Update on MIS Reporting for RPM Plus Rwanda, October 2005 ... · Update on MIS/M&E/Reporting for...

Update on MIS Reporting for RPM Plus Rwanda, October 2005 Draft Report (not for wide distribution)

Rational Pharmaceutical Management Plus Center for Pharmaceutical Management Management Sciences for Health 4301 N. Fairfax Drive, Suite 400 Arlington, VA 22203 Phone: 703-524-6575 Fax: 703-524-7898 E-mail: [email protected]: www.msh.org/rpmplus

mailto:[email protected]

http://www.msh.org/rpmplus

Update on MIS/M&E/Reporting for RPM Plus Rwanda (October 2005) In Rwanda, the Global Fund reporting format does not include specific indicators for ARV drugs management. The HIV/AIDS-related drug management information that is collected by RPM Plus (in collaboration with the MOH) relate to stock level of ARVs at ART sites, number of persons treated and regimens used. Development, Production and Distribution of ARV drugs SOP and Forms RPM Plus in collaboration with the Ministry of Health (Direction of Pharmacy, TRAC) developed SOP to guide the use of different tools for tracking ARV drugs use and inventory management at facility level (and store level where applicable). The SOP and forms are now used at national level in a total of 75 sites (GF, PEPFAR, MSF, private sites). The initial set of SOPs, Forms and Register Books are printed by RPM Plus and made available to all the ART sites after training the staff in their use. Forms included in the SOP The key tools for data capture are:

• Fiche de réquisition et livraison des ARV (ordering and receiving form): This form contains information on stock on hand at the site, quantity estimated by the site; and on another form, quantity estimated by Camerwa (the central medical store) for the site and quantity distributed to the site.

• Fiche d’information sur les patients (ARV drugs and patient information sheet): This form contains information on numbers of patients on ARVs, numbers of patients on specific regimes, and site target growth (patients to be enrolled) for the 3 following months

• Rapport mensuel de consommation des ARV (Monthly activity report) : Contains information on quantity in stock at the 1st day of the month reported, quantity received and dispensed during the month, quantity returned to Camerwa, quantity of drugs expired and expired date.

• Retour de stock (Stock return sheet) • Fiche de stock ARV (Stock movement/bin/stock cards) • Fiche de contrôle de température (Temperature control sheet) • Bon de réquisition et livraison interne (internal ordering and receiving form) • Registre de consommation journalier (Dispensing Register) • Fiche des ARV périmés (Expiry and damage inventory sheet) • Fiche d’inventaire (Inventory sheet) • Procès verbal de péremption (Minutes for expired ARV) • Manuel de quantification des ARV (Quantification manual for ARV at facility

level)

Others tools used at ART sites: There are other tools used at sites not developed by RPM Plus Rwanda but implemented by MOH, for example: • Dossier médical du patient (Patient card): it contains information on patient

profile, weights, names, sex, age, regime, drug schedule/appointment, adverse drug reaction.

• Ordonnance médical (Prescription card) The 2nd and 3rd SOPs are what ART sites submit monthly to TRAC/ MOH. The 1st SOP is submitted by ART sites to CMS (Camerwa) quarterly when ART sites come for the requisition.

The following pages included different forms used by RPM Plus Rwanda.

FICHE D'INFORMATION SUR LES PATIENTS

Nom de la FOSA: ….…………………………….. Mois rapporté (M): …………………..

Programme d'appui: …………………………….. Année: ……………….………………..

District sanitaire: ………………….…………….. Province: ………..………………………………..

Nombre de patients sous

ARVs au dernier jour

du mois rapporté

Nombre de patients à enroler le 1er mois suivant

le mois rapporté

Nombre de patients à enroler le 2ème mois

suivant le mois rapporté

Nombre de patients à enroler le 3ème mois

suivant le mois rapporté

(M = mois rapporté) (M+1) (M+2) (M+3)

Régimes

A B C D NOMBRE TOTAL DE PATIENTS

Adultes et enfants sous comprimés

Enfants sous sirop/suspension buvables

Régimes de première ligne

1 Stavudine (30) /Lamivudine/Névirapine

2 Stavudine (40) /Lamivudine/Névirapine

3 Zidovudine/Lamivudine/Névirapine

Changement

1

2

3

4

5

6 Régimes de deuxième ligne

1 Tenofovir /Didanosine (250) /Kalétra

2 Tenofovir /Didanosine (250) /Kalétra

3

4

Régimes pédiatriques (sirop/suspensions buvables)

1 Stavudine /Lamivudine/Névirapine

2 Stavudine/Lamivudine/Efavirenz

3 Zidovudine/Lamivudine/Kalétra

4

Préparé par: …..…………………………………. Date: ……………………….

