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Current Status of HIV Pharmaceutical Management in Guangxi Province, China
Helena Walkowiak, Management Sciences for Health /SPS
Sharri Hollist, MSH/Strengthening Pharmaceutical Systems
Beth Yeager, MSH/SPS
Dr Connie Osborne, WHO
Dr Zhang Lan, WHO
December 9, 2008
Outline of Presentation
Overview of the WHO, MSH, Guangxi province ARV management Program
Objectives of the Assessment Key findings Options/strategy for strengthening ARV
pharmaceutical management in Guangxi Province
ARV Management in Guangxi Province - Strengthening Pharmaceutical Systems (SPS) Program – An Overview
Funded by U.S. Agency for International Development
Implemented by Management Sciences for Health and supported by WHO
5 year award June 29, 2007 – June 28, 2012
In collaboration with NCAIDS and WHO Workshop in Guangxi
Province to introduce a tool for assessing the management of ARVs (July 2008)
Key Objectives of the Assessment
Map the flow of ARV medicines through the supply system including the processes of procurement, quantification, distribution and dispensing
Understand the roles and responsibilities of staff at each level in managing medicines for the ART Program
Identify forms, tools and procedures used for procuring ARV medicines, managing inventories, recording medicines transfers, dispensing, and reporting data
Solicit feedback on which procedures and tools currently being used are effective in managing ARV medicines and which may need to be strengthened to support program scale up
Site Visits: December 3 to 7, 2008
Unit UnitLevel
Guangxi Autonomy
Provincial CDC The Fourth People's Hospital Provincial/City
Guilin CDC Guilin The Third People's Hospital City
Luzai County CDC Luzai County People’s Hospital County
Liuzhou CDC Guangxi Autonomy Longtan
HospitalCity/Provincial
Heng County CDC Heng County People's Hospital County
Status of the ART Program
The number of patients on ART is increasing rapidly From approximately 3,500 at end of 2007 to 5,217
including 144 children at end September 2008 7,000 projected at end of 2008 and 15,000 at end
2009 Increase of patients from 2007 to 2008 averaged
106% at sites visited (range 21% to 194%) 2nd line – 25 plus several patients waiting for VL results 37 treatment sites in 21 counties
3 sites provide treatment for children ARVs are procured primarily by the MOH, with additional
donations from the Clinton Foundation and Glaxo
ARV Supply System in Guangxi Province
ARVs are dispensed at 3 levels of health care system – provincial, prefecture/city and county levels
At each level, CDC orders for the sites from the level above usually quarterly using a pull system Longtan Hospital orders directly from Provincial CDC Some stores and sites have been ordering monthly
due to shortages at provincial store Lead time: between 1 day and 1 week Supplies are collected and transportation is reported
to be a significant cost Some sites requisition medicines from CDC store
monthly or quarterly, and others as needed
Key Findings: Strengths
In general, many ART pharmaceutical management operations are reported to be working well Standard procedures for ordering, receiving and
dispensing medicines and reporting are followed across sites
Communication and coordination between provincial level and stores/sites is generally good and sites can return short dated stock for exchange
Guangxi ARV drug management protocol available Storage space is generally adequate and secure;
pallets, shelving and A/C available in most sites Dispensing supplies – envelopes and labels available
Key Issues (1)
Inadequate stocks of ARVs at Provincial Store No ARVs purchased through national procurement in
2008 ARVs are procured through bidding process at provincial
level as necessary to fill the gap No stockouts have occurred for patients but the
provincial level staff are on constant alert to manage shortages
Orders from lower levels often cannot be filled in full increasing order frequency, management and transport costs
To avoid stockouts, sites issue smaller quantities to patients who must return more frequently to collect refills increasing their transportation and in some cases accommodation costs
Key Issues (2)
Record keeping and reporting needs to be strengthened No standard forms to record inventory
transactions (receipts, issues, running balance) Other gaps – expiry date monitoring and
temperature monitoring tools “Too many forms” – some forms and reports are
reported to be duplicative; tools need to be streamlined and consolidated where possible
In long term, sites request a database linked to the patient information system
Key Issues (3)
Written standard operating procedures for managing medicines and controlling inventories at each level are not in place Many staff managing ARVs are part time so sites want
standardized procedures and simple tools to streamline activities to ensure efficient use of staff
No formal methods for forecasting needs Methods used for annual planning and quarterly or
monthly procurement are diverse e.g. buffer stocks Developing assumptions about future use reported to
be especially problematic as guideline changes are implemented and numbers of patients and regimens used increase
Sites request “simple tools” and procedures to analyze data and quantify needs supplemented by training
On-going and proposed support under the SPS program
Review of existing manual forms and tools to identify options to streamline, consolidate and fill gaps
Draft SOPs and related tools have been developed First training on SOP implementation – June 2009 Develop procedures and a supervision tool for
monitoring Provide follow up support
Site visit findings were discussed with national and provincial stakeholders and partners to prioritize needs, identify options and develop an action plan to strengthen existing ARV management systems in Guangxi Province eg., Strengthening quantification procedures suggested by other partners