of such meetings submitted to the H and a brief made to the entire H. Following the establishment of the WG and development of its work plan, the following are some of the activities that have been carried out successfully to date- ssessment of the status of commodity management in the county and dissemination of results to county, sub-county and facility teams. his has enabled these teams to identify challenges in commodity management and design/plan for interventions to address these gaps urses examining health records chievement he establishment of the commodity WG has resulted in tremendous progress towards improvement of commodity management and security in the county. For instance, the county has now prioritized addressing commodity management issues and routinely supports activities proposed by the WG to address any challenges. apacity building activities have been conducted and there is evidence of improved inventory management practices in the county. ommodity data reporting rates for all programmatic commodities are improving with the target of 80% already achieved for some of the commodities. oreover, there is evidence that the county is using this data to support planning and management decision making aimed at improving availability of health commodities. 9

14 H pdates e-activation of the Kenya ational edicines and herapeutics ommittee By Victor umbi members deliberate on proposed erms of eference for ounty s during the retreat in June 2014 core mandate of H is to strengthen health commodity systems and implement interventions aimed at improving pharmaceutical services, pharmaceutical care; and appropriate use of medicines and health technologies. he ational edicines and herapeutics committee () is the highest level therapeutic decision-making body in a country being a key component of the ational edicines Policy. here have been two previous s in Kenya, appointed in 2000 and 2007 respectively. However these committees were not fully functional and mainly focused development or review of linical anagement and eferral Guidelines, the Kenya ssential edicines ist and the ational Guidelines for ancer anagement he third and current was appointed in pril t is anchored in the Kenya ational Pharmaceutical Policy (KPP) of 2012 and the draft Kenya Health ector trategic Plan of o ensure functionality and sustainability of the, the H program prided the following support: echnical assistance in the review and update of the erms of eference in arch 2014 echnical support towards a two day orientation workshop targeting all the members and core representatives from the inistry of Health. he workshop took place on 10 th and 11 th June 2014 Guidance on formation of expert committees and drafting of a calendar of activities ome of the outputs already achieved by the revitalized include the following: atified s for the raft s for ounty s: these will form the basis of engagement with ounties to finalize the os and improve functionality of s and ounty and lower levels) raft alendar of ctivities/ action plan raft expert committees and their membership functional multidisciplinary body to coordinate policies on medicine use like the in Kenya is one of the key interventions advocated by the World Health rganization to promote appropriate use of essential health products and technologies. t is anticipated that the revitalized, by executing its mandate across the various areas under its scope, will have a big impact in improving use of medicines and other health products in the country and contributing to improving health outcomes among the whole population in a cost-effective way. 10

15 H pdates upporting Forecasting and Quantification for better use of county resources in ombasa, Kenya By osalind Kirika and ntony wangi Group photo trained in pediatrics and used to think that as long as children are treated, the health needs of a community were met. However, after working for 20 years in the health sector, have learnt that to meet a community s needs, one needs to have stronger and better health systems, says r. Khadija hikely, ombasa ounty irector of Health. r. Khadija hikely was speaking during the ombasa ounty Health ommodity Quantification Workshop held in January he exercise was meant to assist the ombasa ounty Health anagement eam (H) in preparing a budget complete with required quantities for health commodities that are required to provide uninterrupted services at government health facilities in the county. Being ounty irector of Health provides me an aerial view of the health systems in the county and know that availability of medicines and diagnosticsis key to the health of my community. his access to medical products for patients is only possible if we know exactly how much medicine the county needs, explains s r. hikely. his is the first time that we as a county are managing our money and this quantification exercise is important in informing our spending, she adds. Quantification, involves estimating how much of each selected health commodity and its cost, is needed to serve clients for a specified period of time. he process was to help quantify and budget for health commodities for the county s 4 hospitals namely oast General Hospital, thereferral facility, Port eitz, udor and ikoni ub-county Hospitals as well as the5 Health enters and 30 dispensaries. he activity was undertaken by a team drawn from the H, ub-county health management teams, hospital staff and some representatives from the primary healthcare facilities (health centers and dispensaries). he exercise is part of funded Health ommodities anagement (H) Program support to county governments and marks a milestone in ombasa county health plans as this is the first county to go through such a comprehensive exercise. Kenya is undergoing a transition period from a entral to a ounty system of government and the need for better funding for health services was highlighted in a a breakdown of the development budgets by the ommission on evenue llocation (), ounty Budgets: report.n the recent past there has been increased focus on how counties are allocating funds. he concern has been the lack of data to support the allocation of funds to different sectors within the counties. r. hikely further explains that the exercise will help them to mobilize resources for health commodities. «With data to support allocation of funds for procurement of medicines and other health products, the county shall be better prepared to allocate funds. oney is scarce and we need to spend it wisely. he planning will also help us reduce stock out and wastages due to excess stock, «she adds. «f the budget allocation is less than the requirements, the county health office can use the quantification report, which is evidence based, to approach the governor, members of parliament and development partners to allocate more funds for purchase of health commodities. t the end of the three-day exercise, ombasa ounty health workers left with a clearer understanding of the purpose and processes of quantification and a county quantification report detailing the quantities and costs of health commodities required by the county for the period January to June he quantification report informed the ombasa county government on resources needed to meet the county s health needs and to facilitate supply and procurement planning. 11

