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Contribution to the Annual Report 2013 of the MMI Network

How to address the shortages of children's medicines

How to address the shortages of children's medicines

A significant proportion of the health care resources at any level is spent on medicines and health supplies. Unfortunately in spite of this, access to medicines remains a global challenge. One of the millennium development goals that are directly impacted by access problems is MDG 4 that seeks to reduce the less than five mortality rate by two thirds. The major killers of this age group are pneumonia (18 %), malaria (16 %), and diarrheal diseases (15 %). All these conditions are largely treatable with low cost medicines which should be available right from the lowest level of care.

Following this EPN decided to investigate the state of medicines for children in the church sector. EPN developed tools and a methodology for investigating the availability, pricing and factors impacting availability of medicines for children modelled along the one used by WHO. The tools and methodology have been validated and studies carried out in Ghana, Kenya, Uganda and Chad in previous years.

In 2013 EPN wanted to engage further improving the access to children’s medicines. Mission for Essential Medicines and Supply (MEMS) in Tanzania and Presbyterian Church in Cameroon Health Services Central Pharmacy (PCC) in cooperation with Cameroon Baptist Convention Health Bureau (CBCHB) collected data in 50 faith based health facilities in both countries.


Objectives

  • To investigate the availability and pricing of selected medicines at national level of the key suppliers for church health facilities and at facility level.
  • To investigate health facility factors that might impact on availability of medicines for children.
  • To identify measure to improve the access to children’s medicines


Method

Two standardised questionnaires were used to characterise the facility, size, staff, services, and the medicines according the international defined essential and priority medicines lists (WHO) and national guidelines. In Cameroon 34 health centres and 16 hospitals were visited. In Tanzania data from 15 hospitals, 5 health centres and 30 dispensaries were collected.

Results

Cameroon

Tanzania

In 15 hospitals the data collectors found only 2 pharmacists, 22 pharmaceutical technicians and 14 pharmacy assistants. In health centres they counted 10 pharmaceutical technicians and 15 pharmacy assistants. Other staff was trained on the job.

In 15 hospitals we found only 8 pharmacists, 14 pharmacy assistants and 20 pharmaceutical technicians. At lover level facilities formally trained pharmaceutical staff is missing.

About 50% of the health facilities have reference books or guidelines on how to use medicines in children.

Access to specific information on children’s medicine is limited: 80% of facilities have no guidelines specifically for children. Only 3 hospitals have the WHO Model Formulary for Children or a BNF for Children and Only 2 out of 50 facilities have access to internet.

Overall 76% of the health facilities had Oral Rehydration Salt (ORS), 24% could offer a package combination of ORS plus zinc tablets but the rest had almost no zinc tablets on stock.

While the most important medicine to treat diarrhoea ORS is available at 94% of the facilities only half can dispense zinc tablets although they should be given in combination.

Ceftriaxone was only available in 33% of the health facilities at all. Like in Tanzania the majority stored only the adult strength.

Ceftriaxone is mostly available as a 1g ampoule. Lower doses for children have to be withdrawn and the rest discarded.

If Salbutamol is available as an inhaler over 90% of the health facilities can’t offer any spacer for children and do not know how to simply use a clean used plastic bottle to build one.

The mark up exceeds often more than 200% compared to the price asked by the drug supply organisation. Health facilities tend to finance other expenses for staff and buildings through medicine prices.

Some patients have to pay 50 to 140% more than the most commonly asked price for a medicine. The mark-up of a price for a patient can be up to 200% above the facility price.

 

 

Conclusions

Measures at different levels of the health system should address the shortages of children’s medicines. Health facilities need to update their treatment guidelines and stock lists. Drug supply organisations should offer children suitable medicines in terms of strength and dosage forms. Proper inventory management skills can reduce stock outs and improve the overall access to children’s medicine.

In both countries experts from different institutions and health facilities discussed the results and defined useful interventions to improve the situation. Thus, EPN runs follow up programmes in order to address the shortages on the different levels of the health systems to improve the access to children’s medicine in 2014.

Contribution to the Annual Report 2013 of the MMI Network
More information: www.epnetwork.org

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