Technical Report: Analysis of Antimalarial Medicine Availability in Amazon Basin Countries: Second Quarter 2011

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1 Strengthening Pharmaceutical Systems Technical Report: Analysis of Antimalarial Medicine Availability in Amazon Basin Countries: Second Quarter 2011 John Marmion August, 2011 Strengthening Pharmaceutical Systems Center for Pharmaceutical Management Management Sciences for Health 4301 N. Fairfax Drive, Suite 400 Arlington, VA USA Phone: Fax:

2 This report is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of cooperative agreement number GHN-A The contents are the responsibility of Management Sciences for Health and do not necessarily reflect the views of USAID or the United States Government. About SPS The Strengthening Pharmaceutical Systems (SPS) Program strives to build capacity within developing countries to effectively manage all aspects of pharmaceutical systems and services. SPS focuses on improving governance in the pharmaceutical sector, strengthening pharmaceutical management systems and financing mechanisms, containing antimicrobial resistance, and enhancing access to and appropriate use of medicines. Summary Recently the Amazon Basin countries have experienced supply problems. Changing incidence and distribution have influenced the ability to program needs accurately. This report collects supply information in participating countries from the central and regional warehouses at the end of the second quarter of Citation This report can be reproduced with credit given to SPS. Please use the following citation. Marmion, John, 2011.Analysis of Antimalarial Medicine Availability in Amazon Basin Countries. Presented to the United States Agency for International Development through the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health Key Words: Malaria,, availability, supply Strengthening Pharmaceutical Systems Center for Pharmaceutical Management Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA USA Telephone: Fax: Web: ii

3 Introduction Since 2002, Management Sciences for Health (MSH) has supported, through its Rational Pharmaceutical Management Plus (RPM Plus) and Strengthening Pharmaceutical Systems (SPS) projects, antimalarial supply management within the framework of the Amazon Malaria Initiative (AMI), funded by the U.S. Agency for International Development (USAID). In 2008, MSH/SPS assisted AMI countries to document antimalarial s stock levels. Countries showed supply chain issues culminating in stock outs and expiration of s. MSH proposed a system to monitor stock levels quarterly and a system to redistribute excess s to partner countries. The system would help avoid supply chain interruptions and over stocked situations. The first round of data collection occurred in September The data provided baseline information so initial donations/exchanges of s could occur and the following years order could be prepared. A regional meeting in Cartagena, Colombia in April, 2010 discussed the results and problems that occurred. Partner countries took the following steps to avoid future stock issues. 1. Urgent stock problems would be resolved with local purchases or exchanges between partner countries. 2. The Strategic Fund would manage donations for treatment of severe and special cases of malaria. 3. The Strategic Fund would organize a yearly consolidated purchase for antimalarial s beginning in MSH would support data collection for the months of antimalarial stock availability at the central and district level AMI counterparts and MSH/SPS consultants collected stock level data on the last day of the second quarter, 2011 and monthly consumption for the past year for this report 1. Current stock divided by the average monthly consumption results in available months of stock on-hand. Findings Nine countries reported data for this report. Antimalarial availability continues to improve within the region. Table 1 shows the percent of s available in central medical stores that are part of the countries treatment protocols. Four countries have less than one month s availability for one or more s. During this quarter five countries provided data for their departments. Countries continue to maintain a high level of s throughout this level. The percent of s available at the department level is shown in Table 1. The stock levels reported for the departmental level are aggregated. Availability across the departments is not completely homogeneous although it has improved significantly this quarter; for instance, all departments in Colombia had at least 82% of s available and the departments in Bolivia had at least 85% of s available. 1 Analysis provided by Henrry Espinoza, Magdalena Jimenez and Yenifer Hinestroza 3

4 Table 1. Percent of s available at the central and departmental levels Central level Department level Country % of % of Medications s Medications s on available on hand available hand Bolivia 9/13 69% 13/13 100% Brazil 16/18 89% Colombia 12/13 92% 10/11 91% Ecuador 8/9 89% 9/9 100% Guyana 9/10 90% Honduras 6/6 100% Nicaragua 3/5 60% 5/5 100% Peru 3/8 38% Several transfers/donations occurred between countries and departments during the last quarter. Ecuador donated/transferred Quinine Chlorhydrate 600mg/2ml to Colombia, Peru and Bolivia. Colombia and Bolivia redistributed s within their respective departments to avoid stock outs in departments with higher incidence. Table 2 shows the transfers that occurred at the country and department level. Table 2. Transfers occurring in the 2 nd semester, Medicine Quantity Donor Recipient Quinine Chlorhydrate 600mg/2 ml 200 Amp Ecuador Peru Quinine Chlorhydrate 600mg/2 ml 200 Amp Ecuador Bolivia Quinine Chlorhydrate 600mg/2 ml 400 Amp Ecuador Colombia Primaquine 15mg 800 Tab Potosi, Bolivia Chuquisaca, Bolivia Primaquine 15mg y 5mg 2,000 Tab Tarija, Bolivia Riberalta, Bolivia Primaquina 15mg y 5mg 1,000 Tab Tarija, Bolivia Guayaramerin, Bolivia Primaquina 15mg y 5mg 1,800 Tab Tarija, Bolivia Pando, Bolivia Artemether-Lumefantrine (6) 2,340 Tab Cauca, Colombia Chocó, Colombia Artemether-Lumefantrine (6) 4,140 Tab Valle, Colombia Chocó, Colombia Artemether-Lumefantrine (12) 30,144 Tab Valle, Colombia Chocó, Colombia Artemether-Lumefantrine (18) 4,500 Tab Valle, Colombia Chocó, Colombia Chloroquine 150 mg 20,000 Tab Antioquia, Colombia Nariño, Colombia 2 Information provided by Nora Giron, Regional Assessor Strategic Fund, PAHO Recommendations. 1. Distribution of the s within department levels. Countries should continue to review the stock levels in each department and redistribute accordingly. Colombia and Bolivia improved antimalarial availability at the department level with in-country redistribution. 4

