BMC Partners Meeting Ghana BMC project Progress Geneva 22 November, 2011
Introduction The Better Medicines for Children (BMC) Project funded by the Bill and Melinda Gates Foundation aims to improve access to essential medicines for children through addressing issues of availability, safety, efficacy, suitability and price. With support from the Bill and Melinda Gates Foundation through the World Health Organization, Ghana embraced the BMC agenda due to its relevance to the national context on access to medicines and Ghana s Child Health Policy. The project is coordinated in Ghana by the Ghana National Drugs Programme of the Ministry of Health and implemented through structures of the Ghana Health Service.
Strategic Objectives Promoting access to essential medicines for children Advocating with policy makers for their inclusion in national essential medicines lists, treatment guidelines, National Health Insurance and procurement schemes. Working with drug regulatory authorities to expedite regulatory actions on selected medicines for children Developing measures to monitor availability, prices and quality of the medicines for children.
Key Components Strengthening local manufacturing capacity Supply chain availability and pricing Update and Adaption of National Child Specific Guidelines Health system issues DTC training Improvement of quality of care Research child medicine issues
Dissemination of Baseline Reports Literature Review on medicines for children Price, Availability and Affordability of medicines for children Supply chain for medicines for children Assessment of the Quality of Care for children in selected hospitals Assessment of Local Manufacturing capacity for child specific dosage forms Peer Review workshops for Drugs and Therapeutics Committees
International Dissemination of Baseline Reports ICIUM 2011
International Dissemination
International Dissemination
Update on Project Activities 2011
Strengthening local manufacturing capacity Active engagement with private sector local industry has led to the following: dispersible, masked taste Zinc sulphate tablets by one company in the country (Quality to be monitored over time) Registered by Food and Drugs Board Second company is at an advanced stage of development
Supply Chain Availability and Pricing Consensus Building and some advocacy actions undertaken with key stakeholders e.g. local manufacturers, the procurement and supply division of the MOH and the NHIA Improving the national selection process to accommodate child specific medicines and dosage forms in the Essential Medicines List (EML), Standard Treatment Guidelines (STG) and Hospital Formularies. Ensuring that Child specific medicines are captured on the National Health Insurance Medicines List. Effective collaboration with the Food and Drugs Board to monitor Adverse Drug Reactions in children
Update and Adaption of National Child Specific Guidelines Adaptation workshop held involving key national stakeholders to adapt to local context Medicines not available identified for action of expert committee Paediatric society engaged through National Annual General meeting to review adapted material Pocket Book Adaptation Process at Editorial Stage with the support of the paediatric society.
DTC training Improvement of quality of care Rational Use Peer review workshops held for Drugs and Therapeutics Committees in the Southern Sector. Northern sector workshops are planned for December. Collaboration with the National Health Insurance Authority for training and retraining of all categories of health staff and claims managers on the concept and activities of DTCs
Pharmacoeconomics Training Participation Multi national participation Nigeria, Rwanda, Cape Verde and Cameroon For Ghana, National Selection Committee Ministry of Health Food and Drugs Board, NHIA and other Quasi Government Agencies Health Facilities Regional Medical Stores CSOs Academia etc.
Pharmacoeconomics Closing Dinner
Capacity building National EML Selection Committee Evidence Profiles Development Group (A succession plan in place to replace older generation)
SIGHTS & SOUNDS OF GHANA BMC
Building capacity in Evidence summaries
Evidence Profiles Development Evidence profiles for the following medicines of key importance to child health developed with support from the University of Liverpool Artesunate for severe malaria Artemether for severe malaria Zinc Sulphate for acute diarrhoea Caffeine citrate for apnoea in premature neonates Chlorhexidine for neonatal cord care Amoxicillin dispersible tablet Long acting Insulin analogues (Glargine/Detemir) for Diabetes Rosiglitazone/Pioglitazone for type 2 Diabetes Tolbutamide for Type 2 Diabetes Gentamicin 10mg/ml or 20mg/ml Ceftriaxone 500mg vial Vitamin K for preventing HDN in neonates
Further Actions on Evidence Profiles Evidence profiles have been discussed with National Selection Committee and the evidence for these have been accepted; further actions are planned for inclusion on current lists on November 28 th 2011
Research Component Neonatal Quality Improvement Initiative Prescription Audit Study
Neonatal Quality Improvement Initiative Implementation of an aspect of the pocket book whilst monitoring the health outcomes (morbidity and mortality) for neonates at the facility and population level This is being done in collaboration with the MOH/GHS, JHU and WHO
Prescription Audit Several paediatric formulations considered priority medicines, and selected as tracer child medicines, are not currently on the Ghana EML and some are consequently NOT available: Artesunate amodiaquine 25mg/75mg co formulated dispersible tablet Gentamicin 10mg/ml vials for injection Ceftriaxone 500mg vials for injection Zinc sulphate tablets Findings from baseline Assessment: Paediatric dispersible tablets (recommended by the WHO) were generally unavailable, with a preference for suspensions. Mean availability tracer child medicine formulations currently listed on the Ghana EML was 4.4% for branded formulations and 28.6% for generics.
