Medicines In Health Facilities Research Articles

Cross-sectional study on the availability of essential medicines at public health facilities in Jur River County, South Sudan

Introduction: The availability of essential medicines in health facilities in Jur River County (JRC), South Sudan, is below expectations. This is despite the requirement that all citizens should be provided with adequate quality health care services. The objective of the study was to assess the availability of essential medicines and inventory management practices in JRC.Method: This was a cross sectional study conducted in 31 of the 51 health facilities in JRC. These were 23 primary health care units (PHCUs) and eight primary health care centres (PHCCs). Data were collected using a structured questionnaire, logistics management information system (LMIS) data reports and checklist forms. All the completed checklists and questionnaires were analysed using IBM SPSS statistics version 20.0 and LMIS data was analysed using excel spreadsheet.Results: The main findings were stockouts and overstocking of essential medicines, low skilled health workers (HWs) and ineffective rotation of medicines in the health facilities. From January – August 2021, the stockouts of essential medicines in PHCUs and PHCCs were 44% and 34% respectively, whereas the incidences of over stockings were 22% and 31% respectively. Almost all (97%) of the health facilities kept records of essential medicines, revealing stockouts of 90.3% on the day of the visit. Of the 31 HWs interviewed 23 (74.9%) were community health workers (CHWs), four (12.9%) nurses and four (12.9%) pharmacy technicians; most (87.1%) had attained secondary education.Conclusion: The quantities of essential medicines were inadequate and able to cover only two months. The major reasons were inadequate supply of essential medicines; recruitment of CHWs and nurses, instead of pharmacy technicians in the management of supplies; ineffective rotation of medicines within and other health facilities. More research is needed on the factors affecting the availability of medicines at the health facilities in JRC.

АНАЛИЗ НОРМАТИВНО-ПРАВОВОГО РЕГУЛИРОВАНИЯ ХРАНЕНИЯ НЕЗАРЕГИСТРИРОВАННЫХ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ В МЕДИЦИНСКИХ И ФАРМАЦЕВТИЧЕСКИХ ОРГАНИЗАЦИЯХ В РОССИЙСКОЙ ФЕДЕРАЦИИ

Compliance with the necessary storage conditions for unregistered medicines by health facilities and pharmacies is one of the most important aspects of medicine provision of patients. Currently, some aspects related to ensuring the storage conditions for unregistered medicines remain insufficiently regulated by the current legislation. The aim of the study is to analyze the legal regulation of the storage in health facilities and pharmacies of unregistered medicines in the Russian Federation which are imported for the purpose of providing medical care to specific patients. The texts of regulatory legal acts of the Russian Federation have been used in this study as well as grammatical and logical methods of their interpretation. It has been shown that at present unregistered medicines can be imported into the Russian Federation to provide medical care to patients for health reasons, including containing narcotic and psychotropic substances. It has been analyzed that this import into the country is provided by a legal entity entitled to it, after which at the regional level such medicines are transferred for storage either to an intermediary pharmaceutical organization or directly to a health facility in which the medicine will be administered to the patient or dispensed for use at home. It has been established that the current legislation of the Russian Federation does not regulate in detail the organization of storage of unregistered medicines. The necessity of developing legal norms regulating the storage of unregistered medicines in health facilities and pharmacies has been presented. The expediency of providing separate storage of unregistered medicines in in health facilities and pharmacies has been substantiated, which, depending on the available space and equipment, can be organized on four levels, which will reduce the likelihood of errors at this stage of their circulation.

Supply chain of some medicines in health facilities in Jos, Nigeria: post Federal Ministry of Health mapping survey

The Nigerian health system is fraught with inadequate personnel, weak logistics systems and poor service delivery. The Federal Ministry of Health (FMoH) report on mapping of partners’ procurement and supply management systems for medical products with its recommendations was evaluated. An assessment of Supply Chain Management (SCM) of health facilities as well as the different categories of personnel that manage them was conducted. The study indicated 79.5% of the facilities received free antimalarials, 46.2% received free ARV and 23.1% received free antituberculosis. Facilities (94.9%) were not involved in the product selection as it was undertaken by providers. Also, 65.4% of the facilities received expiring drugs, 87.2% did not have well trained and efficient staff. In addition, 88.5% admitted that supplies were sometimes delayed and they (65.4%) are usually not intimated of the reasons, 66.2% do not calculate average monthly consumption, 59.5% submit LMIS report monthly while 60.0% do not have inventory control system. The study indicated that stock out and supply interruptions still exist several years after FMoH survey and recommendations. This study found that logistic challenges still exist at the SDPs implying that either FMoH recommendations were not implemented or implementation was ineffective in addressing the challenges.
 Keywords: inventory management, logistics, procurement and supply management, supply chain management

