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Procuring Single-Use Injection Equipment and Safety Boxes: A Practical Guide for Pharmacists, Physicians, Procurement Staff and Programme Managers
Geneva, Switzerland, World Health Organization [WHO], 2003 May 5. (WHO/BCT/03.04)The objective of this guide is to accompany pharmacists, physicians, procurement staff and programme managers through the process of procuring single-use injection equipment and safety boxes of assured quality, on a national or international market, at reasonable prices. International organizations have established standardized procurement procedures for medicines and medical devices. This guide describes how these procedures can be used to ensure the procurement of injection equipment and safety boxes. Institutions procuring injection equipment need to develop a list of manufacturers that are prequalified on the basis of certain criteria which include international quality standards. This guide provides steps and tools for procurement, including a pre-qualification procedure of injection equipment for purchase. Developing a monitoring system for supplier performance will improve and safeguard the quality of injection equipment selected and prevent or eliminate unreliable suppliers.
Bethesda, Maryland, Center for Human Services, Quality Assurance Project, 2002 Feb. 16 p. (Operations Research Results; USAID Contract No. HRN-C-00-96-90013)Private drug outlets have grown increasingly important as the main source of malaria treatment for residents of malaria endemic areas. Unfortunately, the quality of information and the quantity and quality of drugs provided is often deficient. The World Health Organization has included the private sector in its Roll Back Malaria strategy, but has noted that it is notoriously difficult to change private sector practices without burdening the governments of developing countries. In the Bungoma district of Kenya, the Quality Assurance Project (USA) teamed up with the Bungoma District Health Management Team and African Medical and Research Foundation to test an innovative, low-cost approach for improving the prescribing practices of private drug outlets. The intervention, called Vendor-to-Vendor Education, involved training and equipping wholesale counter attendants and mobile vendors with customized job aids for distribution to small rural and peri-urban retailers. The job aids consisted of: (a) a shopkeeper poster that described the new malaria guidelines, provided a treatment schedule, and gave advice on the appropriate actions to take in various scenarios; and (b) a client poster that depicted the five approved malaria drugs and advised clients to ask for them. The training of wholesalers began in April 2000. (author's)
Rational Pharmaceutical Management Plus. GDF / MSH Drug Management Consultant Training Workshop in Vietnam: trip report.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Nov 11. 12 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-076; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)More than eight million people become sick with Tuberculosis (TB) each year. TB continues to be a major international killer disease because of poor access to effective high quality medicines, irrational treatment decisions and behaviors, and counterproductive financial priorities by some national health systems that impede progress. Access to TB medicines is becoming less of a problem as both first and second-line TB treatments are made available to developing countries through global initiatives such as the Global TB Drug Facility (GDF) and the Green Light Committee (GLC) of the World Health Organization's (WHO) Stop TB department in Geneva. Since 2001 Management Sciences for Health (MSH) through the USAID-funded Rational Pharmaceutical Management Plus (RPM Plus) program has collaborated with Stop TB to promote better overall TB drug management by GDF and GLC secretariats and by national TB control programs. RPM Plus activities include technical assistance to the GDF and the GLC to develop program monitoring tools, conduct TB program monitoring missions to recipient countries of GDF drugs, audits of monitoring missions conducted by partner organizations and training workshops on TB pharmaceutical management. GDF and GLC secretariats operate with minimal staffs and both depend greatly on partner organizations to carry out the necessary in-country work to make sure TB medicines are received, distributed and used according to guidelines. The number of countries receiving GDF and GLC support is ever increasing requiring even more assistance from partner organizations like MSH/RPM Plus. (excerpt)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct. 13 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-075; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)USAID, through its SO5 TB global objective, promotes TB pharmaceutical management activities through the RPM Plus program. The global activities support the DOTS scheme, a WHO initiative, documented to break the transmission of TB when implemented correctly by national TB programs (NTP). One of the five primary elements of the DOTS scheme is an uninterrupted supply of TB drugs. RPM Plus provides technical assistance to the following WHO/Stop TB organizations: The Global TB Drug Facility (GDF): established in 2001 to provide free grants of TB medicines to countries unable to satisfy their medicine needs and to serve as a source of good quality TB drugs for those countries having their own funds; The Green Light Committee (GLC): technical support group for the DOTS Plus program. Initiated by the WHO and its partners to promote the correct treatment of multi-drug resistant (MDR) TB. The GLC makes medicines available to countries at affordable prices. As part of the global support RPM Plus also provides training in Pharmaceutical Management for TB at various World Health Organization consultant-training courses promoted by the Stop TB Department. (excerpt)
