3rd Partners Meeting on Better Medicines for Children · Tanzania medeor 4 14 13 Uganda UPMB 89 14...
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www.epnetwork.org 3rd Partners Meeting on Better Medicines for Children Update Ecumenical Pharmaceutical Network / EPN Albert Petersen Difäm - Tübingen EPN board chair November 2011
Transcript of 3rd Partners Meeting on Better Medicines for Children · Tanzania medeor 4 14 13 Uganda UPMB 89 14...
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3rd Partners Meeting on
Better Medicines for Children
Update
Ecumenical Pharmaceutical Network / EPN
Albert Petersen
Difäm - Tübingen
EPN board chair
November 2011
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Hospitals schools etc
1 Cameroon CBC 30 15
2 Chad Koyom 8
3 Ethiopia ECS 20
4 Ghana CHAG 49
5 Kenya MEDS 140 20
6 Liberia CHAL 12
7 Malawi CHAM 56
8 Namibia CHS 12
9 Nigeria CHAN—Medi 70
10 Sierra Leone CHASL 25
11 South-Africa St. Mary Hospital 1
12 Tanzania MEMS 95 100
Tanzania medeor 4 14
13 Uganda UPMB 89
14 Zambia CHAZ 43
15 Zimbabwe ZACH 111
16 India CMAI ( 439)
Altogether:
1204 Hospitals
16 Countries
2088 times 3 books
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EPN Surveys:
Access to CM in Health Facilities
Kenya / Uganda / Chad / Ghana
(more to follow if funds available)
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Multi-country study
on availability and pricing of
selected childrens medicines
in FBO-Drug Supply Organisations
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Participating 12 DSOs
Abbreviation Name Country
BUFMAR Bureau des Formations Médicales Agréés du Rwanda Rwanda
CBC Cameroon Baptist Convention Cameroon
CDC Catholic Drug Centre Ghana
CDMU Community Development Medical Unit India
CHAM Christian Health Association of Malawi Malawi
CHAN Christian Health Association Nigeria Nigeria
CHAZ Christian Health Association Zambia Zambia
JMS Joint Medical Store Uganda
MEDS Mission of Essential Drugs and Supplies Kenya
MEMS Mission for Essential Medical Supplies Tanzania
PEK Pharmacie Evangélique de Koyom Chad
PCC Presbyterian Church in Cameroon Cameroon
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Pharmac. trained staff: from 1 to 26
Price list based on NML 11 (12)
Medicine offered from 43 to 412
Customers from 25 to 2000
Exporting 3 (12)
Value of medicines from 88.000
2010 € to 13.000.000
Differences between12 DSOs
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18 key medicines – 30 dosage forms
Core WHO EMLc 2011
Available?
- in line with National Medicine List?
-Standard Treatment Guidelines?
Price?
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Country National Medicine List Standard Treatment Guideline
Cameroon 2001 ?
Chad 2004 ? Ghana 2010 2010
India 2011 ?
Kenya 2009 2002
Malawi 2009 2009 Nigeria 2003 2008
Rwanda 2010 2007
Tanzania 2007 2007
Uganda 2007 2010
Zambia - ?
Challange: Lists / Guidelines outdated
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Country DSO Theoretically
available
Theoretically
available [%]
Classification
Cameroon CBC 15 83,33 High
Cameroon PCC 17 94,44 High
Chad PEK 10 55,56 Fairly high
Ghana CDC 10 55,56 Fairly high
India CDMU 11 61,11 Fairly high
Kenya MEDS 16 88,89 high
Malawi CHAM 8 44,44 Low
Nigeria CHAN 12 66,67 Fairly high
Rwanda BUFMAR 11 61,11 Fairly high
Tanzania MEMS 12 66,67 Fairly high
Uganda JMS 18 100,00 high
average 12,73 70,71
Availability accoring EMLc 2011
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Country DSO Theoretically
available
% Classification
Cameroon CBC 10 (11) 91,00 High
Cameroon PCC 11 (11) 100,00 High
Chad PEK 8 (10) 80,00 Fairly high
Ghana CDC 12 (15) 80,00 Fairly high
India CDMU 12 (16) 75,00 Fairly high
Kenya MEDS 14 (16) 88,00 high
Malawi CHAM 10 (14) 71,00 Fairly high
Nigeria CHAN 9 (12) 75,00 Fairly high
Rwanda BUFMAR 9 (13) 69,00 Fairly high
Tanzania MEMS 12 (14) 86,00 High
Uganda JMS 15 (15) 100,00 High
total 83,18
Availability accoring present NEML
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Availability acc. WHO-EML and NML
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“Integrated Management of Childhood Illness”
Country DSO ORS Zinc sulphate Treatment possible?
Cameroon CBC √ - No
Cameroon PCC √ - No
Chad PEK √ √ Yes
Ghana CDC √ - No
India CDMU √ - No
Kenya MEDS √ √ Yes
Malawi CHAM √ - No
Nigeria CHAN √ - No
Rwanda BUFMAR √ - No
Tanzania MEMS √ - No
Uganda JMS √ √ Yes
Total 11 3 3
Treatment possible according
IMCI guidelines?
Diarrhoea
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Country DSO Cotrimoxaz
ol
Ampicillin Gentamicin Ceftriaxone Treatment possible?
