A situation analysis

Medicine Management - A Situation Analysis

 

A significant body of literature on the pharmaceutical sector in Tanzania is available, including recent assessments, surveys and consultations commissioned by the Minister of Health, Community Development, Gender, Elders and Children (MoHGDEC)and WHO and conducted by various consultancy groups. Numerous recommendations have been made; many of these recommendations are yet to be implemented.

  • Medicine Management 3
Our initial assessment of medicine management in the Dodoma region in 2011 showed there are important strengths already in place. A National Medicine Policy (NMP), Standard Treatment Guidelines (STG), the Integrated Logistic System (ILS), administrative and governing structures and infrastructure (health facilities and roads) are in place.

There is significant interest and investment in the pharmaceutical sector from the  Government of Tanzania (GoT) and donors.

A zonal Medical Stores Department (MSD) is available in Dodoma and health facilities order medicines based on needs through the ILS while kits have been phased out. Communication and infrastructure possibilities are widely available, including Internet and mobile phones. Dodoma has a school of pharmacy and a regional training centre that facilitates local training courses. Health Facility Governing Committees (HFGCs) members are appointed and offer a bridge to the community, translating needs and issues. An important number of projects, initiatives and partners are involved in medicine supply activities.

 

Despite these strengths, there is work to be done regarding the management of medicines supply and use in Dodoma region. While policy, guidelines, structures, systems are in place, implementation and processes are weak. Access to medicines is severely hampered and consequently quality of services is insufficient in many cases. Procedures are bureaucratic and cumbersome. A large number of partners and donors are involved which leads to a very fragmented supply system and financial flow. There is limited information sharing among partners and donors. These shortcomings mean that the supply side of the health system doesn’t live up to expectations and thus discourages health seeking behaviours and community enrolment in CHFs.

Findings in 2011

Public health facilities have a mostly functioning pharmacy system and stock essential medicines based on the National Medicine Policy and Essential Medicine List. Weaknesses relate to storage conditions, insufficient stock management including challenges with quantification and forecasting. Availability of medicines, evident with significant stock out levels, is a major problem. The more remote a health facility, the more stock outs have been observed.

  • Medicine Management 2
The baseline survey in 2011 found an average availability of essential medicines of 53%, inadequate record keeping and storage conditions underpinned by a severe shortage of pharmaceutically trained health workers.

Generally the focus has been on supply chain management and less on medicine use and community health behaviour. There is significant over use of antibiotics and insufficient medicines for children. Adherence to Standard Treatment Guidelines (STG) is poor. A general crisis of the health workforce is reflected in critical shortages of pharmacy staff at all levels of the public health system. Pharmaceutical staff lacks continuing education.

Through the situation analysis and discussions at a Joint Planning Workshop in Dodoma, the following seven key issues were identified as needing attention:

 

  • Availability of medicines, supply chain management, MSD performance
  • Pharmaceutical staff
  • Funding for medicines: allocation, flow, access
  • Supervision
  • Involvement of HFGC, Hospital Therapeutic Committees (HTCs) and management teams at all levels
  • Accountability and pilferage
  • Use of medicines