Assessment of availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia during COVID-19 pandemic

BACKGROUND: The emergence of COVID-19 pandemic has disrupted the supply chain and stock of medicines and drugs across the globe. Tracer drugs are essential medicines that address the population's priority health problems. Thus, this study aimed to assess availability of tracer drugs and basic diagnostics at public primary health care facilities in Ethiopia. METHODS: Facility based cross-sectional study was employed in four regions and one city administration. The primary health care units (PHCUs) were purposively selected in consultation with respective regional health bureaus. Finally, 16 hospitals, 92 health centers and 344 health posts were included. This study adopted WHO's tool that was being used to rapidly assess the capacity of health facilities to maintain the provision of essential health services during the COVID-19. Descriptive analysis was done using frequency and percentage, and results were presented. RESULTS: The overall mean availability of tracer drugs in PHCUs was 77.6%. Only 2.8% of PHCUs have all tracer drugs. The mean availability of basic diagnostic at national level was 86.6% in PHUs except health posts where it was less. Health facilities with all basic diagnostic services was 53.7%. Of the total 344 health posts assessed, 71% were providing diagnostic testing for malaria using either laboratory equipment or rapid diagnostic test (RDT) while 43% provide urine test for the pregnancy. Conclusion: This study shows availability of all tracer drugs in PHCUs in Ethiopia was extremely low. There was regional variation in availability of tracer drugs and basic diagnostics. It is very crucial to increase availability of tracer drugs and diagnostics. Drugs and diagnostic materials should be supplied according to the capacity and location of health facilities.

Registration of antimicrobials, Kenya, Uganda and United Republic of Tanzania, 2018

Objective. To determine the proportion of essential and non-essential antimicrobial medicines that are registered on the drug registers in Kenya, Uganda and United Republic of Tanzania.Methods We categorized all antimicrobials on the national drug registers and essential medicines lists of the three countries using the British National Formulary. We also categorized all antibiotics according to the World Health Organization access, watch and reserve (AWaRe) classification. We calculated the proportions of essential and non-essential antimicrobials that were registered by antimicrobial class and AWaRe classification. Findings In 2018, Kenya had 2105 registered antimicrobials, Uganda had 1563 and the United Republic of Tanzania had 1327. Of these medicines, 1353 (64.3%) were non-essential in Kenya, 798 (51.1%) in Uganda and 706 (53.2%) in the United Republic of Tanzania. Kenya had 160 antimicrobials on its national essential medicines lists, Uganda had 187 and the United Republic of Tanzania had 182; of these, 33 (20.7%), 50 (26.7%) and 52 (28.6%) were not registered, respectively. High proportions of antimycobacterial and antiparasitic medicines were not registered. Of essential access antibiotics, 14.3% (4/28) were not registered in Kenya, 8.6% (3/35) in Uganda and 20.5% (8/39) in the United Republic of Tanzania, nor were 25.0% (3/12) of watch antibiotics in Kenya, 14.3% (2/14) in Uganda and 19.1% (4/21) in the United Republic of Tanzania. Conclusion Suboptimal registration of essential antimicrobials and over-registration of non-essential antimicrobials may encourage inappropriate use, especially since non-essential antimicrobials do not appear on national treatment guidelines. Countries should prioritize registration of the antimicrobial medicines on their essential medicines lists

Essential medicine selection during the COVID-19 pandemic: Enabling access in uncharted territory

The COVID-19 pandemic requires urgent decisions regarding treatment policy in the face of rapidly evolving evidence. In response, the South African Essential Medicines List Committee established a subcommittee to systematically review and appraise emerging evidence, within very short timelines, in order to inform the National Department of Health COVID-19 treatment guidelines. To date, the subcommittee has reviewed 14 potential treatments, and made recommendations based on local context, feasibility, resource requirements and equity. Here we describe the rapid review and evidence-to-decision process, using remdesivir and dexamethasone as examples. Our experience is that conducting rapid reviews is a practical and efficient way to address medicine policy questions under pandemic conditions

Comparative analysis of private retail community pharmacies' participation in the national health insurance scheme of Nigeria and Ghana: implications for access to essential medicines

BACKGROUND: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme. METHODS: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1st July 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country. RESULTS: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111). CONCLUSION: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana

Essential medicines for emergency care in Africa

Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications.The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.Methods:We undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.Results:The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres).Conclusion:The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa

Prescription et dispensation des medicaments essentiels generiques dans la Prefecture Sanitaire de la Mambere-Kaderei (Republique Centrafricaine)