(point focal de la prise en charge)

Fonction au sein de la FOSA: ……….………….

FICHE DE REQUISITION/LIVRAISON DES ARV N°…

(La requisition inclut un mois de stock de sécurité)

Nom de la FOSA:----------------------------------- Numéro de la dernière requisition:---------------------- Mois:------------------------

Année:---------------------- Province:-----------------------------------------------

PRODUIT FOSA

CAMERWA N° Code Désignation Dosage Forme Condit.

unitaire Qté en stock

Qté demandée

Qté estimée

Qté accordée

N° de lot

Date d'expiration

Observations

1 Lamivudine + Stavudine + Névirapine

150+30+200 cé 1 boîte (60 cés)


150+40+200 cé 1 boîte (60 cés)

3 Lamivudine 150 cé 1 boîte (60 cés)

4 Lamivudine + Stavudine 150+30 cé 1 boîte (60 cés)


6 Abacavir 300 cé 1 boîte (60 cés)

7 Zidovudine 300 cé 1 boîte (60 cés)

8 Zidovudine + Lamivudine 300 + 150 cé 1 boîte (60 cés)

9 Stavudine 20 cé 1 boîte (56 cés)



12 Didanosine 200 cé 1 boîte (56 cés)


14 Efavirenz 600 cé 1 boîte (60 cés)



17 Indinavir 400 cé 1 boîte (180 cés)

18 Ritonavir/Ritopnavir (Kalétra) 133,3/33,3 cé 1 boîte (180 cés)

19 Nelfinavir 250 cé 1 boîte (270 cés)

20 Névirapine 200 cé 1 boîte (60 cés)

21 Ritonavir 100 cé 1 boîte (60 cés)

22 Tenofovir 300 cé 1 boîte (30 cés)

23 Lamivudine sirop 10 mg/ml Sirop 1 flacon de …. ml

24 Stavudine pdre suspension 10 mg/ml Pdre susp 1 flacon de …. ml

25 Zidovudine sirop 10 mg/ml Sirop 1 flacon de …. ml

26 Névirapine suspension 10 mg/ml Susp 1 flacon de …. ml

27 Efavirenz sirop 30 mg/ml Sirop 1 flacon de …. ml

28 Abacavir sirop 20 mg/ml Sirop 1 flacon de …. ml

29

REQUISITION TRIMESTRIELLE:

REQUISITION URGENTE:

Préparée par (Fosa) Pour livraison (CAMERWA)

Nom et Prénoms: ……………………………… Nom et Prénoms: ………………………………..

Titre: …………………………………………… Titre: ……………………………………………

Signature et date: ………………………………. Signature et date: ……………………………….

Approuvée par (Fosa) Pour réception (Fosa) Pour réception (Camerwa)

Nom et Prénoms: ……………………………… Nom et Prénoms: ……………………………….. Nom et Prénoms: ………………………………..

Titre: …………………………………………… Titre: …………………………………………… Titre: ……………………………………………

Signature et date: ………………………………. Signature et date: ………………………………. Signature et date: ……………………………….

RAPPORT MENSUEL DE CONSOMMATION DES ARV Nom de la FOSA:----------------------------- Date de soumission du rapport:---------------------- Programme d'appui:-------------------------

Mois rapporté:------------------------

District sanitaire:------------------------------ Année:----------------------

Province:----------------------------------------N° Code Désignation Dosage Forme Condit.

unitaire Qté en stock le 1er jour du mois rapporté

Qté reçue pendant le mois rapporté

Qté dispensée pendant le mois rapporté

Qté retournée pendant le mois rapporté

Perte du mois rapporté (casses, périmés, abimés)

Date d'expiration

Observations


150+300+200 cé 1 boîte (60 cés)


150+40+200 cé 1 boîte (60 cés)

3 Lamivudine 150 cé 1 boîte (60

cés)

4 Lamivudine + Stavudine 150+30 cé 1 boîte (60

cés)

5 Lamivudine + Stavudine 150+40 cé 1 boîte (60

cés)

6 Abacavir 300 cé 1 boîte (60

cés)

7 Zidovudine 300 cé 1 boîte (60

cés)

8 Zidovudine + Lamivudine

300 + 150 cé 1 boîte (60 cés)

9 Stavudine 20 cé 1 boîte (56

cés)


cés)


cés)

