CAMBODIA EXPERIENCE ON MTP (MONITORING, TRAINING, PLANNING) TO REDUCE INAPPROPRIATE MEDICINE USE IN HOSPITALS

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 -Self-initiative, self-conduct, self-assessment, self-decision making -Interventions needs to be incorporated in the existing management system

2- Objective  To learn lessons from experiences in drug use interventions in the past  To discuss the problem 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  Select pilot hospitals for MTP implementation  Assign 6 people as MTP team  Training of MTP Team 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

3.1-Flow of activities in MTP T T M M M M M M M M M M T T T T T T T T P P P P P P P P P P M M Indicator Initial Workshop Evaluation Workshop

3.2-Self-monitoring vs MTP MTP approach Self- Monitoring strategy MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP MTPMTP Indicato r Periodic evaluation at MOH

3.3-Monitoring - To identify the specific drug use problem - To select a priority problem - To determine indicators and data source - To identify the target of intervention When MTP has been running: - To follow up commitments from the previous session - To measure the impact of intervention - To conclude the achievement 3.4-Training - To discuss the problem agreed in the Monitoring in more details - To collect supporting information - To collect related scientific information to set up the norms or standard reference, e.g., reference books, standard treatment guidelines, etc. - To collect information about the intervention efforts considered effective, and to discuss the suitable intervention strategy to choose. - To agree upon an intervention strategy and to discuss the intervention steps. 3.5-Planning - To set a target of achievement - To set measures to achieve target, including the sequence of activity, the program, and the person responsible for execution. - To agree on who is responsible for the execution of the plan. - To facilitate communication and coordination among MTP team members - To agree upon schedule of the next MTP session.

4- Experiences on using MTP - First phase 6 Hospitals - Second phase 7 Hospitals

4-Result 1 (K andal Abs Reduction in Normal Delivery)

4-Result: 2 (Kg Cham Reduce Abs in post Cesarean) % of patients receiving antibiotics Reduction of the average medicine cost per patient from 15.3 to US$ 6.1 (US$ 2000/month)

4-Result: 3 (Siem Reap: Reduce Abs in Traumatology)

4-Result: 4 (OM Chhey: IV fluid reduction in normal delivery)

4-Result: 5 (BB: IV fluid reduction in Maternity and Traumatology Ward)

4-Result: 6 (BB: Abs reduction in Malaria)

4-Result 6 (BB Abs Reduction in Malaria)

5-STRONG POINTS MMTP is strongly supported by the DG for Health WWHO supported both, budget & Technical expert to develop MTP in CAMBODIA. EExisting Technical Working Group in each RH acting as DTC for improving the Use of Drug. EExisting network of supervision and monitoring system from central to Province and OD level. GGood cooperation with National Programs.  Sustainable achievement

6-WEAK POINTS SSome hospitals have difficulty to define a real strategy for improving drug use  After the end of financial support and intervention from central level no data will be collected and achievement will not be monitored and reported  Time availability of MTP team member ransfer of some MTP team members to other facility RReduction of hospital income for drugs.

7-Summary of result Health FacilitiesPriority problemIntervention result 1-Kandal Hospital -Use of Abs in normal delivery -Reduction from 100% down to 15%(target 10%) 2-Kanpong Cham Hospital -Use of Abs in post- Caesarean surgery -Abs use post- scrotal hernia surgery. -Reduction from 100% down 36%(Target 10%) -Reduction from 100% (target 10%)down to 33% in 3 meetings -Average cost IPD 15.3 to 6.1$ 3-Siem Reap Hospital -Abs use in Tromatology Ward -Reduction from 100% down to 63% (target 50%) 4-Oddar Mean Chhey Hospital -Use of IV fluid in normal delivery -Reduction from 27% down to 0% (target 0%) 5-Battambang Hospital -IV fluid use in Maternity -IV fluid use in Traumato -Abs use in Malaria -Reduction from 70% down to 0%.(target 0%) -Reduction from 70% down to 0% (target 0%). -Reduction from 30% down to 20%(target 0%)

8-Conclusion(1)  Flexible approach, not time-consuming, not costly  Good for sensitive issues  Interventions seems not too “sophisticated”  Encourage DTC to initiate activities and internal experts to contribute  A comprehensive approach, a combination of adult learning and managerial strategies.  Involved stakeholders in hospital, the “negative” consequences of rational drug use could be discussed accordingly

8-Conclusion(2)  MTP can be implemented in both sector public and private. Its can be solve problem themselves, if there are any supported from PHD.  MTP can be extended in nationwide, if they select the right people to be train them.  MTP reduce health care cost, if they strictly monitor, supervise and providing the training to prescribers. So the community will be participation and support  To reduce the prescribing problems and improving RUD for healthcare workers and patients.