Les bonnes pratiques de prescription et de dispensation sont des prerequis a l'usage rationnel des medicaments essentiels generiques. Cependant; il y a peu d'etudes sur le sujet en Afrique subsaharienne; en particulier en zone rurale. Cette etude descriptive transversale a ete realisee a partir d'un echantillon representatif de 14 formations sanitaires de la prefecture de Mambere- Kadei. Les donnees ont ete collectees par interview des soignants et des patients juste apres la consultation et a la sortie du point de dispensation. Les indicateurs OMS de l'utilisation des medicaments ont ete employes pour la collecte de donnees. 512 prescriptions ont ete analysees. Le nombre moyen de medicaments par consultation etait 3;5; 68;6de medicaments ont ete prescrits par la Denomination Commune Internationale. Les prescriptions des antibiotiques (31;4) etaient frequentes; et 29des patients ont recu des injections. 82;1de medicaments prescrits sont conformes a la liste nationale des medicaments essentiels. Concernant la dispensation; les medicaments prescrits ont ete dispenses pour 79;5de prescriptions. 21;5de medicaments delivres avaient un etiquetage inadequat. 69;6des patients connaissaient la posologie correcte des prescriptions. La duree moyenne de consultation et de dispensation etait respectivement de 8;3 et de 5 minutes. Dans la Mambere- Kadei; on observe la polypharmacie; un usage excessif des antibiotiques et des injections. Les medicaments ne figurant pas sur la liste des medicaments essentiels et les specialites restent eleves. En termes d'interventions; les programmes de formations sur l'usage rationnel des medicaments essentiels generiques pour les soignants et des campagnes de sensibilisations des populations semblent necessaires

Revision de la liste nationale des medicaments essentiels: les nouveautes

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Procedure de preselection des fournisseurs de dispositifs medicaux a la centrale d'achat des medicaments essentiels et generiques du togo (CAMEG-Togo)

Un des objectifs principaux des politiques pharmaceutiques dans les pays en developpement est la disponibilite; l'accessibilite geographique et financiere de produits pharmaceutiques de qualite pour les populations. La Centrale d'Achat des Medicaments Essentiels et Generiques du Togo (Cameg-Togo); association a but non lucratif; a ete creee en 1998 pour assurer l'approvisionnement des formations sanitaires publiques ou privees a but non lucratif; dans le contexte du recouvrement des couts. Si l'on parle principalement des medicaments; les dispositifs medicaux tiennent une part de plus en plus importante dans le volume des achats de produits pharmaceutiques au sein des centrales d'ach at ; des hopitaux et des programmes de sante. C'est pourquoi; la Cameg-Togo a decide en 2002; avec l'appui de la Cooperation francaise; de renforcer ses competences dans l'evaluation de la qualite des dispositifs medicaux. Ainsi; le dossier de preselection des fournisseurs par appel d'offre international et en particulier la fiche d'information technique relative aux dispositifs medicaux; ont ete revises et les pharmaciens charges de l'analyse technique des dossiers; ont ete formes. La Directive europeenne no 93/42/CEE du 14 juin 1993 est la reference reglementaire actuellement utilisee par la Cameg-Togo pour la preselection des fournisseurs des dispositifs medicaux. Le referencement a la reglementation americaine est en cours afin d'accroitre le nombre de fournisseurs eligibles pour la preselection. L'objectif de cet article est d'une part; de tracer les grandes lignes de la Directive europeenne utilisee par les fabricants de dispositifs medicaux pour l'obtention du marquage CE garant de la qualite; de l'efficacite et de la securite des dispositifs medicaux et d'autre part; de presenter la procedure de preselection des fournisseurs de dispositifs medicaux et en particulier; la fiche d'information technique specifique; utilisee par la Cameg-Togo

Liste modele des medicaments essentiels de l'oms (revision 2003): les changements apportes

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Problematique de la prise en charge des medicaments essentiels de la liste officielle du Mali par les etablissements d'importation et de vente en gros de produits pharmaceutiques : cas de Africa-Lab SA

Notre travail de recherche qui s'est deroule en 6 mois avait pour objectif de contribuer a la mise en ouvre d'un plan d'approvisionnement et de gestion plus performant des stock de medicaments essentiels au niveau des grossistes prives. Nous nous sommes rendu compte que l'approvisionnement et la gestion plus efficaces des ME au niveau de ces etablissement necessitent non seulement une bonne selection des ME et un controle strict du stock permettant de regulariser les commandes; mais aussi des materiels de travail et des personnels qualifies. Nous avons pu remarquer cela apres une analyse administrative appliquee qui a necessite un stage dans etablissement d'importation et de vente en gros des produits pharmaceutiques (Africa-Lab Mali SA.). Ce stage concernait les principaux services en charge de la vente et du stockage des produit qui sont :le service de la facturation; la comptabilite-caisse et le magasin de stockage et de la repartition

Creation d'un systeme d'approvisionnement en medicaments essentiels et de recouvrement de cout dans la Region Centrale au Togo

Dans la region centrale du Togo; l'introduction du recouvrement de cout a permis d'assurer un approvisionnement adequat et regulier en medicaments essentiels et a ameliore l'accessibilite aux soins curatifs de qualite. Une fois l'investissement initial mis en place; le systeme peut se perenniser avec un appui exterieur degressif