CAMBODIA EXPERIENCES ON MTP (MONITORING-TRAINING-PLANNING) TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPITAL Prepared by Dr. Sok Srun and Dr. Chroeng Sokhan

1- Background Previous indicator-based supervision and monitoring program in Cambodia did not show significant improvement. Inappropriate prescribing practices in health facilities Intervention to improve prescribing is uneasy to conduct, especially in private facilities Interventions needs to be incorporated in the existing management system

2- Objective To discuss the problems of drug use in the health care system To discuss the efforts in improving drug use carried out so far To develop the innovative strategy for rational drug use in the health care system.

3- Intervention Method (Stage 1) Select 6 pilot hospitals Assign 6 people of each hospital as Hospital MTP Teams Training of MTP Teams on MTP process Schedule the meeting to: define problems on drugs use develop an innovative strategy to improve drug use define target monitor the implementation and evaluate the achievements National evaluation workshop Wider implementation (Stage 2) if Stage 1 is successful

4- Self-monitoring vs MTP Periodic evaluation at MOH Self- Monitoring strategy Indicator Indicator Indicator Indicator Indicator Indicator Indicator M T P M T P M T P M T P M T P MTP approach

Kandal RH: Reduction of AB use in normal delivery 5- Stage 1 :Result: 1 Kandal RH: Reduction of AB use in normal delivery

6-Stage 1:Result: 2 Kg Cham: Reduction AB use in post Cesarean and Post Scrotal Hernia surgery % of patients receiving antibiotics Reduction of the average medicine cost per patient from 15.3 to US$ 6.1 (US$ 2000/month)

7- Intervention Method (Stage 2) Select 7 pilot hospitals Assign 6 people of each hospital as Hospital MTP Teams Training of MTP Teams on MTP process Schedule the meeting to: define problems on drugs use develop an innovative strategy to improve drug use define target monitor the implementation and evaluate the achievements National evaluation workshop involving hospitals from Stage 1 Nation-wide implementation if Stage 2 is successful

Siem Reap RH: AB use in Traumatology Ward 8-Stage 2: Result 1 Siem Reap RH: AB use in Traumatology Ward

OM Chhey RH: IV Fluid reduction in normal delivery 9-Stage 2: Result: 2 OM Chhey RH: IV Fluid reduction in normal delivery

10- Stage 2: Result 3 (Battambang) IV fluid reduction in the Maternity and the Trauma Ward AB Reduction in the Malaria Battambang

5- Conclusion (1) Flexible approach, not time-consuming, not costly to improve appropriate use of drugs in hospitals MTP is good for solving sensitive problems Encourage Hospital Technical Committees to initiate activities in improving appropriate use of drugs A comprehensive approach, a combination of adult learning and managerial strategies. Involving stakeholders in hospital, the “negative” consequences of rational drug use could be discussed accordingly

5- Conclusion(2) MTP can be implemented in both sector public and private. With the supports from PHDs, MTP can be used to solve drug use problems by themselves. MTP can be extended nationwide. The “right people” should be selected from each hospitals. If MTP imlementation is conducted with monitoring, supervision, and continuous training, MTP can reduce the health care cost. The community will participate and support this efforts To reduce the prescribing problems and improve RUD for healthcare workers and patients.