16 W BF ommodity eporting ool trengthens ata ollection fforts n Kenya By Joseph Warero enior dvisor Bungoma ounty eporting ate for Family Planning and alaria Kenya has slowly gone through the paces of transition from a central to county-based system of government. his shift brought out the need for further alignment and improvement in the reporting structures within the health sector. s the counties adopted this new structure and harmonized their operations, a critical step has been to ensure timely reporting of health sector data from counties to the central level to inform the resupply of medicines. he inistry of Health (oh) in Kenya also uses this information to meet the reporting requirements of international donor agencies and development partners. he oh therefore monitors the national health sector performance through a set of agreed upon indicators. he -funded Health ommodities and ervices anagement program implemented by H in Kenya, promoted the use of the istrict Health nformation ystem (H) at the county level through a series of targeted orientations that brought together data managers, pharmacists, nutritionists, and lab coordinators. H-2 is a web-based system currently in its second version in Kenya, that provides a common health sector information management platform where data is accessible at national, county, sub-county and facility levels. upport for improved reporting rates has also seen H collaborating to build capacity with other implementing partners such as PHPlus who operate in other regions and use lessons learnt from Hs implementation of H in its focus counties. t the national level, H has worked to strengthen collaboration between the disease focused Priority Health Programs and the Health nformation ystems nit towards utilization of H2 for evidence-based planning and quantification of health commodities in the county through sensitization workshops that helped bridge collaboration between the units. Following the management adage that what gets measured gets done, weekly follow-ups of reporting rates across H focus counties has revealed rapid improvement in reporting of family planning commodities. n Bungoma county for instance, this has increased from a baseline n ecember 2013 of 25 percent before the H conducted a H orientation, to a new high of 93.5 percent for the month of July he current reporting rate goal is to work towards a reporting rate of 80% and above for all health commodities. mprovements in the reporting rate are a first step towards the longer term vision of improving the quality of data from the health facilities and promoting evidence-based decision making for the procurement reproductive health, malaria, tuberculosis, and HV health commodities. 12

17 JB F H F H2 F BY Y PG JB F H F H2 F BY Y PG 1. ollect all the reports for the reporting period applicable; follow up any non-reporting sites 2. Verify that the forms are complete, appropriately filled and signed off 3. ross check basic calculation as per applicable formulas for the form 4. nsure that the computer you have is connected to the internet 5. pen your preferred browser (Google hrome is recommended) 6. ype the following address to access the H2 login screen 7. f you are a new user and do not have a login to H2 click on the green button at the top right corner written [ ] and follow the instructions to create a login for yourself 8. ogin n o H2 using the username and password you created 9. ession timeout ; if your computer remains idle for over 10 minutes, H2 automatically switches you to offline mode or the session is timed out and you will need to log in afresh 10. o access the data entry screen, first locate the health facility you want to register data for. his is displayed on the left-hand side of the window 11. o quickly search for the health facility you want to enter data for, use the search box just above the tree (the green symbol) and enter the name of the facility 12. From the data set dropdown list, select the relevant reporting form (H 643B F- for ab onitoring eagents) and next select the reporting period 13. For each commodity row, key in the quantities from the facility reports 14. lick on the un Validation button to validate the entries on the form 15. lick on the omplete button at the bottom of the screen to save the data entered 13

