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

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