Transcript Poster presentation

Improving Access and Use of
Medicines through Private Sector
Initiatives: A case for an Essential
Medicines Franchise in Ghana
Eghan Kwesi, Mensah D, Idun J,
Staley,R. Marsden,A. Arhinful,K. OforiAdjei,D. Dodoo A.
ABSTRACT
Problem Statement: Licensed Chemical Shops (LCS) and non-prescription
drug outlets account for over 66% of total community drug outlet visits in
Ghana. These practioners however lack the ability to recognise and
appropriately manage simple ailments. Their drug procurement activities are
resource–heavy and inefficient, resulting in high prices to consumers, while
regulatory and supervisory visits by the legal regulator are irregular and
limited. To address these issues, Strategies to Enhance Access to Medicines
(SEAM)
established
a
working
relationship
with
the
Ghana
Social
Marketing Foundation Enterprise Limited (GSMFEL) as its implementing
partner to operate a franchise.
Objectives: The franchise provides a structured approach technique through
technical training to LCS for recognising simple ailments;
provide
commercial skills to assist selected LCS operators to run sustainable
enterprises;
develop
a group
purchasing
program accompanied
by
systematic distribution practices for a network (franchise) of LCS; and
provide effective and regular supervision to enhance quality of service
delivery.
Design: Pre- and post-intervention design.
Setting and Population: Seventy-nine rural to peri-urban based LCS
serving a population of about 500,000 were franchised based on preidentified criteria including minimum educational status; catchment area;
and absence of a local pharmacy shop.
Intervention:
Following
multi-stakeholder
meetings,
local
experts
developed, field tested and harmonised training manuals for a modular
training programme for franchisees. Simultaneously, a centrally coordinated
logistics and supply system was initiated to supply all products for the
franchisees by the franchisor. Nationwide and regional baseline assessments
were
carried
out before the
interventions.
Post-intervention
regional
assessments are planned for October 2004 and March 2005.
Outcome
Measures:
Pre
and
post
training
knowlegde
assessment;availability of tracer drugs; stocking and supply of insecticide
treated nets; proportion of symptoms properly responded to; and number of
referrals to health facilities.
Results: Findings will report changes in the above indicators following the
intervention. These would include availability of tracer drugs, stocking and
supply of insecticide treated bed nets and percentage changes in response to
presenting illnesses according to the taught protocols including referral to
appropriate public health facilities.
Background
Demographics
source: 2000 census data
Population:
19 Million
Population
Density:
79.3 pers/sq.km
Sex
Locality
Growth Rate:
Male: 49.5%
Female: 50.5%
Rural: 56.2 %
Urban: 43.8%
2.7%
Economic Indicators
GNI per capita
Inflation Rate 2003
Per Capita Health
Spending
Ghana is a tropical country situated in the West Coast of Africa and located between latitudes
4 ˚ & 11˚ North of the equator
$340
23.6%
$8
PHARMACIES
1028
CHEMICAL SELLER 7000
Life Expectancy:
58
Maternal Mortality Rate: 214
HIV Prevalence:
3.8%
Background
The Strategies for Enhancing Access to Medicines
(SEAM) Program was established in 2002 with a
trinity of country-level public-private initiatives to
improve access to essential medicines and
commodities. The three (3) components are:
• Establishing a franchise of chemical seller shops
that provide essential medicines and health supplies;
• Improving pharmaceutical supply and promoting
more appropriate use of medicines in the Mission
sector (Catholic) of Ghana; and
• Strengthening the Pharmacy Council’s capacity to
regulate chemical seller shops in Ghana
Problem Statement
Almost sixty –six (66%)1 of Ghanaians visit the
Licensed Chemical Seller ( LCS) as their first
point of call when accessing health care
services. Yet most have little or no healthcare
background. Additionally LCS are small
individually run operations with high overheads.
This had lead to
• Poor quality service provision by LCS
• Resource- heavy and inefficient operations
leading to high prices.
• Additionally there exist a low level of regulatory
and supervisory visit from the authorities
Objective Questions
The problems raises two questions
• Can we enhance the access to medicines
and improve rational use of medicines by
private sector initiatives?