18 PF nterview with r Githuka By Yvonne tieno and Wambui Waithaka he -funded Health ommodities and ervices anagement (H) program is working with the ational & ontrol Programme (P) to strengthen health commodity security systems, tracking and supply of HV prevention commodities (condoms, lubricants and supplies for injecting drug users). r. George Githuka, the Key Populations Programs anager, P, explains the work the program has been implementing. What are key populations? Formerly known as ost at isk Populations (P), these are sub populations at higher risk of contracting and transmitting HV. hey include male and female sex workers, s (men who have sex with men) and PWs (People Who nject drugs) What does your work involve? he key populations are often hard to reach as their risky sexual activities are illegal and criminalised, they are discriminated against and stigmatised and they often hide from public. y work involves developing policies and guidelines to facilitate and guide programming that would reach these key populations with preventive and promotive health services. What are some of the steps you have taken to reach these key populations? he most important step in reaching key populations is working with them. What we have done is identified a few willing to work with us. We have built their capacity and together we work to reach and take services to others of the Key population. he backbone of the program is providing them with condoms and lubricants; sterile needles and syringes. We alo empower them to use these preventive tools consistently and correctly. pecific work done includes developing guidelines and training curricula with representatives from the key populations being part of the process and training some of the key population as peer leaders and educators. For example they train their colleagues on condom negotiation skills, going for HV testing (which should be every 3 months), reproductive health services and counselling and treatment services.he key population are also members in the national level technical working group that coordinates and guides the HV response in these populations We also help in the provision of condoms and lubricants which are critical in prevention of HV. he condom distribution is usually through both push and pull systems. We push condoms to bars and hotels while key populations pull condoms from facilities. t the program level we estimate the quantities of condoms needed by the key populations. (B: r. Githuka has since left the Key Populations program.) 14

19 How do you quantify for the condoms Quantification is done depending on the levels of usage and coverage of the people needing condoms. First we determine the number of people who need condoms, then how many sexual acts need to be protected, then how many are actually used. his helps us calculate how many condoms are needed. What data sets do you use to get these numbers? nformation is obtained from major studies for example K 2012, KH 2008/9 and biannual surveys on condom use. Periodic polling booth surveys are also conducted amongst sex workers. We also analyse condom distribution data from K. ll these data sets are then used to project the annual condom forecasts for coming years.his is done during the national P quantification exercise with Funded Health ommodities and ervices anagement (H) program providing technical assistance. he latest K 2012 had a question specifically on condom use so we will have more accurate data going forward. What about regular monitoring? Besides quantification of condoms, H also supports P in generation of monthly stock status updates. his gives real time information on the stock status of condoms.his report is used to brief decision makers including the Principal ecretary and make decisions on distribution.he same is also shared with donors who commit to procurement of condoms at various levels. What is the status of condom use in the country? ast year, the annual distribution for female condoms was approximately 1.7 million pieces while for the male condoms was 175 million pieces. he difference in distribution is that more people are familiar with the male than the female condom and more people know how to use it. here is also the issue of cost where the male condom can be bought for Kshs 2.50 while the female condom cost Kshs 50. Programming for the female condom is also not as advanced. ot many people know how to use it. istribution is currently focussed to female sex workers, some discordant couples and family planning services. he female condom is not meant to replace the male condom, it is meant to bridge the gap where the male condom is not working. Why is it important to have a day dedicated to the female condom? he day is meant to create awareness on the female condom as well as a forum to advocate for increased funding for procurement of the female condom. he current status is that even if we create awareness and increase demand for the female condom, we don t have enough commodities to meet the demand. However, it s important to note that the cost of purchasing a female condom is much lower than treating a person with HV. n my view, condoms-whether male or female-remain the only protection for these key populations. 15