Rational Pharmaceutical Management Plus. Workshops on TB pharmaceutical management: trip report, Sondalo, Italy and Tbilisi, Georgia, July 6-17, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Jul 31.  p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-073; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)A regular supply of TB medicines is one of the main components of the DOTS and DOTS Plus schemes. RPM Plus contributes to these schemes through facilitation of training workshops in collaboration with other TB partners. In July 2005 RPM Plus participated in two training activities for pharmaceutical management of tuberculosis in Sondalo, Italy in collaboration with World Health Organization and in Tbilisi, Georgia in collaboration with GOPA/German Development Agency. There were 12 participants in the Sondalo workshop and 9 participants in the Tbilisi workshop representing the entire Caucasus region. (author's)
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005 Oct 27. 19 p. (USAID Development Experience Clearinghouse DocID / Order No: PD-ACH-068; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)Many national TB programs continue to encounter problems in providing quality TB medicines to patients when they need them. While lack of financial resources may be one constraint for procuring all TB medicines needed, national programs experience a host of other problems in pharmaceutical management. Strong pharmaceutical management is one of the key pillars to effective tuberculosis (TB) control; without appropriate selection, effective procurement, distribution, stock management and rational use of TB medicines and related supplies, individuals will not be cured of the disease and countries will not reach global targets. Management Sciences for Health's Rational Pharmaceutical Management Plus (RPM Plus) program funded by USAID in collaboration with Stop TB Partnership's Global TB Drug Facility (GDF) housed at World Health Organization (WHO) Geneva conducted a workshop at the 36th International UNION World Congress on Tuberculosis and Lung Health on October 19th 2005 at Paris, France. This is the fourth year MSH and GDF have collaborated in such an event at the UNION congress due to popular demand by national TB programmes and their partners. (excerpt)
Over-the-counter access, changing WHO guidelines, and contraindicated oral contraceptive use in Mexico.
Studies in Family Planning. 2006 Sep; 37(3):197-204.This study examines the prevalence of contraindications to the use of oral contraceptives in Mexico by sociodemographic characteristics and by whether this family planning method was obtained with or without a doctor's prescription. Using data on smoking behavior and blood-pressure measurements from the 2000 Mexican National Health Survey, the authors found that, under the 1996 World Health Organization (WHO) medical eligibility guidelines, the prevalence of contraindications is low and that no significant differences in contraindications exist at any level between those who obtain oral contraceptives at clinics and those who obtain them at pharmacies. In 2000, however, WHO substantially revised its criteria regarding the level of hypertension that would constitute a contraindication for oral contraceptive use. Applying the new guidelines, the authors found that 10 percent of pill users younger than 35 and 33 percent aged 35 and older have health conditions that are either relative or absolute (Category 3 or 4) contraindications. The relevance of these findings to the larger debate concerning screening and over-the-counter access to oral contraceptives is discussed. (author's)
Geneva, Switzerland, WHO, Division of Diarrhoeal and Acute Respiratory Disease Control, 1994 Nov. 3 p. (Update No. 18)If diarrhoea in children is to be managed correctly, there is need to look beyond public sector health facilities. Good management has to be promoted in the home, and there is also a need to improve the practices of all providers of care, particularly in the private sector. Retail drug businesses are particularly important providers of care because: in most countries, pharmacies and over-the-counter drug stores are widely distributed geographically; they are the most frequently visited of all health-related facilities; for purposes of training, drug retail outlets are relatively easy to reach; products sold and advice given to customers for treating diarrhoea are generally inappropriate and, in some cases, dangerous. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], Essential Drugs and Medicines Policy Interagency Pharmaceutical Coordination Group, 1999.  