• Specifically, can the above objectives be
achieved through an essential medicines
franchise in a sub-Saharan African country
with limited resources?
Intervention
• An Essential Medicines Franchise network – branded as
CAREshops was set up in the Volta Region as a pilot The Volta
Region, with its 1.6 m people , is served by only 621(8.8%) and
17(1.5%) of the National 7000 LCS and 1028 Pharmacies 2
• A Structured modular training programme was implemented for
the accredited CAREshop Managers. This was over a 10 week
period with 2 week breaks in between modules.
• A group purchasing program and a logistically sound distribution
network was established by GSMFEL CAREshop Franchisor
• Regular monthly supervisory and mentoring visits were conducted
with the CAREshop
• Periodic impact assessment of programwas is undertaken through
- Review of Records,
- Drug Availability and Affordability surveys,
- Mystery shopping and Field observations .
1. MSH baseline Survey 2000 Ghana
.
2. Pharmacy Council 2002
Methodology & Outcome Measures
• Based on the training needs assessment a Pre
and post training knowledge assessment was
conducted.
• Data was collected on the availability of tracer
drugs in CAREshops
• Level of stocking and supply of insecticide
treated nets– a key indicator in relation to
contemporary initiatives in malaria control were
and prevention in CAREshops were measured
Results 1- Improvement in knowledge
of CAREshop operators
Training Assessment
100
80
98
77
76
86
72
67
before
60
31
40
35
Mging Ailments
Business &
Entrepreneurship
Dev
0
Drug Supply Mgt
20
Introduction to
Franchising
% score > 60
120
after
The number of
LCS obtaining
a 60% basic
score before
and after
training was
measured
This tool will
be reapplied
in Oct
2004and Jan
2005
RESULT 2
Tracer Drug Availability CAREshop Franchise
Tracer Drugs Allowed to Stock
VR N=66
Acetylsalicylic acid tabs 300mg
Franchise Jan
2004 N= 79
All Regions
100.0%
99.6%
100%
Aluminium Hydroxide 500mg
89.4%
80.4%
98%
Amodiaquine 200mg
22.7%
20.0%
34%
Chloramphenicol Eye Ointment
27.3%
30.8%
45%
Chloroquine Tab 150mg
97.0%
94.4%
100%
Chlorpheniramine 4mg Tab
78.8%
68.8%
100%
Condoms
97.0%
94.4%
100%
Ferrous Sulphate/Fumarate 200mg Tab
62.1%
56.4%
98%
Ibuprofen 200mg Tab
86.4%
76.4%
100%
Oral Rehydration Salt
89.4%
92.4%
100%
100.0%
96.8%
100%
Secure
86.4%
84.0%
90%
Sulfadoxine/Pyrimethamine tab 500mg/25mg
68.2%
63.2%
100%
3.0%
1.6%
7%
Paracetamol tab 500mg
Treated Bednets
Average % for Tracer Drugs
70.0
67.3
Availability of 15 tracer drugs (franchise to non franchise :70% to 83%
Availability of ITN (franchise to non franchise : 3% to 7%
83.7%
Discussion
• Measurable improvement noted in medicine supply and use by
CAREshops especially through the established group purchasing
and distribution system
• Increase in knowledge and practice level of Franchise Chemical
Sellers observed
• Observations of the current interventions also show that working
with the private sector requires an understanding of the motivations
of private sector providers
These motivations include, but in most cases are not limited to
– financial benefits
– image enhancement
– increased skill and competence leading to increased
commitment to proper sale and supply of medicines
Conclusion
• Private sector initiatives can improve
access to medicines
• Franchising of essential medicine
suppliers provides opportunity for training,
improvement in service delivery and cost
of reduction in supply chain
• Regular monitoring and an understanding
of the motivation private sector providers
is essential for success
Next Steps …..
 Conclude and Implement Access dimensions for evaluation
 Evaluation to measure the CAREshop Program impact on
* Quality of Dispensing (communication and
counseling)
* Quality of Stocked products
* Appropriateness of Recommendations
* Affordabilty and availabilty of essential medicines
* Acceptabilty /satisfaction with the CAREshop outlets

Assess the enablers and constraints of the franchise program
implementation
Post intervention regional assessment planned for October 2004
and March 2005