20 P gency designates the Kenya Pharmacy and Poisons Board (PPB) as a egional entre of xcellence in Pharmacovigilance By r dinda Kusu n the recent years, Kenya has experienced an increased access to essential medicines and medical supplies including those for HV/, malaria, tuberculosis and other diseases. his increased access which is due to several public health initiatives has called for the need to strengthen systems for promoting medicine quality assurance and patient safety. o match access and patient safety, the H/H program with funding from has continued to systematically build the capacity of the Pharmacy and Poisons Board (PPB) to implement one-national integrated pharmacovigilance system using a systematic capacity building approach which ensures that both institutional and human resource capacities are strengthened, robust and functional as shown in the figure above. apacity Building odel sed for Kenya Pharmacovigilance ystem trengthening dapted from: Potter,., and. Brough ystemic capacity building: hierarchy of needs. Health Policy and Planning 19: he comprehensive Pharmacovigilance ystem trengthening led the PPB with technical assistance from the H Program and engagement of other stakeholders has born fruits resulting in: nstitutionalization of one pharmacovigilance system for all medicines and medicinal products oll-out of an integrated system that incorporates monitoring and reporting of suspected poor quality medicinal products and suspected adverse drug reactions (s) Functional Pharmacovigilance department with designated staff. vailability of Pharmacovigilance guidelines, standard operating procedures (Ps), job-aids and reporting tools in public, private and faith-based health facilities. echanisms for stakeholder coordination and communication raining curricula for in-service providers Post arketing urveillance strategy. stablishment of ntiretroviral sentinel surveillance sites Pharmacovigilance training at pre-service level at the Kenya edical raining ollege and the niversity of airobi. 16

21 Post graduate aster s course in Pharmacoepidemiology and Pharmacovigilance at the niversity of airobi. evelopment and implementation of a premier pharmacovigilance electronic reporting system (PV) stablishment of a functional safety monitoring and reporting system which has resulted in... increased reporting of suspected s from 1,459 (ept 2011) to over 8,000 (June 2014) and poor quality medicinal products from 175 (June 2011) to 600 (June 2014). Kenya is the 4 th highest reporting country of s in frica and based on pharmacovigilance reports received by the PPB, several regulatory decisions have been undertaken e.g. review of treatment guidelines; and quarantine, re-call, withdrawal of suspected poor quality medicinal products. o promote innovation, cost-effectiveness and sustainability, the H program supported the development and implementation of Pharmacovigilance electronic reporting system (PV), the 1st vigiflow compatible e-reporting system in frica. ay 2014 marked another huge milestone for Kenya the integrated Kenya pharmacovigilance system with Kenya PPB being recognized by ew Partnership for frica s evelopment (P) gency as a egional entre of egulatory xcellence () in Pharmacovigilance in frica. Kudos to the PPB, H and other stakeholders in implementing the systematic capacity building approach to strengthen the Kenya Pharmacovigilance ystem to promote patient safety and to Foster - Free Generation and nd Preventable hild and aternal eaths. screenshot of the Pharmacovigilance eporting ystem lick here For a list of other P gency designated egional entres of egulatory xcellence () 17

22 V F H F n early arch, H conducted an rientation on at Vihiga ounty. y ame is amuel gar gar, onsultant pediatrician and the Head of epartment hild Health and Pediatrics, Vihiga istrict Hospital and hair Vihiga istrict Hospital shares his experience from the training. Participants from Vihiga ounty share their experience after a Forecasting and Quantification workshop held at the ounty in arch 2014 orah Kiboko ounty Pharmacist Vihiga he plays the role of the advisory team to the Hospital anagement team (H). he H are the ultimate decision makers in the hospital. he gives advice on, all issues that crop up on procurement, storage and appropriate use of drugs and medicine. We also play a role in the development of standard treatment guidelines and develop standardized protocols on treatment and adherence. For example, we check on the prescription habits and the quality of prescriptions and then advice health workers if the standard treatment guidelines are not followed. We do this through ontinues edical ducation essions (s.) s play a great role as they help standardize care and quality of treatment across patients. his helps ensure that patients use drugs rationally i.e. using the right drug for the right disease, for the right patient and at the right dose, frequency and duration. his helps do not develop resistance to drugs, and additional helps lowers the expenses at a facility. oday s meeting was relevant because we were able to reflect on things we were doing without a clear approach. We now know the importance of measuring and documenting our processes over period of time. y work involves planning and budgeting for ommodities, coordination and making orders for pharmaceutical and non-pharmaceutical commodities. Vihiga ounty has approximately 42 government health facilities that serve a population of 600,000. n the past we have experienced challenges in forecasting and quantification of commodities. For example, some facilities did not place orders for commodities, while others ordered more than they needed or under stocked. For example, there was a facility that ordered drugs worth a week and half given the drawing rights. We assume that this is because they didn t have the knowhow. nitially forecasting and quantification was done from facilities and procurement was done at K. ow the procurement is done at the county level. n both cases, accurate data is required from the facilities. his workshop is meant to help ensure accuracy in forecasting and quantification of commodities for the ounty. he facility consumption data is used to forecasting on the needs of the county for the next quarter. his data received from the facility informs the budget and allocation of funds for commodities for Vichuga district. he report will be used to determine how much the ounty will allocate for commodities. he exercise leads by funded H has been informative because participants have grasped concepts that they didn t have before. We expect that henceforth our quantification of commodities will be better and we shall avoid challenges faced in the past as mentioned above. For example, sine facilities were receiving medicine from K and they weren t sure that the orders would be sufficient, some facilities would order more than they required because they didn t know when they would receive commodities next. rdering only what we need 18

