Management of Medicines and
Pharmaceutical Supplies for use in
the prevention and treatment of Preeclampsia and Eclampsia
Grace Adeya, SPS/MSH
February 23, 2011
Why Consider Medicine and Pharmaceutical
Supplies Management Issues?
 Effective management of PE/E helps ensure
that medicines and supplies are on hand for
immediate administration.
 Effective management requires careful
product selection, procurement, storage,
distribution, and use.
 PE/E medicines are in many countries part of
the national pharmaceutical supply system
 Subject to the same structural, financial and
human resource constraints as all products that
rely on this supply system
Pharmaceutical Management Cycle
Selection
Use
Management
Support
Procurement
Distribution
Policy and Legal Framework
Selection


Build consensus on protocol for
PE/E with committee of experts
and consult best practices
Use the following selection criteria
 At what level of health system?
Who will use them?
 Types of medicines? First-line
medicine?
 Cost
 Safety and efficacy
 Quality and stability (storage
conditions)
 Availability for procurement
 Registered for use in country?

Include selected PE/E in national
essential medicines list (EML) and
standard treatment guidelines
(STGs)
Selection
Use
Management
Support
Procurement
Distribution
Policy and Legal Framework
Selection: Who is making the purchasing
decisions at the health facility level?
Background of personnel managing
medicines at health facility level
DRC (N = 30)
7 % pharmacy technicians
80% Nurses
Mali (N=100)
18% - pharmacists
3% - pharmacy technicians
4.8% - matron/nurse/midwife
22% - no training
Percentage of respondents trained in the
management of uterotonic / PE/E medicines
27%
21%
0%
45%
41%
28%
90%
65%
14%
2%
37.3%
15%
Proportion of Facilities with a copy of the
NEML
Percentage of respondents who know
MgSO4 is in the NEML
Percentage of respondents who know
Oxytocin is in the NEML
Percentage of respondents who know
Calcium Gluconate is in the NEML
Percentage of respondents who know
Diazepam is in the NEML
Procurement
Selection
Use
Management
Support
Procurement
Distribution
Policy and Legal Framework
 Quantity needed
 Cost
 Quality: packaging, cold
chain
 Shelf life
 Supplier performance
 Management
information system
(MIS) to monitor
consumption
 Medical Supplies e.g.
BP machines
Procurement: Staff knowledge and use of
essential data for quantification of
requirements
Knowledge of the stock on hand
Knowledge of the quantity dispensed per
day
Knowledge of the facility’s consumption
for one month
Knowledge of when and how the
medicines were used
Ability to use the recorded data for
retrospective analysis
DRC (N = 30)
Mali
(N=100)
70%
58%
53%
5%
47%
4%
33%
7%
10%
10%
The Procurement Cycle
Review Drug Selections
Collect Consumption
Information
Determine Quantities
Reconcile Needs and Funds
Distribute Drugs
Choose Procurement Method
Make Payment
Locate and Select Suppliers
Receive and Check Drugs
Specify Contract Terms
Monitor Order Status
Selection: Cost and Product
versatility issues
Year
Product Name
2007
2008
2009
Average
Diazepam 5 mg/ml (general anticonvulsant/antiepileptic; generalized anxiety; pre-operative)
Average of Supplier (US$)
$
0.06
$
0.07
$
0.07
$
0.07
Average of Buyer (US$)
$
0.08
$
0.10
$
0.06
$
0.08
Magnesium Sulfate 500 mg/ml (PE/E anticonvulsant )
Average of Supplier (US$)
$
0.09
$
0.10
$
0.09
$
0.09
Average of Buyer (US$)
$
0.17
$
0.17
$
0.17
$
0.17
Source: MSH International Drug Price Indicator Guide
Distribution and Inventory
Management
 Effects of heat and light
 Cold chain equipment and
transportation
 Cold box or packs
 Refrigerators
 Excursion?
Selection
Use
 Inventory monitoring system
Management
Support
Procurement
Distribution
Policy and Legal Framework
 Stock cards and registers
 Distribution network and
transportation
 Vertical vs. Integrated (How
do PE/E products fit into
overall supply system?)
 Delivery kit system?
 Non-facility locations
Distribution: Storage Conditions
DRC
(N = 30)
Mali
(N=60)
Stock/storage location is secure (locked door, wire mesh on the windows,
locked cabinets)
83%
87%
Storage location is visibly free of harmful insects and rodents
83%
83%
Products are arranged well on shelves or pallets
78%
92%
Products are arranged so that identification labels and expiration or
manufacture dates are visible
67%
82%
Products are stored and organized according to expiration dates (FEFO)
67%
85%
Boxes and products are in good condition
94%
87%
Boxes and products are protected from water and moisture
94%
80%
Products are protected from direct light and sun at all times
94%
88%
The store has operational refrigerators
28%
43%
The temperature of the cold chain is recorded and monitored regularly
0%
7%
Temperatures of the cold chain are between 2°C and 8°C
0%
3%
Storage Conditions
Use
 Policy: Who is allowed to
prescribe MgSO4?
 Training in PE/E
management: What skills
are needed?
 Service delivery protocols




Indications
Dose
Contraindications
Management of side
effects
 Skilled birth attendants
 Client counseling
 Adverse drug reaction
monitoring
Selection
Use
Management
Support
Procurement
Distribution
Policy and Legal Framework
USE: Respondents Knowledge of
Recommended Treatment
DRC (N = 30)
Mali (N=100)
Percentage of respondents who
know Oxytocin is the
recommended medicine for the
practice of AMSTL
90%
56%
Percentage of respondents who
know MgSO4 is the
recommended medicine for the
management of PE/E
8%
23%
USE: Product Availability
DRC
(n = 18)
-
Mali
(n = 60)
46%
Oxytocin 10 IU/ml ampoule
78%
34%
Magnesium sulfate 4 g ampoule
11%
10%
Magnesium sulfate 2 g ampoule
-
9%
Calcium gluconate 10 mg
ampoule
22%
15%
Diazepam 10mg inj
56%
-
Medicines Available
Oxytocin 5 IU/ml ampoule
Management Support
 Standard Operating
Procedures
 Financing
 Information management
(MIS)
 Human resources
 Preservice education
 Continuing education
 In-service education
 Monitoring and
supervision
Selection
Use
Management
Support
Procurement
Distribution
Policy and Legal Framework
Management Support:
 Advocacy for Maternal Health:
 Maternal health issues should always be included among the
health priorities.
 Are maternal health program personnel at the table when
decisions are being made on priorities for procurement
 Forum for improved and regular communication
between doctors, midwives and pharmacists e.g
Drug and Therapeutics Committees
 Improved selection, quantification and ordering of
uterotonics
 Clarification of roles and responsibilities of pharmacy,
delivery room and recovery ward personnel
Policy and Legal Framework
Selection




Management
Support

Use
Procurement
Distribution
Policy and Legal Framework



EML and STG
Registration issues
Importation
Centralized vs.
decentralized; vertical vs.
integrated programs
Financing mechanisms:
cost recovery, cost
sharing, insurance
Pharmacovigilance
PE/E service delivery
protocols
Human resources: who is
authorized to prescribe
and dispense?
Thank you