Availability and affordability of children essential medicines in health facilities of southern nations, nationalities, and people region, Ethiopia: key determinants for access

BackgroundChildren in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples’ regions (SNNPR), Ethiopia.MethodA medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected essential medicines (EMs) for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The amount of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EMs.The resultsAvailability varied by sector, type of medication, and level of health facilities. The average availability of EM was 57.67% for the public sector and 53.67% for the private sector. Ceftriaxone, SOR, zinc sulfate, and cotrimoxazole were the most widely available types of medications in the two sectors. The median price ratios (MPR) for the cheapest drugs LP were 1.26 and 2.24 times higher than their International Reference Price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and 91 % of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day’s or more wages for the LPGW.ConclusionAvailability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs.

Quality of Drug in Health Facilities: A Cross-sectional Study.

Poor quality drugs result minor to detrimental effect on human health. The drug should be of standard quality and should be used appropriately in order to meet its therapeutic efficacy. This study aims to assess the quality of drug in Nepal. A cross sectional study was conducted in randomly selected 88 health facilities in Nepal from 10th April to 30th June 2016. Selective medicines were collected from both private licensed pharmacies and selected public health facilities. Face to face interview with health facility in-charge of selected health facilities was carried out along with the direct observation of the medicine storage room. The collected medicine samples were dispatched to two laboratories for in-vitro analysis. The labels of the collected medicine were analyzed. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft excel 2007 and analyzed in SPSS version 20. Out of 172 brands, nine brands of medicines were found substandard. Information regarding storage conditions, direction for use and category of the drug were lacking in the label of some brands of medicines. Some selected health facilities were found not meeting major requirements for drug storage: protection from sunlight, moisture, heat, well ventilation and proper sanitation. Few drugs were found to be substandard in Nepalese market from both public and private sectors. Adequate labeling and proper storage condition of medicines in health facilities were lacking.

Evaluating medicine prices, availability and affordability in Bangladesh using World Health Organisation and Health Action International methodology

BackgroundPrevious studies have shown limited availability of medicines in health facilities in Bangladesh. While medicines are dispensed for free in public facilities, they are paid out-of-pocket in private pharmacies. Availability, price and affordability are key concerns for access to medicines in Bangladesh.MethodsThe World Health Organization/Health Action International survey methodology was used to determine price, availability and affordability of 61 lowest price generic (LPG) and originator branded medicines in public facilities, private retail pharmacies and private clinics across 6 regions of Bangladesh. Medicines for non-communicable and infectious diseases, and both on and off the national Essential Medicines List were included. Prices were compared internationally using Median Price Ratio (MPR).ResultsMean LPG (originator brand) availability in the public sector, private retail pharmacies, and private clinics was 37%, 63 (4) percent, and 54 (2) percent, respectively. Medicines for Non-Communicable Diseases (NCD) and essential medicines were significantly less available than infectious disease medicines and non-essential medicines, respectively.Mean LPG (originator brand) MPR was 0.977 in the public sector, 1.700 (3.698) in private retail pharmacies and 1.740 (3.758) in private clinics. Six medicines were expensive by international standards across all sectors.The least affordable treatments in both private sectors were bisoprolol (hypertension), metformin (diabetes) and atorvastatin (hypercholesterolemia).ConclusionAvailability and affordability of NCD medicines are key concerns where the burden of NCD is rising. These findings show improvement from earlier studies, but room for further advances in availability and affordability of NCD medicines in Bangladesh. A small number of medicines are consistently expensive across sectors in Bangladesh, suggesting the need for strategies to address prices for certain medicines.

Disposal Practice of Unfit Medicines in Nongovernmental Hospitals and Private Medicine Outlets Located in Mwanza, Tanzania.