23 help us better utilize our resources at the county. artin ifuna Pharmaceutical Health echnologist abatia Health entre From the training, have been able to upgrade my skills in commodity management of both pharmaceuticals and non- pharmaceuticals. election of commodities and determining how much my facility consumes in a quarter. Have particularly benefited from learning how to adjustment consumption and do quantification using an electronic tool. Previously we used to do this manually and it used to take approximately three days. However with the excel sheet, the formulas are there and all you need to do is input your data and it will take at most a couple of hours to complete your quantification exercise. a proper handover. Having 8 service delivery points for HV test kits compounded the issue. his training is useful for me because have learnt how to be accurate in making my orders and taking note of any issues on the top up forms. For example the number of sick patients suffering from an ailment should tally with the number of tests conducted. also know how to make orders it faster and where to look for information. n case of assumptions are necessary, now know how to be more realistic. he problem with using the wrong data is that you end up exaggerating and this leads to spending money on commodities you don t need. With accurate data, you save a lot of money. his training has reinforced the need for the accuracy and consistency in filling out the stock cards and top up forms. Previously we used to do this manually and it used to take approximately three days. t now takes us less than three hours. Phildelia himanyula ab technologist Vihiga istrict Hospital t the Hospital we do various routine tests including haemograms, chemistry and liver functions, diabetes. We are also a satellite site and we receive specimen for 4tests from 32 facilities weekly. n our lab we use stock cards on a daily basis, however when changing shifts, it was had to track the stock status because we were receiving stocks and handing over on a daily basis without 19

24 P PK Participants Peter kenga, Hamisi sub county district hospital, ose nyino, Boyani dispensary and verlyne mbwere from duku dispensary lice icheni from and nn Buff from P follow proceedings during H 2 meeting Participants from Homabay working on their computers during a orientation the use of H 2 by H Joseph Warero enior dvisor, H orients eunora kubasu and ahat oor from PH Plus marisha through the H tool aroline lwande from P making a presentation on tools during a partners meeting Participants in agroup discussion on the use of H2 in Homabay ounty 20

25 lice icheni adresses participacants from H departments and implementing partners H 2 orientation workshop harles buru from F funded H implemented by Futures group follows proceedings at a Health Partners meeting in Kisumu Peter guhiu of H during a Quantification exercise in Vihiga ounty Participants in group discussions during the Health partners eeting in Kisumu 21

26 22 anaging for esults: upportive upervision Field Visit by Project anagement eam By dinda Kusu and harles uma he project management team conducted an H-focused supportive supervisory field visit to evaluate the results of the program s activities at health facility level in Western and yanza regions of Kenya. he visit conducted between 19 th -22 nd ay 2014 focused on assessing the status of commodity management, pharmaceutical and laboratory service delivery both in general and with specific reference to the priority health programs- HV/, alaria, Family Planning & eproductive Health and uberculosis. broad range of facilities covering all levels of the health system and across the public and FB sectors were selected for the visit and included Vihiga and achuonyo Hospitals; akunga ural Health emonstration entre in Vihiga; t Joseph s ission Hospital in igori; and mukura ission Health entre in Busia among others. he team was accompanied by staff from the program and PHplus Western Kenya during the exercise. n line with the theme of the visit- Partnerships for sustainable results, the team also evaluated the program s collaboration with other regional implementing partners in rolling out interventions and in leveraging both technical and financial resources in activity implementation. oreover, the ounty Health anagement eams in the visited counties were able to share their experiences and perspectives on their work with H and strategies adopted to ensure maximization of impact and sustainability of results from their collaboration with the program. he field visit concluded with a half- day debrief meeting where the team shared their findings and recommendations with the H and PHplus teams with highlights of specific actions for each. his was followed by the quarter 2 progress review meeting for H program where achievements, challenges, lessons learnt and plans for the subsequent quarter were presented and discussed. ne of the teams at the Vihiga Hospital laboratory discussion session at igori ounty Hospital discussion session at mukura ission Hospital he Pharmacy store at the akunga ural Health emonstration entre F WH PG 4 P B Q F K F F V B V Y B K P P P P P Y X X H G Y Z G K Q W Z G K Q W Z G K Q W Z G H Z G W H K Z

