Denis Kibira HEPS Uganda How to assess Access to Medicines

Objective of presentation To equip the participants on how to measure the aspects of access to essential medicines in a supply chain and familiarise with the tools used. Apr-09 MeTA CSO Workshop

To equip the participants on how to measure the aspects of access to essential medicines in a supply chain and familiarise with the tools used.

What are essential medicines Essential medicines are intended to be available within the contest of functioning healthcare systems at all times, in adequate amounts, in appropriate dosage forms, with assured quality , and at a price the individual and community can afford. Apr-09

Essential medicines are intended to be available within the contest of functioning healthcare systems at all times, in adequate amounts, in appropriate dosage forms, with assured quality , and at a price the individual and community can afford.

4 A s A vailable – On shelves for dispensing to patients A ccessible – geographical or physical location of medicines A cceptable – answering need, quality, generic/brand A ffordable by the target group Apr-09

A vailable – On shelves for dispensing to patients

A ccessible – geographical or physical location of medicines

A cceptable – answering need, quality, generic/brand

A ffordable by the target group

Rational Use of Medicines (RUM) Right medicine, Right time, Right dose, Right cost, Right information Appropriate indication Appropriate medicine – safe, efficacious, effective (quality) Appropriate administration, dosage, duration Appropriate patient Appropriate patient information Appropriate evaluation Apr-09

Right medicine, Right time, Right dose, Right cost, Right information

Appropriate indication

Appropriate medicine – safe, efficacious, effective (quality)

Appropriate administration, dosage, duration

Appropriate patient

Appropriate patient information

Appropriate evaluation

Exercise 1 Selecting of a basket of medicines Accessing availability of medicines at a facility dispensary

Selecting of a basket of medicines

Accessing availability of medicines at a facility dispensary

Tools A list of 100 medicines classified according to their indications (see list)

A list of 100 medicines classified according to their indications (see list)

Methodology Participants in 4 groups are asked to select a basket of 30 medicines (a) to be used for research or survey based on: Disease patterns in country Pick as many medicines in each category depending on the importance or prevalence of the disease in the country May not pick medicine in some categories if the disease is not important Knowledge of the efficacy of the medicines not important

Participants in 4 groups are asked to select a basket of 30 medicines (a) to be used for research or survey based on:

Disease patterns in country

Pick as many medicines in each category depending on the importance or prevalence of the disease in the country

May not pick medicine in some categories if the disease is not important

Knowledge of the efficacy of the medicines not important

Cont’d At the facility the dispensary shelves are checked for availability (b) of each medicine in the selected basket (a) The percentage of availability of medicines is determined as: % availability = b/a x 100

At the facility the dispensary shelves are checked for availability (b) of each medicine in the selected basket (a)

The percentage of availability of medicines is determined as:

% availability = b/a x 100

Using WHO medicines indicators to assess medicines use at health facilities Number of medicines per encounter Prescribing by generic names Use of injections Use of antibiotics Lesson 2:

Using WHO medicines indicators to assess medicines use at health facilities

Number of medicines per encounter

Prescribing by generic names

Use of injections

Use of antibiotics

Tools A list of 30 patients’ prescriptions in which highlights were made on medicines prescribed by brand names, injections and antibiotics (see list)

A list of 30 patients’ prescriptions in which highlights were made on medicines prescribed by brand names, injections and antibiotics (see list)

Methodology 1. Participants counted the total number of medicines prescribed in all the 30 prescriptions. Determine the number of medicines per encounter. Number of medicines per encounter = Total number of prescribed medicines 30 2. Participants counted the total number of medicines prescribed by generic names in all the 30 prescriptions. Determine the percentage of medicines prescribed by generic names. % generic prescribing = Total prescribed by generic name x 100 Total number of medicines prescribed

1. Participants counted the total number of medicines prescribed in all the 30 prescriptions. Determine the number of medicines per encounter.

Number of medicines per encounter = Total number of prescribed medicines

30

2. Participants counted the total number of medicines prescribed by generic names in all the 30 prescriptions. Determine the percentage of medicines prescribed by generic names.

% generic prescribing = Total prescribed by generic name x 100

Total number of medicines prescribed

Cont’d Participants counted the total number of injections prescribed in all the 30 prescriptions. Determine the average injection use. % injection use = Total number of injections prescribed x 100 Total number of medicines prescribed Participants counted the total number of antibiotics prescribed in all the 30 prescriptions. Determine the average antibiotic use. % antibiotic use = Total number of antibiotics prescribed x 100 Total number of medicines prescribed

Participants counted the total number of injections prescribed in all the 30 prescriptions. Determine the average injection use.

% injection use = Total number of injections prescribed x 100

Total number of medicines prescribed

Participants counted the total number of antibiotics prescribed in all the 30 prescriptions. Determine the average antibiotic use.

% antibiotic use = Total number of antibiotics prescribed x 100

Total number of medicines prescribed

Thank you! Questions, comments …???? Apr-09 MeTA Uganda

Questions, comments …????