Improving Access to and Rational Use of Medicines in Malawi Pharmacy Assistant Training Global Symposium on Health Systems Research Jessica M Crawford, Malawi Country Director 2 October, 2014
Presentation Overview • Background • Pharmacy Assistant Training Program • Theory of Change • Methodology • Results • Conclusion and Recommendations
Pharmaceutical staff are primarily designated to higher levels of the health system. Health Facility Level Training Level of Pharmacy Staff Pharmacist Central (Degree) Hospital Pharmacy District and Technician Rural Hospital (Diploma) Health Center and None Community
Pharmaceutical staff shortage results in clinical health workers and unqualified staff performing pharmaceutical and medicines management – Limited availability and poor quality of data from health centers. – Poor inventory management leading to stock shortages and wastage. – Unqualified personnel dispensing to patients. – Clinicians spending more time on logistics and dispensing.
Pharmacy Assistant Training Program 3 year initiative to train 150 students • Partnership between Malawi Ministry • of Health, Malawi College of Health Sciences, VillageReach and University of Washington Global Medicines Program MOH goal to train and deploy 650 • Pharmacy Assistants by 2020 Training is a 2 year certificate with • strong emphasis on practical training and supply chain management Support from Barr Foundation, USAID | • DELIVER project, and Vitol Foundation
Theory of Change Intermediate Intervention Outcomes Impact Outcomes Improve • • Improve inventory availability of management medicines • Improve • Improve patient Pharmacy information understanding Assistant Improve health availability and and adherence students and outcomes and quality • Increase rational graduates Improve • use of medicines lives saved placed in dispensing • Improve quality health standards of care centers • Improve health • Improve patient worker satisfaction efficiency
Theory of Change Intermediate Intervention Outcomes Impact Outcomes Improve • • Improve inventory availability of management medicines • Improve • Improve patient Pharmacy information understanding Assistant Improve health availability and and adherence students and outcomes and quality • Increase rational graduates Improve • use of medicines lives saved placed in dispensing • Improve quality health standards of care centers • Improve health • Improve patient worker satisfaction efficiency Population and Routine Monitoring Data sources: health center based Modeling and Evaluation surveys
Methodology includes a cluster, quasi-experimental design with pre-and post-samples and decision analytic modeling Method Details • Monthly supervision visits to intervention sites Routine Monitoring • Quarterly data collection at comparison sites and • Collect information on key health center Evaluation indicators throughout project Population • Led by University of Washington and Health • Community surveys measure incidence and Center treatment rates in community for common Based childhood illness Surveys • Health center surveys include time motion and patient interviews • Baseline data were collected in March, 2014 • Follow-up surveys are planned at 12- and 24- months post-deployment • Difference-in-differences estimator within a multivariable regression framework will be used Lives Saved • Decision analytic model to represent the Modeling consequences of differential access to treatment on morbidity, mortality, DALYs. 8
Health centers with pharmacy assistant students showed improvements in dispensing standards and storeroom conditions. 90% 80% 70% 60% 50% 40% Baseline (February) 30% Endline (August) 20% 10% 0% Intervention Comparison Intervention Comparison Intervention Comparison Intervention Comparison Dispensing Storeroom Conditions Data Quality Medicines Availability 9
Clinicians at health centers with pharmacy assistant students spent dramatically less time on dispensing and logistics tasks. Clinician Time Spent on Logistics Tasks “I am completely relieved to have 70 this additional workload of dispensing and inventory 60 management taken over by those specially trained to do the job.” 50 “I am no longer dispensing, or dealing with supply chain issues 40 other than approving issues and orders. Now, I am able to see more 30 patients in a day, and provide more 20 thorough examinations .” “This program is a big relief to us 10 clinicians working in the rural and remote health centers. I am already 0 getting calls from fellow in charges Intervention Comparison who are enquiring on how they can Baseline (Feb 2014) Endline (Aug 2014) get a placement at their facility .” 10
Conclusions and Recommendations • Intermediate data indicates that pharmacy personnel at a health center level can bring forth significant benefits to the health system and people of Malawi. Training of Pharmacy Assistants addresses staff shortage by shifting logistics • and dispensing tasks away from currently overloaded clinical staff. We anticipate impact evaluation results • to demonstrate improved access to and use of medicines in population. Limitations of note: • – Short time frame to see impact on morbidity and mortality Upstream supply chain challenges affecting – medicines availability The Malawi MOH and partners should • continue to support training of Pharmacy Assistants.
Thank you
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