Abstract
ProblemHistorically in Thailand, access to poison antidotes was limited and antivenom stock management was inefficient.ApproachIn 2010, the country established a national antidote programme, which created national and subnational antidote stocks, managed their distribution and trained health-care providers on clinical management and antidote use. In 2013, the programme incorporated antivenoms to improve stock management and avoid wastage due to stock expiry.Local settingBefore the programme, health-care providers consulted poison centres on clinical management of poisoning and some antidotes were not available. Individual hospitals stocked antivenoms, which often expired before use.Relevant changesToday, the National Health Security Office finances and manages the centralized procurement of antidotes and antivenoms and all Thai patients have a right to antidotes regardless of health insurance. National and subnational stock levels are determined based on demand, treatment urgency and cost. A web-based system, which incorporates geographical information, was introduced for requesting antidotes and antivenoms. Poison centres provide training, 24-hour consultation services and outcome monitoring. Antidotes and antivenoms are now readily available and used correctly and clinical management has improved. Moreover, better stock and distribution control has helped avoid antivenom wastage and reduced antivenom costs, from US$ 2.23 million United States dollars (US$) to US$ 1.2 million.Lessons learntThe programme’s success depended on strong and sustained policy support, adequate funding, improved operational capacity, training for health-care professionals and the provision of 24-hour online consultation services. A web-based centralized procurement and distribution ensured these essential medicines were available, minimized costs, reduced waste and saved lives.
Highlights
According to the Ramathibodi Poison Center in Thailand, there are more than 15 000 cases of poisoning in the country each year.[1]
The National Health Security Office was established by law to manage the Universal Health Coverage Scheme,[5] which caters for 75% of the population and receives an annual budget funded through general taxation
Medicines were selected and procured centrally, and management of the supply chain was outsourced by the Government Pharmaceutical Organization to the private sector. This resulted in annual savings of a few billion Thai baht (i.e. 50 to 100 million United States dollars; US$).[9,10]
Summary
Problem Historically in Thailand, access to poison antidotes was limited and antivenom stock management was inefficient. Approach In 2010, the country established a national antidote programme, which created national and subnational antidote stocks, managed their distribution and trained health-care providers on clinical management and antidote use. In 2013, the programme incorporated antivenoms to improve stock management and avoid wastage due to stock expiry. Local setting Before the programme, health-care providers consulted poison centres on clinical management of poisoning and some antidotes were not available. Lessons learnt The programme’s success depended on strong and sustained policy support, adequate funding, improved operational capacity, training for health-care professionals and the provision of 24-hour online consultation services. A web-based centralized procurement and distribution ensured these essential medicines were available, minimized costs, reduced waste and saved lives
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