PHARMACY SERVICES IN TANZANIA Carl Sherman, Laura Brown, Jill Strykowski

Transcription

1 PHARMACY SERVICES IN TANZANIA 2012 Carl Sherman, Laura Brown, Jill Strykowski

2 Pharmacy in TZ: From Top to Bottom Infrastructure Regulatory Bodies National Formulary Manufacturing Distribution Education Labor Force Ilula District Hospital

3 Our Pharmacy crew. Frank Sanga, Pharmaceutical Technician (3 yrs training) 5 Liter Jugs of Oral Morphine Solution!

4 Tanzania: Snapshot Area: 364,898 sq. mi. Population: 43,739,000 65% are under 25 yo 77% live in rural areas GNP per capita: $1260 Avg HH spending/mo: $25 Life expectancy: 53(m) 58(f) Probability of dying under the age of 5: 108/1000 Total health expenditure per capita: $68 Total expenditure on health as % of GDP: 5.1% Source: 2009 figures, Global Health Observatory, World Health Organization

5 TZ Healthcare: Infrastructure Level III Referral: 4 Level II Regions: 26 Level I Districts: 126 Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health and Social Welfare

6 TZ Healthcare: Infrastructure National Local Referral Hospital Consultant Hospital Regional Hospital District Hospital Health Center Dispensary Village Health Service Specialty inpatient/outpatient services Serves 10,000,000 Advanced inpatient/outpatient services Serves 1,000,000 Expanded inpatient/outpatient services Serves 250,000 Basic inpatient/outpatient services Serves 50,000 Outpatient services for 3-5 villages Serves 10,000 Minimally trained health workers Serves 1,000-5,000 Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

7 TZ Regulatory Bodies Ministry of Health and Social Welfare (MoHSW) Pharmacy Council Maintains register of pharmacists, technicians, and assistants Requires yearly renewal of registrations Policy and Planning Division Establishes the Standard Treatment Guidelines/NEMLIT Publishes the National Formulary in conjunction with the TFDA Tanzanian Food and Drug Authority (TFDA) Regulates quality and distribution of pharmaceutical products Sets standards for pharmacy operations Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

8 National Essential Medicines List in Tanzania (NEMLIT) 2007 Route of administratio n Categorized by health care facility A) Dispensary B) Health Centre C) District Hospital D) Regional and Referral Hospital Name of medicine Pharmaceutical forms and strengths

9 Drug Manufacturing Three primary manufacturers Tanzania Pharmaceutical Industries (Arusha) Shelys Pharmaceuticals (Dar es salaam) Zenufa Laboratories (Dar es salaam) Other manufacturers Interchem Pharmaceuticals (Kilimanjaro) Mansoor Daya Chemical (Dar es salaam) AA Pharmaceuticals (Dar es salaam) Keko Pharmaceuticals (Dar es salaam) Tanzansino United Pharmaceuticals (Dar es salaam) Arusha Moshe Dar es salaam Source: Tanzanian Food and Drug Authority.

10 Wholesale Supply Chain Direct acquisition from manufacturers Distributors and other private entities Government hospitals Ministry of Health and Social Welfare Medical Stores Department (MoHSW) Distributes drugs to 9 zones in Tanzania Establishes purchasing accounts for government hospitals Sets a standard price for drugs throughout the country Drugs specifically manufactured for MSD Government hospitals obligated to buy through MSD Source: Interview with Frank Sanga, Manager of Pharmacy Services, Ilula District Hospital, 2012.

11 Wholesale Supply Chain MSD Iringa Branch 436 Dispensaries 49 Health Centers 10 District Hospitals 3 Municipal Hospitals 3 Regional Hospitals Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

12 Wholesale Supply Chain Private Wholesaler: Acacia Pharmacy o Wholesale and retail o Margins of ~15% o Staffed by two 4-year Pharmacists o Must sell to government hospitals at MSD + 10% MEMS: Distributes donated medications, many foreign Source: Interview with manager of Acacia Pharmacy, Iringa, 2012.