27 inistry of Health JB : G PG BY ools sed: oh 642 [aily activity register () for laboratory commodities] or other consumption record, op up forms, xpiry monitoring charts and aboratory stock cards, oh 643 (Facility onsumption eport and equest form (F) for laboratory commodities including HV apid est Kits, Blood creening eagents, malaria diagnostics, haematology reagents, chemistry reagents etc. ata sources: 1. he Quantity consumed is obtained from the aily ctivity egister for aboratory eagents and onsumables (H 642) 2. aboratory stock cards provide the beginning balance, receipts, losses, adjustments, number of days out of stock and any expiring stock 3. aboratory op-up forms also provide data on stock transfers between the facility (lab) store and the various testing points within the facility 4. he nd of onth Physical ount is obtained by conducting a physical count of stocks held at all testing points and the facility (lab) store. Procedure: tep 1: dentification of data sources btain all the relevant documents from the testing points within the facility such as V, P, hospital wards, V, laboratory, etc. (oh 642) aboratory op-up form ab stock cards tep 2: Preparation and checking of data btain data on the quantity consumed and number of tests done by type of laboratory test (from, op-up forms) and stock on hand data (op-up forms and laboratory stock cards) from all testing points. (B: dd the quantity of tests used as repeats to the consumption) o For testing points where there is no, use the op-up forms From the facility (lab) store, obtain the stock on hand data from the laboratory stock cards heck for any discrepancies between the physical count and the recorded stock on hand. btain explanations for any unresolved discrepancies, e.g. losses, and provide or seek support to address them ecord any losses, adjustments, short expiry stocks and days out of stock. btain the beginning balance for the month from the previous month s closing physical count. btain the quantity received during the month from lab store stock cards or delivery notes from K or other routine supplier. tep 3: Key ata lements for aggregation For each commodity, sum up the following data elements across all the testing points (including the lab bench) and the facility / lab store:- ata et esting Points Facility / ab tore Quantity sed ü umber of ests one ü ays out of stock ü Quantity expiring in less than 6 months ü ü nd of onth Physical count ü ü osses and wastage ü ü djustments (positive and negative) ü ü tep 4: Filling the H 643 For each laboratory commodity, fill in all the data elements obtained above into the F (H643). ote: ll quantities should be entered in the units indicated in the column nit of ssue tep 5: etermining the Quantities to rder his is the Quantity required for e-supply. alculate the quantity, in units, for each laboratory commodity that your health facility should order, guided by the following steps:- - etermine the average monthly consumption () from the consumption & stock out data of the current reporting period (refer to the aboratory Quantification job aid) - alculate the aximum stock level () i.e. the maximum quantity that a facility should have at any one time. = x aximum onths of tock (ax ). aximum = ead time (in months) + [1.5 x e-rder Period (in months)] (B: ead time is time taken from ordering to receipt of supplies). - ubtract the nd of onth Physical ount from the value obtained above; this gives the Quantity equested for re-supply in units. tep 6: ata Quality hecks he following data elements should be checked: o. ata quality heck 1 he Beginning Balance should match the Physical ount at the end of the previous month 2 otal Quantity sed should not be more than (Beginning Balance + Quantity received + Positive adjustments egative adjustments) 3 ays out of stock should not be more than the number of days in that month 4 onsumption should be zero for commodities that were stocked out for the entire month tep 7: eport ubmission he completed and validated facility report should be submitted to the ub-ounty ab oordinator by latest 5th of every month. he ub-ounty ab oordinator reviews the data and enters into H2 by the 10th of every month. 23

28 With changing trends where both communicable and non-communicable conditions are a major challenge, laboratories are an important part of most disease management. Health ommodities and ervices anagement is a national level -funded program with a 5 year mplementation period (pril 1, 2011-arch 31, 2016). he program is anchored on Kenya s objective of strengthening health systems for sustainable delivery of quality services and has three outcome areas - strengthened inistry of Health commodity management, strengthened pharmaceutical services and strengthened laboratory services