Transcript Poster presentation - WHO archives

A BASELINE SURVEY
OF THE
PHARMACEUTICAL
SECTOR
IN TANZANIA
R. Shija1, R.Malele2 ,
1. WHO, Tanzania 2.
Muhimbili University
Collage of Health Sciences,
Tanzania
ABSTRACT
A cross sectional survey on monitoring and assessing the
pharmaceutical sector in Tanzania was carried out so as to
know whether or not the population has access to essential
drugs that are of good quality, efficacious and are being
used properly. The survey also aimed at generating current
information on the pharmaceutical situation in Tanzania.
To achieve this, the WHO level II core indicators were
used.
The survey was carried out in 2002 involving four randomly
selected geographical areas namely, Mwanza, Kilimanjaro,
Mbeya and Dar es Salaam. From the four areas a total of
20 public health facilities were selected (five from each
study area). Around each of the health facilities visited, 15
households (making a total of 300), and one private
pharmacy/drug outlet were surveyed. Face to face
interviews, exit interviews plus retrospective record data
sampling methods were used in data collection.
Some of the key results of this survey include; 87% of key
drugs to treat the top 10 diseases were available; on average
51% and 86% of the lowest daily government salary was
spent to purchase medicines from the private pharmacies
for children and adults respectively; the average stock out
duration for medicines in the public health facilities was 28
days; prescribing according to the Essential Medicine List
was 98.5%; patient knowledge on dispensed drugs was 80%
and number of patients receiving antibiotics and injections
per encounter were 42% and 14% respectively.
The general analysis of the survey data shows some
improvement in the performance of some indicators of the
pharmaceutical sector. The major recommendation is that,
those indicators which, depicted unfavourable results
should be addressed with new strategies of a revised
National Drug Policy and the Pharmaceutical Master Plan.
Indicators for Tanzania
• Population
34.5
million
26 : 74
• GNP/Capita
$260
• Per capita health
expenditure
$9
• Pharmaceutical annual
expenditure per capita
$2
• Allocated public expenditure
per capita-Pharm $1.30
46% of
6.5
• Infant mortality
102
• <5 mortality
154
• Maternal mortality
530
• Life expectancy
51
• Access to health facilities
93% (1 hr)
• Population / health facility
7,431
83%
• Annual malaria deaths
GDP
• Annual Inflation
• Total fertility
• Immunization coverage
(02/03)
• Agriculture
62%
• Dependency ratio 104%
• Urban : Rural
public+private
• Literacy
5%
>100,000
Introduction and Background
The overall objective of the National Health Policy is to
improve the health and well being of all Tanzanians with a
focus on those most at risk and to encourage the health
system to be more responsive to the need of the
population.
Inspite of the progress made since independence and the
recent favourable economic growth realized so far, the
Tanzania’s health indicators are still below the acceptable
levels due to, amongst others:
• Shortfalls in the annual health sector budget allocations
• Increased demand for health care due to expanding
population and changing disease patterns
• Increased costs of essential health care inputs e.g.
personnel emoluments, drugs, equipment and medical
supplies.
Tanzania has taken several steps in an attempt to improve the
situation. In 1991 it endorsed the first National Drug
Policy (NDP), whose overall objective was to make
available to all Tanzanians at all times the essential
medicines which are of quality, proven effectiveness and
acceptable safety at a price that the individual and
community can afford. The NDP also serves as a basis
upon which future planning of the pharmaceutical sector
is carried out. A master plan for 1992 – 2000 was developed
indicating the objectives, strategies, time frames and the
budget required to achieve development in various key
areas of the pharmaceutical sector.
Introduction and Background
(2)
Monitoring and assessing the pharmaceutical
situation in Tanzania, like in any other country, is
important so as to know whether or not the
population has access to essential drugs that are
of good quality, efficacious and are being used
rationally.
The International Network for Rational Use of
Drugs (INRUD) in collaboration with the World
Health Organization (WHO) has developed core
indicators for monitoring national drug policies
that can be used to systematically assess,
evaluate and monitor the formulation and
implementation of various strategies and
components of the pharmaceutical system.
This study adopted the use of level II core
indicators which measure access to drugs and
medical supplies by the population, quality of
drugs and rational use of drugs.
Objectives
• To assess the country capacity such
as availability, infrastructure, logistic
and human resources to improve
access and rational drug use.
• To monitor the process and
strategies
used
in
the
implementation
of
various
components of the pharmaceutical
sector to see if they achieve the
objectives of
NDP and the
Pharmaceutical Master Plan.