5 2. Develop criteria for minimum stock for central, regional and health centers. Each storage level should have guidelines for minimum stock level in case of outbreaks. 3. Transfer s between countries. Possible options to lend or donate s are listed below Medication Potential Donor Potential Recipient Mefloquina 250mg Guyana Peru Chloroquine Phosphate 250mg Bolivia, Suriname Peru, Honduras Primaquine 15mg Suriname, Honduras Nicaragua, Peru, Colombia Quinine Chlorhydrate 600 mg/2ml injectible Ecuador Quinine Sulfate 300mg Bolivia Peru No potential recipients are apparent due to not using this presentation of the 5

6 Treatment for second line and severe malaria Treatment for p. vivax Treatment for p. falciparum Anex 1: Availibility of Medications at the Central Level Bolivia Brasil Colombia Ecuador Guyana Honduras Nicaragua Peru Suriname Central Level Artemether-Lumefantriene 12 Kg tableta 140, , , Artemether-Lumefantriene 18 Kg tableta 204, , , , Artemether-Lumefantriene 24 Kg tableta 1,531, , , , , Artemether-Lumefantriene 6Kg tableta 32, , , , Artesunate 100 mg tableta Artesunate 250 mg tableta - - Artesunate 50 mg tableta 7, Artesunate+ SP (Adolesc) - - Artesunate+ SP (Adultos) 1, Artesunate+ SP (Niños) 4, Artesunate-Mefloquine 100/220 mg x 3 tab , Artesunate+Mefloquine 100/220 mg x 6 tab , Artesunate-Mefloquine 25/55 mg x 3 tab , Artesunate-Mefloquine 25/55 mg x 6 tab , Mefloquine 250 mg tableta 16, , ,450 Sulfadoxine-Pyrimethamine 25/500mg 39, Chloroquine phosphate 150 mg tableta 753, ,618, , , Chloroquine phosphate 250 mg tableta 13, , , , , Primaquine phosphate 15 mg tableta 235, ,598, , , , ,222, , Primaquine phosphate 5 mg tableta 40, ,566, , ,755, Primaquine phosphate 7.5 Mg tableta Artemether 80 mg/ml - 1 ml ,085 Artesunate rectal 7, Artesunate sodium bicarbonate 60 mg/1 ml , ,000 2,111 Clindamycin clorhydrate 300 mg tableta 4, Clindamycin phosphate 150 mg/ ml x 4 ml - - Clindamycin hidrocloride 150 mg capsula 3,000 3, Doxycycline 100 mg 11, Quinine chlorhydrate 300 mg/ ml x 2 ml Quinine chlorhydrate 600 mg/ ml x 2 ml 1, Quinine dichlorhydrate 300 mg/ ml x 2 ml , , , Quinine dichlorhydrate 600 mg/ ml x 2 ml Quinine dichlorhydrate 125mg/ml-4 ml 85, Quinine sulfate 300mg tableta 11, , , , Quinine sulfate 500 mg 229,

7 Treatment for second line and severe malaria Treatment for p. vivax Treatment for p. falciparum Anex 2 Availability of antimalarial s at the department level, June 30, Bolivia Colombia Ecuador Nicaragua Perú Department level Artemether +Lumefantrina 12 Kg tableta 36, Artemether +Lumefantrina 18 Kg tableta 45, Artemether +Lumefantrina 24 Kg tableta 290, , Artemether +Lumefantrina 6Kg tableta 25, Artesunate 100 mg tableta Artesunate 250 mg tableta 2, Artesunate 50 mg tableta 4, , Artesunate+ SP(Adolesc) Artesunate+ SP (Adultos) Artesunate+ SP (Niños) 1, Artesunate+Mefloquine 100/220 mg x 3 tab Artesunate+Mefloquine 100/220 mg x 6 tab Artesunate+Mefloquine 25/55 mg x 3 tab Artesunate+Mefloquine 25/55 mg x 6 tab Mefloquine 250 mg tableta 6, , Sulfadoxine- Pyramethamine 25/500mg 2, Chloroquine Phosphate 150 mg tableta 115, , Chloroquine Phosphate 250 mg tableta 26, , , Primaquina Phosphate 15 mg tableta 43, , , , , Primaquina Phosphate 5 mg tableta 13, , , Primaquina Phosphate 7.5 Mg tableta 6, , Artesunate rectal 1, Artesunato sodium bicarbonate 60 mg/1 ml - 0 Clindamicine clorohydrato 300 mg tableta Clindamicine phosphate 150 mg/ ml x 4 ml inyectable Clindamicine hydrocloride 150 mg capsula Quinine clorohydrate 300 mg/ ml x 2 ml inyectable 1, Quinine chlorohydrate 600 mg/ ml x 2 ml inyectable Quinine dichlorohydrate 300 mg/ ml x 2 ml inyectable , Quinine dichlorohydrate 600 mg/ ml x 2 ml inyectable Quinine sulfate 300mg tableta 2, ,

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