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

3. 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

4. 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.

5. 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

6. 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

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

8. 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)

9. 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

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

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

12. 10- Stage 2: Result 3 (Battambang)
IV fluid reduction in the Maternity and the Trauma Ward
AB Reduction in the Malaria
Battambang

13. 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

14. 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.