EPN Guidelines for Effective and Efficient Pharmaceutical Services
Publication date: 2006
ECUMENICAL PHARMACEUTICAL NETWORK GUIDELINES FOR EFFECTIVE AND EFFICIENT PHARMACEUTICAL SERVICES Guidelines in order of priority Indicators for evaluating the guidelines Compliance with best practices for drug storage and management. Presence of check list for good storage conditions Percentage of stock outs % of expired medicines (in relation to average inventory value) Service level (% fulfilment of requested demands) Presence and use of bin or stock cards Regular calculation of minimum and maximum stock Presence of annual audit/inventory reports of drug store Presence of SOPs (procurement, receiving, issuing) Regular monitoring reports. Compliance with rational drug use guidelines. Not less than two indicators to be used from WHO guidelines for each of. - Prescribing Dispensing - Facility Patient care. Functioning medical supply system Structures—warehouse and stores EDL stocked Meets CHS needs for supply, cost, and delivery Low levels of wastage Availability of stock records Availability of standard operating procedures and evidence of implementation Procedure manuals or guidance for personnel and financial activities. Functioning Drug and Treatment Committees (DTC) in hospitals Membership defined Terms of Reference in place Regular meeting Date of last meeting Drug list adapted to needs Standard treatment guidelines in evidence All ‘owners’ have a maximum understanding of roles, best practice, and management information. Also understanding of Revolving Drug Fund concept and implementation of methods of increasing access for the poorest Basic understanding of: - Rational drug use concept - Essential drugs concept - Management of HIV/AIDS–related demands - Awareness of health and drug production in country - Costing mechanisms for pharmaceutical services - Sustainability of CHS concepts - Strategic planning. Implementation of standard operating procedures for procurement. Availability of SOP procurement document Self-assessment results of SOP audit. Improvement in access to medicines for an institution, passed on to patients. Affordable prices Prices compared to other institutions Independent pharmacy budget List of exemptions. Quality assurance policy in place and implemented. Structure in place to ensure compliance to registration standards Frequency of regulatory authority visits Written standard operating procedures Access to and usage of a quality control laboratory Compliance with national regulatory authority standards (or an appropriate alternative, such as WHO). Pricing policies in place and operationalised. Documented pricing policy (formula and accounting process, and accounting for windfalls) Price list Implementation evidence Government subsidies extended. % trained personnel (pharmaceutical) % salaries paid by government % national health budget that goes to CHS for medicines (subsidised medicines received) Government contribution to infrastructure development. Guidelines in order of priority Indicators for evaluating the guidelines Pro-poor ethic in evidence. Exemption policy Promotion of insurance schemes Differential pricing Advocacy activities - For provision/subsidies for the poor Tax exemptions available to CHSs. Documentation of existing taxes (current government tax policy) List of current exemptions - Documentation (application letters, acceptances and rejections). Transparency mechanisms in place in support of ‘Health for All’ Audited reports available Annual reports available Collective planning (annual, strategic) mechanism in place Policy on monitoring and evaluation written and implemented Organogram (professional profile) Staff recruitment policies written and implemented. Service provision of ARVs ARV delivery systems in place Drop-out rates Numbers receiving ARVs Effective community involvement system in place Evidence of system Evidence of topics raised and actions resulting from the system Awareness levels of the local community of system Cross-institutional information sharing. Evidence of information collected Evidence of information passed to other institutions, the government systems national drugs policy, and national health management information systems and within hierarchies. Compliance with drug donations guidelines. Selection of three indicators from guidelines Mechanism in place to allow for representation at regional and national levels in relevant debates. Selection of three indicators appropriate for the local debate environment At least one pharmaceutically trained person per institution knowledgeable in key areas. Quantification of drug needs Drugstore management Quality assurance Rational drug use Unit costing Record and data management Appropriate financial management Local production Access to key pharmaceutical information. Available in the pharmacy area: - Essential Drugs List – National drugs policy - National (or WHO) formulary – DTC/PTC guidelines - Standard treatment guidelines – WHO essential medicines publications - New and obsolete drugs list – International medicines pricing indicators - Registered drugs list – Rational drug use information - Local production manuals. – Reports from CHSs on pharmaceuticals - Available in the institution: – Managing drug supply manuals. Regular assessment of pharmaceutical unit work Annual reports of unit evaluation Church leaders’ awareness of key messages Comparison to baseline in three selected areas appropriate to the local environment Pharmaceutical function represented at all levels of discussion Minuted discussions at various levels Interview results Disaster preparedness procedures in place. Documentary evidence Review data of three selected indicators Empowerment of home-based care teams in rational drug use Evidence of training Verbal evidence of implementation
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