Abstract
Background: As a key partner of Ministry of Health (MOH) Ethiopia, The Clinton Health Access Initiative (CHAI) had been implementing the Child Survival Project (CSP) since October 2015. Strengthening DTC was one of its focuses to improve overall supply chain management (SCM). The objectives of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major hindering factors for their functionality. Methods: A descriptive study design was employed with mainly qualitative data collection methods and analysis. The assessment made use of both qualitative and quantitative data, generated from primary sources through key informant interviews and from secondary sources through desk review methods. Results: DTCs were introduced in Ethiopia in the early 1980’s. The mandate of DTCs has been given to four different government organizations since this time. As a result, its implementation was lagging. Recently, the government and its partners have given attention to DTCs. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in health facilities (HFs) improved from 85% to 98% between 2015 and 2019 during baseline and endline assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63%. The CHAI/CSP regular supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same facility revealed significant association between the two variables at p<0.0001. Conclusions: Providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating bodies for DTCs and similar structures at Regional Health Bureaus and woreda health offices should be established.
Highlights
A Drug and Therapeutics Committee (DTC) is a platform for organizing multi-disciplinary professionals in a given health facility (mainly hospitals and health centers (HCs)) to improve the sustainable availability and rational use of essential medicines and medical devices at health facilities (HFs)[1]
The key informant interviews (KII) participants have more than 12 years’ experience on DTC related implementation. These KII participants are working at Ministry of Health (MOH) (1); Ethiopian Pharmaceuticals Supply Agency (EPSA) central office (1); Regional Health Bureau (RHB) (6); EPSA regional hubs (3; Bahir Dar, Mekelle and Hawassa); Ethiopian Food and Drug Administration (EFDA) (1) and partners working/supporting or experienced in DTC implementation (9), namely the private sector, World Health Organization (WHO), United Nations Population Fund, Promoting the Quality of Medicines Plus (PQM+) Program, Global Public Health/ United States Pharmacopeia, United States Agency for International Development (USAID)/Chemonics/PSM, USAID Transform Health in Developing Regions, USAID/AIDS/Free and United States Pharmacopeia
The majority of participants revealed that they have participated in the development of DTC guidelines, training materials and delivering DTC training for professionals
Summary
Background A Drug and Therapeutics Committee (DTC) is a platform for organizing multi-disciplinary professionals in a given health facility (mainly hospitals and health centers (HCs)) to improve the sustainable availability and rational use of essential medicines and medical devices at health facilities (HFs)[1]. Following irrational use of medications in hospitals in low- and middle-income countries, developing DTCs for hospitals was suggested as a starting point to act as an agent of change. This recommendation was forwarded from the first International Conference on Improving Use of Medicines (ICIUM), which was conducted in Thailand in 1997, taking lessons from high-income countries, where more has been documented about the effectiveness of such committees[5]. A chi-square test of independence examining the relationship between facility and pharmacy head training on DTCs and functionality of DTC in the same
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