Community Based Approaches to
Reduce Medication Stock outs
Sonak Pastakia, PharmD, MPH
Assistant Professor,
Purdue University College of Pharmacy
USAID-AMPATH Partnership
Access to Quality Medicines
• Up to 70% of essential
medicines can be
stocked out in public
health facilities
• In Kenya, almost 30% of
drugs have been found
to be counterfeit
Community Revolving Fund
Pharmacies
One Time Donation
AMPATH
Community
Revolving
Fund
Pharmacy
• Supervises
running of CRFPs
• Drugs sold to patients
• Ensure
transparency
• Community involved in
management
• Facilitate
procurement
• Restocked using funds
from sales
• Run by government
staff
Patients
• Ensure
sustainability by
paying for drugs
• Waiver system
for very poor
patients
Features of the RFP model
• Acts as a backup to MOH
in case of stock outs
• Slightly higher priced than
MOH
• Prices lower than in the
private sector
• Community ownership
• Fee waivers for indigent patients
• Minimal operating costs
Pilot RFP program
• RFP model implemented in 3 sites within the
AMPATH catchment area over 1 year
• Mini RFPs in 10 dispensaries – mainly supporting
hypertension and diabetes care
• Availability of essential medicines has improved from
30% to 90%
Number of patients served
Mosoriot
Q2 2011 Q3 2011 Q4 2011 Q1 2012
1,154
Turbo
1,932
2,846
2,606
8,538
1,382
2,516
2,717
6,615
2,695
2,695
17,847
Eldoret
Total
Avg Patients / Week
1,154
89
Total
3,314
5,362
8,017
255
412
617
Pilot RFP program
Avg Co-pay per Patient
Mosoriot
Turbo
Eldoret
Total
Income Statement Summary
Revenues
Cost of goods sold
Gross Profit
Expenses
Net Income
Gross margin %
Profit margin %
Q2 2011 Q3 2011 Q4 2011 Q1 2012
$ 1.55 $ 0.75 $ 1.07 $ 1.45
$ 1.69 $ 0.76 $ 1.12
$ 1.40
$ 1.55 $ 1.14 $ 0.93 $ 1.32
Q2 2011
$ 1,784
$ (1,718)
$
66
$ (38)
$
29
4%
2%
Q3 2011
$ 3,774
$ (3,310)
$ 464
$ (54)
$ 411
12%
11%
Q4 2011
$ 4,960
$ (4,510)
$ 451
$ (100)
$ 351
9%
7%
Overall
$ 1.18
$ 1.10
$ 1.40
$ 1.18
Q1 2012
$ 10,598
$ (8,527)
$ 2,071
$ (54)
$ 2,017
20%
19%
Total
$ 21,117
$(18,065)
$ 3,052
$ (245)
$ 2,807
14%
13%
Revolving Fund Pharmacies - Income Summary
$12,000
$10,000
$8,000
Revenues
$6,000
Gross profit
Net income
$4,000
$2,000
$-
Q2 2011
Q3 2011
Q4 2011
Q1 2012F
Challenges
• Reliable staffing at the health
facilities
• Infrastructure
– Accessibility to some sites
is challenging due to poor
roads and availability of
transport
– Informatics – a pilot system
will be introduced in the
next month
• Security of drug product and
cash collected
• Changing the mind set of
patients accustomed to free
medications
Future plans
• Expand to all AMPATH sites – additional seed funds are
needed
• Replicate the model for other services including laboratory
tests
• Publish preliminary data on the success of the program
• Engage key decision makers in government to explore ways of
implementing the model in all health facilities in the country
• Make use of mobile technology for inventory management
and banking
Proposed informatics system
Pharmacy Dispensing System
1. Product receipt from supplier with
logging in central inventory system
2. Distribution to
inpatient and outpatient
dispensing points with
computer logging of all
transactions
Telephone Network Based Connectivity
All steps in the dispensing process will have
real time connectivity to enhance tracking of
products at every point in the medication
distribution process
5. Data from previous visits
available for decision support
to improve adherence and
minimize overutilization and
diversion
3. Dispensers will use
android based tablets and
cell phones to record all
dispensing transactions
4. Patient’s ID’s
and product bar
codes will be
scanned with all
data collected in
the android
enabled device
Acknowledgements
• Abbott/Abbott Fund
• Pfizer Global Health
Fellows program
– Phillippe Grandin
• Eli Lilly and Company
• Celgene Corporation
• Purdue University
College of Pharmacy
• Indiana University
School of Medicine
Thank You