Every day people are dying in the developing world because they cannot access affordable, quality medicines. Modern pharmaceuticals have revolutionized health care, but weak health systems prevent many people from accessing basic life-saving medicines. The health of men, women, and children can be dramatically improved throughout the world by enhancing access to and improving the use of essential medicines and other health care technologies.
Gaps in the management and availability of essential medicines and health commodities have been a constant weakness for developing countries. These gaps hamper the ability to access and distribute the pharmaceutical and medical supplies needed to treat infectious diseases. We have seen particular success in addressing pharmaceutical management challenges when interventions include: increasing access to products and services, improving the use of those products and services, promoting rational pharmaceutical use, developing public-private partnerships, providing thorough assessments and trainings, and improving procurement processes.
In Rwanda, MSH through its USAID-funded Strengthening Pharmaceutical Systems (SPS) Program, worked with a large hospital to cut its quarterly medicine procurement budget by 2.7 million Rwandese Francs (12% of the budget) over a period of six months, while at the same time improving the use of medicines. This was accomplished through the establishment of a Drug and Therapeutics Committee, composed of a multidisciplinary group of the hospital’s health professionals, whose mandate is to review medicine use in the hospital and implement changes for improvement.
MSH actively promotes the engagement of the private sector in public pharmaceutical management systems worldwide to help fill the gap in providing services. In Tanzania, MSH worked with the Tanzania Food and Drugs Authority to implement the Accredited Drug Dispensing Outlets (ADDO) initiative through funding from the Bill & Melinda Gates Foundation and later USAID and other donors. This initiative created a platform to increase access to basic essential medicines and other public health interventions in underserved areas. The ADDOs program enables community medicine shops to provide high impact prevention and treatment close to home for family planning and major childhood killers including: malaria, diarrhea, and malnutrition. MSH and partners created a model for accreditation and regulation of private drug sellers to improve access to quality medicines and services. Strategies included developing business incentives, training and accrediting personnel, and monitoring adherence to standards. Each ADDO dispenser, over 4,000 are trained – nearly 90% are women, now serves an average of 145 customers per month. Private-Public partnerships help leverage resources to fill gaps and provide solutions to complex challenges to improve health.
MSH has helped many countries and nongovernmental organizations strengthen their pharmaceutical procurement processes and promote savings based on cost-effectiveness analysis. MSH helps them compare actual consumption and use, allowing the purchase of more products for more clients with the limited funds available. We developed the VEN (vital, essential, nonessential) method to help categorize medicines and medical products so that health systems can properly prioritize their needs. Through publication of the International Drug Price Indicator Guide, MSH makes comparative price information more widely available to allow for better purchasing decisions. A survey of more than 50 users of the International Drug Price Indicator Guide found that 68% of them use the Guide for comparing prices recently obtained from suppliers and 42% use it to plan their budget or tender. Sixty-four percent of the survey respondents stated that they do not have access to any other source of comparative international price information. Of the survey respondents, 44% said that using the Guide has contributed to better acquisition prices or other savings for them, with half saving 11-30%.
With funding from the President’s Emergency Plan for AIDS Relief (PEPFAR), MSH through the Partnership for Supply Chain Management helps support the global Supply Chain Management System (SCMS) project. SCMS procures essential medicines and supplies at affordable prices; helps strengthen and build reliable, secure and sustainable supply chain systems; and fosters coordination of key stakeholders. Today SCMS provides more than half of the anti-retroviral medicines (ARVs) supplied by PEPFAR, supporting some 1.25 million people on treatment. SCMS has helped save the US Government money by buying almost all generic drugs – helping treatment programs reach more patients with the amount of funding.
For example, in Vietnam, SCMS is providing enough antiretrovirals to support over 28,000 people in need of treatment. My colleague, Juanita Flomsbee, SCMS Country Director in Vietnam, explains that procurement assistance goes even further in Vietnam, “Besides providing ARVs, procurement of commodities to support prevention in high-risk groups plays a big role in the SCMS program here. The Government of Vietnam, with PEPFAR support and funding through SCMS, started a methadone treatment program about two years ago … There are currently 3,000 people in the methadone program. SCMS provides all the drugs and trains all the dispensers.”
Patient adherence to antiretroviral therapy (ART) for AIDS is critical for individual patient treatment success and to decrease the likelihood that antimicrobial resistance will develop to ARV medicines. Within a program funded by the Swedish International Development Cooperation Agency (Sida), MSH is working with national AIDS control programs to develop cost-efficient ways of monitoring and improving health system performance in relation to adherence to ARV treatment. A facility based intervention in Kenya demonstrated that introducing a simple appointment tracking mechanism and using facility generated indicators were affordable as well as feasible and led to an improvement of 28.3% in appointment keeping. Other facility level ART interventions are ongoing in three other East African countries.
Ensuring that health systems can procure, pharmaceuticals, medical equipment and other supplies at an affordable price and in an efficient manner is critical to saving lives. Strengthening the rational use of and access to medicines within health systems leads to self-sustaining pharmaceutical management systems that provide quality medicines and commodities to save the lives of millions. Successful interventions have been developed by the global health community over the past decades that not only improve the pharmaceutical sectors, but also strengthen health systems as a whole.
Jonathan D. Quick, MD, MPH is President and Chief Executive Officer of MSH. Dr. Quick has worked in international health since 1978, he is a family physician and public health management specialist