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Health Commodities and Supply Chain Management
Tina Brock, BSPharm, MSPH, EdDAssociate Dean for Global Health &
Educational Innovations
University of California, San Francisco
Local investment isimportant everywhere
Quality is important everywhere
Value is important everywhere
Care delivery value chain
Human nature must be considered
Why don’t individuals use medicines optimally?
• Don’t have access to health providers
• Don’t have access to medicines
• Medicines available are not of good quality
• Can’t afford to pay for medicines
• Don’t understand how to take medicines properly
• Too cumbersome to take medicines properly
• Don’t believe medicines will work
• Medicines cause troublesome side-effects
• Competing interests… just forget.
Why don’t health systems/countries use medicines optimally?
• Not enough providers to prescribe/dispense
• Products are not available
• Products available are not of good quality
• Products available are not appropriate for health needs
• Can’t afford to procure medicines
• Don’t understand how medicines should be used
• Too cumbersome to implement pharmaceutical management systems
• Competing interests… food, water, safety.
What if…
• There are 87 pharmacists serving 4 million people
• The roads outside of the capital city are underdeveloped
• There is an Ebola outbreak and wife of the Dep Chief Pharmacist has passed away
worldmapper.org
Pharmacists per 1 million population
Malta 2500
South Africa 250
Liberia 25
Somalia 2
Pharmacist & pharmacy density
What does medicine look like?
What are the goals of pharmaceutical management?
• Ensure access to a consistent supply of high-quality, efficacious medicines with the public system
• Control wastage of medicines
• Promote the rational use of medicines
• Improve coordination and synergy among stakeholders in the medicines supply chain
JARGON ALERT!
Easterly Paradox
Bill Easterly, NYU
Focus of US health professionals training
Pharmaceutical Management Framework
Could you…
Forecast how many medicines the catchment area for your hospital will need for the next 3 years
Acquire funding to purchase these medicines
Negotiate a corruption-free tender process for purchasing these medicines from a variety of suppliers (mostly outside of the country)
Plan where and how to store these medicines when received
Assure the quality of the medicines
Devise a plan for getting the medicines to the point of use
Monitor the inventory of these medications; replenishing as needed
Screen for any product-related problems, report these to appropriate agencies and make local decisions based on these data
Monitor the use of the medicines to make sure they are prescribed, dispensed and used appropriately
Where can you learn more?
• MDS-3
• PSM Toolbox
• E-drug list
• Short courses – People that Deliver
– i+ solutions
• Long courses (degrees)– http://
grad-schools.usnews.rankingsandreviews.com/best-graduate-schools/top-business-schools/logistics-rankings
4 cases
• ADDOs – EADSI– Access
• Human Capacity – Bangladesh– Support
• Drug cards – Kenya– Quality assurance
• Needs assessment – Roatan– Diagnosis
Drug shops in East Africa (EADSI, ADDO)*
• Duka la dawa baridi are authorized to sell only a limited list of medicines, not including basic essential prescription medicines
• Prescription medicines are available illegally
• Quality of medicines cannot be assured
• Difficulty in finding reliable and legal sources of medicines and other health care commodities to sell
• Lack of adequate facilities for storing medicines properly
• Dispensing staff lack basic qualifications, and training, and shop owners lack business skills
• High prices charged to consumers
• Inadequate regulation and supervision
*Tanzania, Uganda, Zambia
Bangladesh – stock-outs of FP commodities
Detection of low-quality pharmaceuticals with paper analytical devices (PADs)
The problem: field screening of pharmaceuticals
Securingpharma.com
Main targets:< 50% API
Substitute APIUnapproved excipients
The big picture
How does it work?
ethambutol
isoniazidDegraded aspirinamoxycillin
Detection of EthambutolSensitivity = 100% (24/24)Selectivity = 98% (101/103)
Swipe pill across paper and dip in water 3 min
Take photo Program scales and transforms image
One “lane” detects multiple drugs
Field testing underway in Kenya
Mercy Maina (AMPATH)
2012/2014: 1200 antibiotics and analgesicsIntegrate with pharmacovigilance at MTRH
KPPB involvement
Testing PADs at FDA 7/2013
Counterfeit TamifluAuthentic Tamiflu
Oseltamivir (as phosphate salt)
Counterfeit difference to note:
Lane E: weak or no green-blue
Lane F: pronounced orange at swipe
ORLane E blue
and lane G Red
All Med
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trics
Misc
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10
20
30
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50
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90Medications Received from Order to Ministry of Health
1St Quarter 2014
By Drug ProductTherapeutic Class
Med
icati
on
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eceiv
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(%
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All Med
icatio
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Vitam
ins-Miner
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Anesthe
tic
Anti-I
nfec
tive
Neuro
psyc
hiat
ric
Analges
ic-Ant
i-Infl
amm
ator
y
Fluids-Elec
trolyt
es
Allerg
y
Respira
tory
Topica
l-Oph
thalam
ics
Endo
crine
Cardiac
Gastro
inte
stinal
Obste
trics
Misc
0
10
20
30
40
50
60
70
80
90Medications Received from Order to Min-
istry of Health 1St Quarter 2014
By Drug Product By QuantityTherapeutic Class
Med
icati
on
s R
eceiv
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(%
)
How to take meds on time without a watch in rural Uganda
• No education• Works as a farmer• Lives with brother, sister-in-law, three
nieces in a 3-room, mud-walled house with no electricity
• Owns a lantern, bed, sofa, bike and a radio (no watch)
• Over 89 days of monitored treatment, 98.9% adherence•Took 90% of doses within 10 mins of 7:20AM and within 17 mins of 7:20PM.
Maier, et al. PLoS 2006
Knows it’s time to take medications “by listening to Radio West’s News & Announcements every morning & evening.”
Perhaps this is what globalization should be – a shared, translated learning experience, rather than one culture swallowing another.
~ Arri Eisen
