Improving Access to and Rational Use of Medicines in Malawi - - PowerPoint PPT Presentation

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.

Central Hospital District and Rural Hospital Health Center and Community Pharmacist (Degree) Pharmacy Technician (Diploma)

None

Health Facility Level Training Level of Pharmacy Staff

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

• n logistics and dispensing.

Pharmacy Assistant Training Program

• 3 year initiative to train 150 students
• Partnership between Malawi Ministry
• f Health, Malawi College of Health

Sciences, VillageReach and University

• f 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

Intervention Intermediate Outcomes Outcomes Impact

Improve health

• utcomes and

lives saved

Pharmacy Assistant students and graduates placed in health centers

• Improve

inventory management

• Improve

information availability and quality

• Improve

dispensing standards

• Improve health

worker efficiency

• Improve

availability of medicines

• Improve patient

understanding and adherence

• Increase rational

use of medicines

• Improve quality
• f care
• Improve patient

satisfaction

Theory of Change

Intervention Intermediate Outcomes Outcomes Impact

Improve health

• utcomes and

lives saved

Pharmacy Assistant students and graduates placed in health centers

• Improve

inventory management

• Improve

information availability and quality

• Improve

dispensing standards

• Improve health

worker efficiency

• Improve

availability of medicines

• Improve patient

understanding and adherence

• Increase rational

use of medicines

• Improve quality
• f care
• Improve patient

satisfaction

Routine Monitoring and Evaluation Population and health center based surveys Modeling Data sources:

Methodology includes a cluster, quasi-experimental design with pre-and post-samples and decision analytic modeling

8

Method Details Routine Monitoring and Evaluation

• Monthly supervision visits to intervention sites
• Quarterly data collection at comparison sites
• Collect information on key health center

indicators throughout project Population and Health Center Based Surveys

• Led by University of Washington
• Community surveys measure incidence and

treatment rates in community for common childhood illness

• 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 Modeling

• Decision analytic model to represent the

consequences

• f

differential access to treatment on morbidity, mortality, DALYs.

Health centers with pharmacy assistant students showed improvements in dispensing standards and storeroom conditions.

9

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Intervention Comparison Intervention Comparison Intervention Comparison Intervention Comparison Dispensing Storeroom Conditions Data Quality Medicines Availability Baseline (February) Endline (August)

Clinicians at health centers with pharmacy assistant students spent dramatically less time on dispensing and logistics tasks.

10 10 20 30 40 50 60 70 Intervention Comparison

Clinician Time Spent on Logistics Tasks

Baseline (Feb 2014) Endline (Aug 2014)

“I am completely relieved to have this additional workload of dispensing and inventory management taken over by those specially trained to do the job.” “I am no longer dispensing, or dealing with supply chain issues

• ther than approving issues and
• rders. Now, I am able to see more

patients in a day, and provide more thorough examinations.” “This program is a big relief to us clinicians working in the rural and remote health centers. I am already getting calls from fellow in charges who are enquiring on how they can get a placement at their facility.”

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