• To collect baseline information on
the pharmaceutical sector in
Tanzania from the facility to the
central level.
Methodology
• Study Design
Prospective and
retrospective crosssectional survey
Tanzania
• Survey Area
4 regions ie Dar es
salaam, Kilimanjaro,
Mwanza and Mbeya
• Facilities per
region
Randomly selected
5 health facilities,
5 pharmacies
1 Medical warehouse
75 Households.
• The study
population
Clients and workers of,
drugs warehouse and
households around the
health facilities
Results
Availability of key drugs in health facilities for
treating the top ten diseases shows that on the
average 87.28% of key drugs are available in
the zonal warehouses.
Availability of key drugs for treating
top ten diseases
Percentage of key drugs
100
80
60
40
20
0
Dar es
Salaam
Mbeya
Kilimajaro
Regions
Mwanza
Results (2)
Stock-out duration
The average stock-out duration for all essential drugs
is 28 days (Median 21.2, Maximum 67.1 days,
Minimum 3 days).
Affordability of key drugs in health facilities
On average 51% and 86% of the lowest daily
government salary was spent to purchase drugs
from private pharmacies for children and adult
patients respectively
Adequacy of drug storage
The average adequacy of storage was found to be 9 for
Zonal warehouses and 7 for public pharmacies.
This rating is out of an 11 ranking scale indicator.
Patient Knowledge
The average patient knowledge about dispensed drugs
was 80%
Percentage prescribed drugs dispensed
Three out of the four regions had between 80% and
90% of the prescribed drugs dispensed. One region
had very low results ie 47%.
Results (3)
The adherence to recommended
treatment for diarrhoea in children.
On the average 44% prescriptions contained
antibiotics. However, ORS was prescribed on average
of 82% of the cases. There are important differences
among regions (Dar es Salaam, 82%; Mbeya, 80%;
Kilimanjaro, 70% and Mwanza, 96%)
100
90
Percentage
80
70
60
50
40
% ORS
30
20
% antibiotics
10
0
Dar es
Salaam
Mbeya
Kilimanjaro
Mwanza
% Antidiarrhoeal
and/or
%Antispasm odic
Regions
Figure 5: Adherence to recommended treatment guidelines in treating
Diarrhoea in children
Results (4)
• Number of patients receiving antibiotics
42% of patients were prescribed antibiotics compared to 39%
reported in 1999.
• Percentage of patients receiving injections
The number of patients receiving injections was 14% compared to
35% reported in 1993.
Adequately labelled drugs
On average 76% of drugs were labelled adequately. A similar study
conducted in Dar es salaam and Coast in 2001 showed 87%
Average number of drugs per encounter
The average number of drugs per encounter is 1.8 compared to 2.2
found in 1992.
• Percentage of expired drugs
There were no drugs in the private facilities shelves with dates
beyond expiry dates. However, in public facilities 13% of key
drugs were expired.
• Guidelines Availability
Only five (5) facilities out of 20 had Standard Treatment
Guidelines in their premises But 98.5% prescriptions were
according to Essential Medicine List
Results (5)
Households survey
Health seeking behaviour
Other Pharmacy/
9% drug seller
7%
Private
Public
facility
facility
9%
38%
Did nothing
Traditional
18%
healer
19%
• At Public facility
77% of all cases
medication was
prescribed.
79% of above
received prescribed
medicines at the
facility, 12% got
part of prescribed
medicines and 9%
did not get any.
Lower income groups do not get all the medicines they need
not get all the medicines they need
How much of the me dicine pre scribe d was
obtaine d: Tanzania 2002
100%
80%
None
60%
Som e
40%
All
20%
0%
<$2
$2-$10
We e k ly e xpe ns e s
>$10
do
Access
Conclusions /
recommendations
Availability needs to be improved by:
• Further strengthening of the Medical Store
Department and its zonal warehouses
• Scheduled procurement cycles should be adhered to
by Districts and health facilities
• Increased budget funding for medicines
• Continuing education in drug management for all
pharmaceutical staff in health facilities
• Constant monitoring of drug use
affordability is low especially for private facilities
Interventions to look at pricing mechanisms of
pharmaceuticals
Rational Drug Use
Patient knowledge on drugs/labelling /antibiotic and
injections misuse
Revision and wide distribution of Standard Treatment
Guidelines and EML
continuing education for prescribers and dispensers
on rational drug use and good dispensing
IEC on proper use of medicines to the community