Cameroon CBC √ √ √ √ Yes
Cameroon PCC √ √ √ √ Yes
Chad PEK √ √ √ √ Yes
Ghana CDC - √ √ √ No
India CDMU √ √ √ √ Yes
Kenya MEDS √ - √ √ No
Malawi CHAM √ √ √ √ Yes
Nigeria CHAN - - √ √ No
Rwanda BUFMAR √ √ √ - No
Tanzania MEMS √ √ √ √ Yes
Uganda JMS √ √ √ √ Yes
Total 9 9 11 10 7
Treatment possible according
IMCI guidelines?
Pneumonia
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Treatment possible according
National Guidelines?
Pneumonia
Ghana
2010
Kenya
2009
Rwanda
2007
Uganda
2010
Tanzania
2007
Malawi
2009
Nigeria
2008
Amoxicillin
< 2 month:
Penicillin+Gentam
icin Amoxicillin Cotrimoxazol Cotrimoxazol Amoxicillin Amoxiclav
Treatment possible possible possible possible possible possible possible
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High availability
Offered by all DSOs
• Amoxicillin oral liquid 125mg/5ml//50mg/5ml
• Amoxicillin solid oral dosage form 250mg/500mg
• Oral Rehydration Salt
• Gentamicin Injection 10mg/20mg/40mg/80mg
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High availability
Offered by 9/11 DSOs
• Ciprofloxacin tablets 500mg
• Cotrimoxazol tablets 120mg/480mg
• Ampicillin powder for injection 500mg/1g
• Benzylpenicillin powder for injection 600mg/3g
• Ceftriaxone powder for injection 250mg/500mg/1g
• Phenoxymethylpenicillin tablets 250mg
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Fairly High availability
• Amoxicillin + Clavulanic acid tablets 375mg/625mg 6/11DSOs
• Procainbenzylpenicillin powder for Injection 1g/3g 6/11 DSOs
• Cotrimoxazol oral liquid 240mg/5ml 8/11 DSOs
• Artemether Oily Injection 40mg/80mg//ml 6/11 DSOs
• Artemether + Lumefantrine 20mg + 120mg tablets 7/11 DSOs
• Doxycycline caps/tabs 100mg 7/11 DSOs
• Sulfadoxine + Pyrimethamine tablets 500mg+25mg 8/11 DSOs
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Low availability
• Amoxicillin + Clavulanic Acid oral liquid various dasoages
–> 4/11 DSOs
• Ciprofloxacin solution for IV infusion2mg/ml 4/11 DSOs
• Artemether + Lumefantrine dispersible tablets
20mg+120mg 4/11 DSOs
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Low availability
• Artesunate Injection 1/11 DSOs
• Artesunate rectal dosage form 1/11 DSOs
• Artemisinin combination tabs 4/11 DSOs
• Zinc sulphate tablets 20mg 3/11 DSOs
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Ratio of the DSO price to MSH median price
Generic name/dosage
MSH
me
dia
n p
rice
€ p
er
un
it in
20
10
BU
FMA
R
CB
C
CD
MU
MED
S
MEM
S
JMS
CD
C
CH
AM
CH
AN
PEK
me
dia
n r
atio
pe
r m
ed
icin
es
Amoxicillin 125mg/5ml Sus 0,003 1,848 2,394 0,758 0,667 0,879 0,727 1,212 1,242 1,182 17,727
1,197
Amoxicillin 250mg tab 0,014 1,007 1,589 3,794 0,667 1,184 0,539 0,872 1,383 1,596
1,184
Amoxicillin 500mg tab 0,024 0,602 1,906 3,893 0,770 1,873 1,176 1,344
1,344
Ampicillin 1000mg Injection 0,128 1,255 2,267 1,697 0,835 1,653
1,653
Ceftriaxone 1000mg Injection 0,292 5,438 1,329 1,780 0,993 3,340 1,635 8,769 2,611
2,196
Ciprofloxacine 500mg tab 0,024 1,295 5,068 3,924 0,907 0,755 0,523 2,025 3,540 1,806
1,806
Cotrimoxazol 240mg/5ml Sus 0,002 2,286 4,143 1,000 1,381 0,905 1,000 1,952 2,000 2,476
1,952
Cotrimoxazol 480mg tab 0,007 1,056 1,549 1,338 0,803 0,972 0,831 1,408 1,127 0,887 1,521
1,092
ORS 1l 0,035 2,740 3,571 5,949 2,103 0,903 1,786 1,737 3,229 9,383
2,740
Phenoxymethylpenicillin
250mg tab 0,011 1,252 2,937 0,739 0,946 0,784 1,180 1,423 1,577
1,216
Doxycyclin 100mg cap 0,010 0,865 2,663 1,288 0,712 0,923 0,721 0,673 1,212
0,894
Max. 2,740 5,438 5,949 1,329 2,103 0,993 3,340 1,952 8,769 17,727 2,740
Min. 0,603 1,549 0,758 0,667 0,714 0,523 0,835 0,673 0,887 1,191 0,894
Median 1,254 2,663 3,794 0,770 1,078 0,784 1,408 1,313 1,510 1,806 1,344
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Stock-Outs I
In 10 out of 11 participating DSOs stock-outs occured
0
1
2
3
4
5
6
7
CDC CBC CHAN JMS MEMS Koyom PCC MEDS BUFMAR CHAM CDMU
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Way forward:
> Filling the gaps
> Moving prices further down, e.g.pooled procurment
> Strengthening networking/information among DSOs
and between DSOs < >facilities
> Strenghtening DSOs by using them