12 Didanosine 200 cé 1 boîte (56

cés)

13 Didanosine 50 cé 1 boîte (60

cés)

14 Efavirenz 600 cé 1 boîte (60

cés)


cés)


cés)

17 Indinavir 400 cé 1 boîte (180

cés)

18 Ritonavir/Ritopnavir (Kalétra)

133,3/33,3 cé 1 boîte (180 cés)

19 Nelfinavir 250 cé 1 boîte (270

cés)

20 Névirapine 200 cé 1 boîte (60

cés)

21 Ritonavir 100 cé 1 boîte (60

cés)

22 Tenofovir 300 cé 1 boîte (30

cés)

23 Lamivudine sirop 10 mg/ml Sirop 1 flacon de ….

ml

24 Stavudine pdre suspension

10 mg/ml Pdre susp 1 flacon de …. ml

25 Zidovudine sirop 10 mg/ml Sirop 1 flacon de ….

ml

26 Névirapine suspension 10 mg/ml Susp 1 flacon de ….

ml

27 Efavirenz sirop 30 mg/ml Sirop 1 flacon de ….

ml

28 Abacavir sirop 20 mg/ml Sirop 1 flacon de ….

ml

32 Préparée par (Fosa) Nom et Prénoms: ……………………………….. Titre: …………………………………………… Signature et date: ……………………………….

FICHE DE RETOUR DE STOCK DES ARV A LA CAMERWA N° ………….

Nom de la FOSA:---------------------------------

Programme d'appui:-------------------------------

District sanitaire:----------------------------------

Province:------------------------------------------

N° Code Désignation duproduit

Dosage Forme Condit.unitaire

Qté retournée Référ. de la fiche de Réq

N° de lot Date de péremption

Obsevations

Préparée par (Fosa) Approuvée par (Fosa) Pour réception (CAMERWA)

Nom et Prénom: ……………………………….. Nom et Prénom: ……………………………….. Nom et Prénom: …………………

Titre: …………………………………………… Titre: …………………………………………… Titre: ……………….……………

Signature et date: ………………………………. Signature et date: ………………………………. Signature et date: ……………….

FICHE DE STOCK N° …………………….

Nom de la FOSA:--------------------------------- STOCK DE SECURITE: 1 MOIS


Code du produit:------------------------------------------------

Dénomination, dosage, forme:--------------------------------

Conditionnement:----------------------------------------------

Conditions de stockage:--------------------------------------- DATE ORIGINE/

DESTINATION ENTREE N° DE

LOT DATE D'EXPIRATION

SORTIE SOLDE SIGNATURE OBSERVATIONS

QUANTITE A REPORTER

CONS. MENS.

JANV FEVR MARS AVRIL MAI JUIN JUILL AOUT SEPT OCT NOV DEC

CM

DATE ORIGINE/ DESTINATION

ENTREE N° DE LOT

DATE D'EXPIRATION

SORTIE SOLDE SIGNATURE OBSERVATIONS

CONS. MENS.

JANV FEVR MARS AVRIL MAI JUIN JUILL AOUT SEPT OCT NOV DEC

CM

FICHE DE CONTROLE DE LA TEMPERATURE

Nom de la FOSA:---------------------------------


Province:------------------------------------------

Mois:-------------------------------------------

Annee:---------------------------------- DATE

TEMPERATUREOBSERVATIONS SIGNATURE

7H30 14HOO

BON DE REQUISITION ET DE LIVRAISON INTERNE DES ARV N°…………

Nom de la FOSA:------------------

Service:-------------------------------

Date:----------------------------------

Mois:----------------------------------

Année:-------------------------------- REQUISITION LIVRAISON

N° Code Désignation Dosage Forme Condit. unitaire Qté en stock(petit)

Qté demandée

Qté accordée

Date d'expiration

Observations

1

Lamivudine + Stavudine + Névirapine

150+300+200 cé 1 boîte (60 cés)

2

Lamivudine + Stavudine + Névirapine

150+40+200 cé 1 boîte (60 cés)

3 Lamivudine 150 cé 1 boîte (60 cés)



6 Abacavir 300 cé 1 boîte (60 cés)

7 Zidovudine 300 cé 1 boîte (60 cés)

8

Zidovudine + Lamivudine 300 + 150 cé 1 boîte (60 cés)








