Improving Access to Essential Medicines

through Public-Private Initiatives:

The Case of the Catholic Pharmaceutical Service

in Ghana

Background Faith-Based organizations in Ghana

Provides 40% of all health services in Ghana Catholic Health Service, the largest body

provides 75% of mission sector health delivery Catholic Health Services

Delivered through 31 hospitals, 66 clinics & maternity homes, 4 drug supply depots,

Situated mostly in rural areas in 18 autonomous dioceses

Access problems identified Availability - drugs out of stock 35% of time Affordability - Nearly a fifth of daily wage

required to treat adult malaria in mission sector

Rational use - average of 5 items on a prescription

Project Objectives

Improve capacity of Catholic Pharmaceutical Service to achieve better pricing and more reliable supply service

Improve quality of prescribing and dispensing services by promoting the rational use of drugs

Key Interventions Advocacy to get buy-in and

consensus agreement on approaches for interventions

Baseline Survey on access dimensions of availability, affordability, quality of services

Re-engineered existing structures for pooled procurement system

Restricted competitive bidding as a means of procurement

Training in inventory management for facilities committed to pooled procurement

Interventions

Trained a team of 4 health professionals from each of 5 hospital on promoting RDU at health facility level using Drugs and Therapeutic Committees, in a ‘learn and do’ cyclic approach

Adapting training

Material – Local &

Int’l Experts

Selection of Facilities

and DTC team

Training( 2-days)

ImplementationAnd Follow-up

in Health Facility

(8 weeks)

Catholic Health Service DTC Design‘Learn & do’ Cyclic Approach

Key Milestones

Procurement of essential drugs by tender has been instituted. First Tender for 20 items yielded an

average of 20% savings on price

DTC established in five facilities Has specific mandate to promote

the rational use of drugs

Lessons Consensus building on implementation

approaches critical for success Prequalifying suppliers assures quality

of products supplied Procurement by tender provides

significant savings “Learn and do” cyclic approach to

delivering DTC training effective in imparting skills to overburdened health professionals

Implications1. Building Capacity and Structures

for sustainable implementation of Program

Maintenance, sustainability vrs staff attrition

Providing Technical Assistance vrs Capital Investments

Ownership of program and commitment of implementing partner

Implications2. Pooled Procurement Systems

Ability to enforce requirements of tender contracts

Supplier’s Delivery of Goods on schedule vrs Client’s Payment for Goods on time

Timely information flow for forecasting, procurement, payment and delivery decisions

3. DTC Program Training

Skill development vrs information dissemination

Credible Expert Trainers, local/international Providing support for institutional work

Future Studies

How to build capacity for sustainable implementation of programs

Ensuring equitable pricing of essential medicines

The effectiveness of DTCs as a vehicle for promoting RDU