p. (WHO/EDM/PAR/99.5)The aim of this document is to improve pharmaceutical procurement practices in countries served by the IPC members. These operational principles for good pharmaceutical procurement are not meant to regulate activities of international agencies, sovereign governments or private companies. They are presented strictly as a set of principles which can be reviewed and adapted by individual governments and public or private organizations in the process of developing their own internal procurement procedures. These objectives and principles are published by WHO’s Department of Essential Drugs and Medicines Policy (EDM) on behalf of the IPC, after an extensive review by experts from international agencies, governments, the pharmaceutical industry, essential drugs supply agencies and universities. Pharmaceutical procurement occurs in many contexts. Although the operational principles presented here are in many respects applicable to all procurement settings and for most types of procurement situations, their primary target is pharmaceutical procurement for public sector health systems. It is recognized that public sector procurement may be managed in a variety of ways, ranging from total in-house systems, through various autonomous or semi-autonomous procurement agencies, to total privatization. These principles are applicable to each of those variations. The document is composed of four chapters. Chapter 1 consists of a brief problem statement which illustrates the need for improvements in procurement practices. Chapter 2 presents the four strategic objectives of pharmaceutical procurement which apply to any health system, whether it is public or private. Chapter 3 presents twelve operational principles for good pharmaceutical procurement, grouped into four categories (management; selection and quantification; financing and competition; supplier selection and quality assurance). Chapter 4 gives more information on the practical implementation of the twelve principles and some useful information on mechanisms to further improve the performance of the procurement system. A section of references and further reading is also included. (excerpt)
Geneva, Switzerland, WHO, . 28 p. (WHO/CDD/SER/87.11)This manual provides an overview of the nature of acute diarrhea and its treatment, especially through the use of oral rehydration therapy (ORT), for pharmacists in developing countries. The composition of oral rehydration sales (ORS) is covered as is how to treat dehydration with ORS solution and how to prevent dehydration. The booklet also stresses that antimicrobial and antidiarrheal agents are not recommended for the routine treatment of acute diarrhea. The information presented in the main text is then reviewed in a series of questions and answers, and the World Health Organization's Diarrhoeal Disease Control Programme is described. Finally, a series of guidelines suggest that pharmacists: 1) persuade mothers to use ORT when necessary, 2) supply ORS packets and ensure that mothers know how to prepare and use the solution, 3) prepare ORS solutions in the pharmacy on a daily basis if packets are not available, 4) explain to mothers how household food solutions or sugar/salt solutions can be used to prevent dehydration, 5) persuade mothers not to purchase expensive and ineffective medication, 6) ensure that all cases of severe diarrhea and dehydration are taken to an appropriate health facility, 7) give advice on ways to prevent diarrhea, 8) participate fully in the diarrheal diseases control program of their country, and 9) advocate the teaching of ORT in pharmacy schools and continuing education programs.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. , 10,  p. (USAID Contract No. DPE-5969-00-7064-00)A visit was made to Uganda to meet with the oral rehydration solution (ORS) promotion committee to review on ORADEX sales targets, formulate regional sales goals based upon current national sales targets, and discuss product distribution concerns; to draft a document with Medipharm, ARMTRADES, and Media Consultants to review the effectiveness of promotional materials; to meet the PRITECH representative and coordinate the supervision of promotional communications between Medipharm, ARMTRADES, and Media Consultants; to meet with USAID/KAMPALA to determine the status of additional monies and provide an update on current project status; and to meet with UNICEF and review roles for continued interaction on the ORS promotional program between USAID/Kampala, UNICEF, and Medipharm. 90,837 sachets of ORADEX were sold through the end of January, 1992; above the target of 79,000. ARMTRADES, however, sold only 42,741 of its 60,000 target, while Medipharm sold 48,096 sachets; substantially more than its 19,000 target. Medipharm expressed concern over ARMTRADES' weak ability to distribute amd market ORADEX, despite ARMTRADES' claim that its sales efforts are being undermined by freely available UNICEF sachets. In response, PATH worked to improve the operational efficiencies of both Medipharm and ARMTRADES. Medipharm's present transportation facilities and institutional capabilities are insufficient to allow it to handle national distribution independently. For now, it must rely upon ARMTRADES to distribute and market ORADEX. Moreover, Medipharm needs continued supervision to properly manage distributor relations to ensure that distributors receive timely and accurate invoices, monthly statements, and payment due notices. These steps combined with accurate production and inventory planning will eventually provide Medipharm with sufficient experience to distribute and maintain stock on its own. Otherwise, the promotion committee suggested revisions for new materials future support and sales personnel and pharmacist training were discussed; and reports were cited which indicate that ARMTRADES is doing well distributing and marketing condoms through a parallel social marketing program.