13 Retail Supply Chain Retail Pharmacy Similar to American retail pharmacies with prescription and OTC products dispensed by a pharmacist Duka la dawa baridi Carries only OTC products Duka la dawa muhimu Accredited drug dispensing outlet Sells some prescription medications Attempt to increase access in rural areas Source: TFDA.

14 Pharmacy Education Pharmaceutical Technician Diploma (3 years) Two Schools Muhimbili School of Pharmacy St. Lukes School of Pharmacy Kilimanjaro Education focuses on supply chain, calculations, and some clinical Pharmaceutical Assistant Certificate (2 years) St Luke s School of Pharmacy Kilimanjaro Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

15 Pharmacy Education Pharmacist Bachelors degree (4 years) Two Schools of Pharmacy St. John s University of TZ (Dodoma) Muhimbili School of Pharmacy (Dar es salaam) Offers 2 year graduate degrees, including Pharmacognosy and Clinical Pharmacy 1:5 admission rate with graduating class sizes of ~40 Demand far exceeds supply for trained professionals Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

16 Industry & Labor Force Statistics Pharmacies/Dukas in Tanzania: 5241 Pharmacists in Tanzania: 704 Pharmacies per 10,000 population: Pharmacists per10,000 population: Pharmacist Salaries Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

17 Industry & Labor Force Statistics Source: Assessment of the Pharmaceutical Human Resources in Tanzania, Ministry of Health of Social Welfare.

18 Dispensary: Foundation of care Tungamalenga Dispensary Village Clinical Officer: Barnabas Image Dispensary

19 Dispensary: Foundation of care Idete Dispensary Ipalamwa Dispensary

20 Ilula Lutheran Hospital - Kilolo Ilula

21 Ilula Lutheran District Hospital Inpatient Mobile Services Outpatient

22 Ilula Lutheran District Hospital Inpatient 70 bed hospital 20 Maternity ward 40 General ward 10 Private ward

23 Ilula Lutheran District Hospital Outpt clinic Mobile Clinics Maternal/Child HIV Outpatient Services Maternal/child clinic HIV Clinic

24 Ilula pharmacy staff Pharmacy Technician as sole pharmacy professional o Frank Sanga has been at Illula for one year o Focus has been on inventory management o Avg salary: ~ 400,000 Tsh/mos = $260/mos Recent addition of Procurement Officer o Background construction o Implementing inventory systems

25 Pharmacy at Ilula Outpatient Services DAWA = Drugs Dispensing by nurses & midwives Approx. 40 scripts per day, 2-3 persons Average Rx price: Tsh ($ ) Scripts in plastic baggies Label 2 x 2

26 Pharmacy at Ilula Outpatient Services Retrospective QA by Frank Sanga No counseling offered Weights estimated by providers APAP- dose 120 mg

27 Pharmacy at Ilula Inpatient Services Primarily dispensing by nurses Meds are one-off on a daily basis Patient chart noted with o/s when out of stock Little communication regarding o/s Patient/pt s family responsible to buy o/s meds at local Dawa Orders for meds are made without regard to availability/stock

28 Pharmacy at Ilula Inpatient Services No pharmacists in a clinical role No Q/A or chart review Nursing commonly adjusts dosing without documentation Monitoring is limited Electrolytes, x-rays, cultures, resistance Some meds are patient supplied/stored/self-dispensed Pitocin ARV

29 Pharmacy at Ilula CTC: HIV Clinic o Documentation with paper logs o Form C1- patient copy o Form C2 o Medication supplied by US (Clinton Foundation, WHO) o Outpatient office visit with Clincal Officer prior to CTC o HIV meds dispensed by Frank Sanga s father, a former Pharmacy Technician (no formal training)

30 Ilula Formulary Antibiotics Amoxycillin, Cloxacillin, Penicillin Cipro Ceftriaxone Doxycycline Metronidazole Co-trimoxazole Erythromycin Gentamycin Chloramphenicol

31 Ilula Formulary Antiasthmatics Salbutamol tablets Aminophylline Not Available Nebulizers MDIs

32 Questions?