16 Indinavir 400 cé 1 boîte (180 cés)

17 Kalétra 133/33 cé 1 boîte (180 cés)

18 Nelfinavir 650 cé 1 boîte (270 cés)

19 Névirapine 200 cé 1 boîte (60 cés)

20 Ritonavir 100 cé 1 boîte (60 cés)

21 Tenofovir 300 cé 1 boîte (30 cés)

22 Lamivudine suspension 10 mg/ml Susp 1 flacon de …. ml

23 Stavudine suspension 10 mg/ml Susp 1 flacon de …. ml

24 Zidovudine suspension 10 mg/ml Susp 1 flacon de …. ml

25 Névirapine suspension 10 mg/ml Susp 1 flacon de …. ml

26 Efavirenz suspension 30 mg/ml Sirop 1 flacon de …. ml

Appouvée par

Pour réquisition Nom et Prenom…………… Pour livraison

Nom et Prénoms: ……………………………….. Fonction :………………. Nom et Prénoms: ………………………………..

FICHE DES CONSOMMATIONS JOURNALIERES DES ARV

FICHE N°

Nom de la FOSA:--------------------------------------

Service:----------------------------------------------Code du produit: -------------------------------------- Dénomination:------------------------------------------ Dosage, forme:----------------------------------------- Condit. Unitaire :-------------------------------------- DATE ENTREE SORTIE SOLDE SIGNATURE OBSERVATIONS QUANTITE CONSOMMEE APRES UN MOIS:

FICHE DES ARV PERIMES ET/OU DETERIORES

Nom de la FOSA:--------------------------------------

District sanitaire:--------------------------------------

Service:- --------------------------------------------- N° CODE DENOMINATION DU PRODUIT EN DCI DOSAGE FORME DATE DE

PEREMPTION OU DE DETERIORATION

QUANTITE OBSERVATIONS

PHARMACIEN DIRECTION DE LA FOSA

Nom et Prénoms Nom et Prénoms

Date et Signature Date et Signature

FICHE D' INVENTAIRE

Nom de la FOSA:--------------------------------- District sanitaire:---------------------------------- Province:------------------------------------------

Date Code Denomination du

produit en DCI Dosage Forme Stock

Theorique Stock Physique

Ecart Date d' expiration

Observations

Celui qui a fait l' inventaire Responsable de la pharmacie Nom et Prénoms………………………. Nom et Prénoms…………………

Date et Signature………………………… Date et Signature………………………

REPUBLIQUE DU RWANDA

PROVINCE DE:

DISTRICT DE SANTE DE :

FORMATION SANITAIRE :

PROCES VERBAL DE PEREMPTION ET/OU DE DETERIORATION DES PRODUITS PHARMACEUTIQUES

Nous, ………………………Gestionnaire de la pharmacie de………..,

avons inventorié les produits périmés et/ou détériores ci-après :

N° Dénomination du produit et

conditionnement Dosage forme Quantité N° de lot Exp. date Référence de la

réquisition Prix unit.

Prix total

1

2

3

4

5

TOTAL

COMMENTAIRES :……………………………

Nous disons une péremption de produits d’une valeur de (en toutes lettres) …………………………………………( en chiffres : )Fait à………………………………….,le……………………………….

Le gestionnaire de la Pharmacie

(Nom et Signature)

Approuvé par le Responsable de la FOSA

.

(Nom et Signature et cachet)

L’an deux mille ……………., le ………... jour du mois de ……………….,

Existing computerization system for ARV drug management The MSH/RPM Plus ART Dispensing Tool is a tool use by the ARV drug dispensers. The tool maintains a record for each of the patients receiving drugs from the dispensing pharmacy. The patient record includes a basic patient profile and the history of drugs dispensed to the patient. The record can be retrieved by the dispensing pharmacist at the time of dispensing. The ART Dispensing Tool also generates reports containing service statistics data and information for facilitating patient follow-up for drug adherence. The system is being piloted in three hospitals (health center, district hospital, referral hospital). RPM Plus provided computers to these facilities to ensure that the facilities will use the tools after the initial training and to facilitate reporting of information monthly to the MOH. Others reports TRAC is also collecting information through the system TRACnet a certain numbers of indicators as well as PMTCT services inside TRAC (MOH).

PROGRAM REPORT 1 Facility 2 Date of Report 3 Total number of pediatric patients (under age 15) who are currently

on ARV treatment?

4 Total number of male pediatric patients who are on First Line Regimen?

5 Total number of female pediatric patients who are on First Line Regimen?

6 Total number of male pediatric patients who are on Second Line Regimen?

7 Total number of female pediatric patients who are on Second Line Regimen?

8 Total number of adult patients (age 15 or older) who are currently on ARV treatment?

9 Total number of male adult patients who are on First Line Regimen? 10 Total number of female adult patients who are on First Line

Regimen?