[Mission report: review of the Programme National de Lutte contre les Maladies Diarrheiques] Rapport de mission: revue du Programme National de Lutte contre les Maladies Diarrheiques.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1992. 13 p. (USAID Contract No. DPE-5969-Z-00-7064-00)The National Program of Combatting Diarrheal Disease stated in 1986, and a document proposed activities in Burkina Faso for 1986-90. UNICEF's help was essential when staff recruiting and oral rehydration therapy was popularized. USAID also provided management and planning aid by means of the project PRITECH. The major donors are WHO, UNICEF, and USAID. Coordination with nongovernmental organizations (NGOs) engaged in primary health care was also stressed including GTZ, la Cooperation Francaise, Save the Children, and AFRICARE. UNICEF is active in 11 provinces and PRITECH in 8 in oral rehydration. National standards for oral rehydration salt (ORS) preparation, feeding of diarrhetic children, and legal problems need to be addressed regarding the strategy of decentralization. The distribution of ORS by the free-of-charge public system since 1985 has been carried out by the central store of the pharmaceutical services directorate. The paying system consists of private pharmacies that acquire the medicaments from wholesalers or from SONAPHARM, the National Pharmaceutical Society. They are obliged to sell at a maximum markup of 130% to the public: 6 of 12 pharmacies did not have ORS in the capital. The supervision of the program consists of the central oversight over provincial health directors who supervise the medical centers and health centers who in turn supervise the primary health centers. The health information direction of studies and planning collect data for the Ministry of Health and Social Action. Recommendation regarding planning, management, and coordination pertain to a definitive document for 1992-96; annual plans; reestablishment of a technical committee; and national policies on ORS acquisition, sales, and distribution including the maintenance of a reserve stock. Standardized provincial level supervision and a household survey are also recommended.
Oxford, United Kingdom, OXFAM, 1982. 277 p.Third World countries face foreign domination of their drug markets, a glut of overpriced and unnecessary medicines, a short supply of essential drugs, technical obstacles to local production, unethical promotion techniques, and inadequate warnings about the side effects of certain drugs that may be banned in the developed world. However, a number of small-scale grass roots projects are attempting to redress this situation. For example, Gonoshasthaya Kendra (People's Health Center) in rural Bangladesh operates a pharmaceutical factory which manufactures inexpensive, essential generic drugs. Profit margins are set lowest on drugs considered most useful, and research and development are tailored to local needs. In addition, countries such as Sri Lanka and Mozambique have adopted comprehensive national drug policies that give priority to essential drugs for primary health care. To make the benefits of modern medicine more available to the poor, Third World governments must prioritize preventive and primary health care services and reallocate resources to the poor majority. National drug policies should include identification of essential drugs, compulsory use of generic names, balanced drug information sheets for prescribers and patients, establishment of an efficient public sector drug distribution system, controls on private distribution, and strict curbs on promotion. Medical training should be rooted in social and economic realities so health workers become oriented toward prevention. Also, the schools, mass media, and community organizations should be used to challenge people's dependence on drugs. The success of new drug policies requires the support of the major drug producing nations. These nations should increase their financial support to UN programs aimed at the needs of developing countries and should not obstruct the World Health Organization in its work on an international code of drug marketing practices. Nongovernmental agencies should publicize examples of constructive policy initiatives and continue to fund community health projects that avoid high technology options. The major transnational drug companies should be consistent in the standards they apply, regardless of loose controls in developing countries, and should demonstrate social responsibility by not creating a demand for nonessential preparations.
Bulletin of the Pan American Health Organization. 1983; 17(2):201-3.A field study to ascertain the status of drug delivery systems for primary health care centers in Latin America was conducted by the Pan American Health Organization (PAHO) in 1980-81. Countries studied included Bolivia, Ecuador, Peru, Honduras, Panama, and the Dominican Republic. The planning and purchasing functions of the drug distribution systems were found to be highly centralized, failing to take local morbidity patterns or drug demand levels into account. Storage areas lacked adequate equipment and were poorly designed. Personnel were insufficiently trained and were found to ignore procedures regarding the handling of damaged or expired drugs. Also noted was a lack of adequate equipment for transporting medicines to rural clinics. A widespread characteristic was the lack of formal supervision and control (excluding fiscal) at national, regional, and local levels. Many essential drugs were unavailable at the local level, and formulations with unjustified associations and products for which there are more advantagous substitutes were found. These results were presented at the PAHO-sponsored Regional Workshop on Administration and Supply of Essential Drugs held in 1981. The workshop made 5 recommendations to governments: 1) every national health plan should include a national drug policy; 2) the drug policy should encompass a registry of all drugs sold, a list of essential drugs by level of care, quality control measures, educational activities for personnel, proper financing, and an evaluation methodology; 3) an integrated system for managing drug distribution should be designed; 4) information on essential drugs, legislation, pricing, and quality control should be exchanged among regions; and 5) centers should participate in the WHO-developed quality certification system. In addition, it was recommended that PAHO should: 1) participate in developing a system of regional cooperation, 2) identify regional centers for training personnel in the management of drug distribution systems, 3) stimulate development of training programs, and 4) support operational research on drug distribution systems.