Problem Prescription Audit to what extent does non adherence to guidelines drive the unavailability of essential medicines or conversely is non adherence a necessary reaction to unavailability, and what is the quality of care offered in such situations Objectives To audit prescribing against the STG for the following conditions: Malaria, Pneumonia, Diarrhoea, Neonatal sepsis, Cord care To assess the stock of first and second line essential medicines for these diseases as specified in the STG To discuss the findings of the audit and availability assessments to focus groups for feedback and to explore current prescription practices and problems. To propose strategies to overcome the identified problems. Prescription Audit Study Started with support from LSTM Research Team Trained and data collection ongoing. Data from field assessment would input the FGDs
Monitoring Framework for Project impact M & E framework has capacity for synchronization with country DHIMS developed by MOH. This would ensure that the DHIMS is child medicines information sensitive with adjustments for age bands for children Priority indicators for Monitoring child medicines developed
Priority indicators 1. Proportion of Government Budgetary Allocation to Essential Medicines 2. Proportion of Government Expenditure on Essential Medicines 3. Proportion of Government Expenditure on cmedicines 4. Percentage of items on ceml imported 5. Existence of cstg as a national policy tool 6. Existence of ceml as a national policy tool
Priority indicators 7. Percentage of Health Facilities with current cstg 8. Percentage of Health Facilities with current ceml 9. Percentage Health Facilities covered in Training in cstg for last X period 10. Percentage Availability of Tracer Child Medicines 11. No. of Stock out days for Tracer Child Medicines 12. Median Price Ratios of Tracer Child Medicines
Priority indicators 13. Prescribing Indicators for Children 14. Dispensing Indicators 15. Percentage of items on ceml produced by Local Manufacturers 16. Percentage adherence to cstg 17. Percentage of items on EML produced by Local Manufacturers 18. Percentage of items on EML imported 19. Ratio of Total purchases of locally manufactured products to Total installed capacity of local manufacturers (by value) 20. Percentage Prescriptions Not Fully served due to NHIA Prices 21. No. of Medication Errors Identified per X Period for Children 22. No. of Medication Interventions made per X Period for Children 23. Total Percentage Purchases of Essential Medicines from local manufacturers by MOH 24. Affordability of Treating uncomplicated Pneumonia, Diarrhoea, Malaria
Activities to be implemented BMC advocacy actions started and awaiting Technical support from WHO/HQ Market analysis of child medicines Optimization of injections for children Training in the use of guidelines and Training in the use of key medicines DTC strengthening Documentation of Lessons Learnt End Term Evaluations and Way Forward
Conclusion BMC Ghana project has achieved some success: Making Zinc available in the country (Quality to be monitored over time) Strengthening evidence based selection of medicines with emphasis on child medicines Strengthening DTCs as agents for rational use of medicines for children at the facility level Steering Committee for BMC have been engaged and active Project has led to an emerging implementation plan for all proposed interventions for child medicines with stakeholder buy in. Implementation of this plan is key to the continued actions on better medicines for children in Ghana
Conclusions Long Term Capacity Building partnerships and collaborations have began with LSTM and JHU. We are also exploring other partnerships to make the Better Medicines for Children Initiative a reality in Ghana
Looking Forward Linking selection processes and antimicrobial resistance of child specific antimicrobials with sentinel sites of surveillance and Community perception of antimicrobial use The burden of counterfeit child specific medicines circulating in the Ghanaian market
THANK YOU FOR YOUR ATTENTION
SIGHTS & SOUNDS OF GHANA BMC