Introduction For a medicine to qualify as safe and effective and to be of good quality, it should be properly labelled, stored, and transported. If a medicine is not handled properly, it ends up being unfit. Improper disposal of unfit medicines contributes to the appearance of their metabolites in the environment. Methods A descriptive cross-sectional study was designed to capture quantitative data. The study was conducted in Mwanza region, Tanzania. The study population comprised nongovernmental hospitals and private medicines outlets in the region. The sample size was 111 facilities. This study was conducted between October 2013 and May 2014. The questionnaire was used to assess experience and challenges of dealing with unfit medicines. A review of waste management records was done to capture data of past disposal for unfit medicines. The coded data were analyzed using Statistical Package for Social Sciences (Version 20.0) computer analysis software. Comparison of proportions between groups was performed using Pearson's chi square. Results The majority of facilities (41.4%) used methods such as the pouring of unfit medicines into the sink and into the dustbin. About 60.4% of facilities were found with unfit medicines at the time of survey. Majority of unfit medicines found were antibiotics (64.1%). Almost 10% of health facilities maintained a register book for recording unfit medicines. Conclusion There was improper disposal of unfit medicines in health facilities studied, whereby commonly reported methods of disposal were pouring into the sink and putting into the street dustbin. In private medicines outlets, there was poor storage management practice as some of the unfit medicines were left unpacked into boxes or separated from the usable medicines and not properly labelled.

Cold Chain Medicines Storage Temperature Conformity by the World Health Organisation in Tanzania

A descriptive study on assessment of medicines cold chain storage conformity with World Health Organization (WHO) requirements in public health facilities was carried out in Dar es Salaam and Dodoma regions. Storage conformity in selected health facilities was assessed by monitoring temperature using temperature data loggers mounted in the refrigerators for a period of 30 days. Results indicated almost half of the health facilities 48.5% visited, did not significantly (P = 0.031) comply with storage temperature (+2°C to +8°C) as per WHO requirement because all recorded Mean Kinetic temperature (MKT) > 8°C. In rural areas, 59.2% of visited health facilities adhered to the WHO recommended storage temperature while in urban areas only 31.6% complied. The study has established electricity failure in urban and lack of gas in rural areas coupled with absence of contingency plan as major challenges to WHO temperature conformity in storage of cold chain medicines in health facilities in Tanzania.

Контроль безопасности лекарственных средств в условиях лечебно-профилактических учреждений: проблемы и перспективы развития

Контроль безопасности лекарственных средств в условиях лечебно-профилактических учреждений: проблемы и перспективы развития

Indicators of quality use of medicines in South‐East Asian countries: a systematic review

To identify indicators of quality use of medicines used in South-East Asian region. A systematic review was conducted searching MEDLINE, Embase and The International Network for Rational Use of Drugs (INRUD) and The World Health Organization (WHO) website. Original studies or reports carried out in the South-East Asian region, explicitly using indicators to measure quality use of medicines, and published between January 2000 and July 2011 were included. A total of 17 studies conducted in 7 of 11 countries in South-East Asia were included. WHO indicators focusing on general medication use in health facilities were most widely used (10 studies). Twelve studies used non-WHO indicators for measuring quality use of medicines in clinical areas (geriatrics and obstetrics) or specific diseases, such as diarrhoea and pneumonia. In five studies, WHO indicators were used along with non-WHO indicators. There was little information available about validity, reliability and feasibility of the non-WHO indicators. The majority of indicators measured process rather than structure or outcome. There were very few indicators addressing non-communicable diseases. A limited number of studies have been published explicitly using indicators of quality use of medicines across South-East Asia. Importantly, existing indicators need to be complemented with valid, reliable and feasible indicators related to non-communicable diseases, particularly those with a high financial burden to meet the current medical challenges in the region.

How to establish a successful revolving drug fund: the experience of Khartoum state in the Sudan

During the 1990s, the Sudan began several initiatives to establish new medicine-financing mechanisms as part of the health reform process. Initial seed stocks were provided to each hospital. Unfortunately these facility-based funds did not regenerate and the hospitals were left without funds for medicines. The Revolving Drug Fund (RDF) was established in 1989 to facilitate access to medicines in health facilities in Khartoum state. This study used quantitative and qualitative research techniques to collect data from health-care providers and users to evaluate the experience of operating an RDF in Khartoum state. Data from personal observations and from archival and statistical records were also analysed. Seven health facilities were sampled for this research. The Ministry of Health has a policy to expand the RDF to the whole country and has already commenced roll-out to seven more states. This policy is based on the experience of the RDF within Khartoum state. Khartoum state has a high (97%) level of availability of essential medicines and this is attributed to the RDF. The RDF medicines were mostly considered affordable by users and very few (6%) patients failed to obtain the prescribed medicines for financial reasons. The RDF could be successfully replicated in other states of the Sudan and in low-income countries with similar contexts on condition that they meet success factors, such as gradual implementation, political commitment and availability of hard currency.