11 Total number of male adult patients who are on Second Line Regimen?

12 Total number of female adult patients who are on Second Line Regimen?

13 Number of new pediatric patients (under age 15) starting ARV treatment this month?

14 Number of new pediatric patients who are WHO stage 4 this month? 15 Number of new pediatric patients who are WHO stage 3 this month? 16 Number of new pediatric patients who are WHO stage 2 this month? 17 Number of new pediatric patients who are WHO stage 1 this month? 18 Number of new pediatric patients whose WHO is unknown this

month?

19 Number of new adult patients (age 15 or older) starting ARV treatment this month?

20 Number of new adult patients who are WHO stage 4 this month? 21 Number of new adult patients who are WHO stage 2 this month? 22 Number of new adult patients who are WHO stage 3 this month? 23 Number of new adult patients who are WHO stage 1this month? 24 Number of new adult patients who are WHO stage unknown this

month?

25 Number of male ARV patients who have had their treatment interrupted this month?

26 Number of female ARV patients who have had their treatment interrupted this month?

27 Number of male ARV patients who have been hospitalized this month?

28 Number of female ARV patients who have been hospitalized this month?

29 Number of male ARV patients who have died this month? 30 Number of female ARV patients who have died 31 Number of male ARV patients lost to follow -up (>3 months)? 32 Number of female ARV patients lost to follow -up (>3 months)? 33 Number of male ARV patients enrolled on treatment more than 12

months ago?

34 Number of female ARV patients enrolled on treatment more than 12 months ago?

35 Number of PMTCT women receiving ARVs this month? 36 Number of male patients receiving STI services this month? 37 Number of female patients receiving STI services this month? 38 Number of new VCT patients who received ARVs this month? 39 Number of cotrimaxole prophylaxis this month? 40 Number of HIV positive patients treated for any Opportunistic

Infection, excluding TB, this month?

41 Number of HIV positive patients who received clinical care for TB this month?

42 Number of HIV positive patients receiving palliative care (in the reporting clinical facility) this month?

PMTCT Monthly Data Collection Form

1. Identification: Name of Health Facility: ……………………………………………………………………………… Health District:………………………………………………………………..………………. Province/Town…………………………………………………..……………..………………… Administrative District:…………………………………………….…………….………………… Month of Collection: …………………………..Years of collection: ………………..…………….. Address: ……………………………………………………………….………….……………… Center’s status 1=Private 2=Public 3=Agréé Date of start of operations: …………../………./…………… Partner (s):…………..…………………..……………………………………………………

1. Antenatal Care

Specification Number Observations

1. Antenatal Care (1st ANC) 2. Women counseled 3. Women tested for HIV 4. Women tested for RPR 5. HIV+ Women 6. RPR + Women 7. HIV+ Women that came back for results 8. HIV- Women that came back for results 9. HIV+ Women that took ZDV home 10. HIV+ Women that took NVP home 11. Partners tested for HIV 12. HIV+ Partners 13. Discordant Couples

2. Maternity

Specification Number Observations 1. Expected deliveries at the Health Facility 2. Deliveries carried out at Health Facility 3. Expected deliveries among HIV+ women 4. HIV+ Women that delivered at Health facility 5. HIV+ Women that delivered at home 6. Women that took ZDV 7. Women that took NVP during labor 8. Expected children for NVP/AZT 9. Children that received NVP/AZT

3. Infant care Cases/Month

Total Cases Specification

New New + Old case

Observations

1. HIV+ Women practicing breastfeeding 2. HIV+ Women practicing artificial feeding

3. HIV+ Women that weaned their children at 6 months

4. Children born of HIV+ mothers and followed up

5. Children born of HIV+ mothers to be tested at 15 months

6. Children tested at 15 months 7. HIV+ children 8. HIV- children 9. Children lost of sight 10. Women lost of sight 11. Notified dead children 12. Notified dead women

4. Family Planning

Cases/Mon

th Total Cases Specification

New New + Old case

Observations

1. Expected HIV+ Women 2. HIV+ Women seen in family planning 3. HIV+ Women on contraception 4.Partners seen in family planning 5. HIV+ Women referred for FP

Date: Name of Responsible: Signature and stamp:

Update on MIS Reporting for RPM Plus Rwanda, October 2005 ... · Update on MIS/M&E/Reporting for...

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Transcript of Update on MIS Reporting for RPM Plus Rwanda, October 2005 ... · Update on MIS/M&E/Reporting for...