1. MTP experience to reduce injection overuse in Lao PDR Dr. Amphayvanh Panyanouvong Department of Curative Medicine Ministry of Health, Lao PDR

2. HEALTH FACILITIES  2 General hospitals  6 Special hospitals  5 Regional hospital  13 Provincial hospitals  126District hospitals  596 Health centers

3. RATIONAL USE OF DRUG  1992: National Drug Policy 1993  1998: Standard Treatment Guideline (FDD- CMD)  1999:Setting up Drug & Therapeutic Committee (DTC) in 7 central and provincial hospitals, designing & implementation of DTC indicators  2001:Introduction & implementation of MTP strategy to be used by DTC to improve rational use of drugs in other 5 provincial hospitals

4. DTC activities in 5 hospitals  Focus on RUD, STG and Drug Consumption  Set up DTC indicators  Collect DTC indicators and feedback to prescribers

5. Problems with DTC indicators  Lots of efforts (time, energy, money) from MOH to conduct activities  Hospital teams are too dependent to MOH  Activity is not sustainable: no “project” (no funding), no activity  Need to encourage hospital to improve prescribing by themselves 2001: FDD-CMD-University work together to introduce MTP strategy to be used by DTCs as a tool to improve drug use

6. MTP strategy  Monitoring – Training - Planning  A serial of small group discussions in hospital, involving hospital DTC members and the prescribers who have problems in a particular drug use  Each serial discussion focuses on ONE problem (e.g. high injection use)  Monitoring: collect data by themselves (e.g. % patients receiving injection)  Training: solve the problem (why it is high and what to do to reduce it)  Planning: Setting up the target, i.e., to what level they have to reduce and when they should collect the data again, too see if they are approaching the target

7. MTP is a continuous activity 3-4 cycles for each problem3-4 cycles for each problem T M P T M P T M P T M P T M P MTP meeting MTP cycle

8. MTP - implementation  Started in May 2001 by FDD in collaboration with CMD and Faculty of Medicine (supported by WHO) May 2001 Sep 2001 1 st Workshop: 8 PHs 2nd Workshop: 8 PHs + 23 DHs May-Aug 2002 Workshop in Central Hospital

9. MTP Action plans in Lao PDR  Overuse of AB in malaria treatment  Overuse of AB in pediatric ARI  Overuse of AB in pediatric diarrhea  Overuse of IV fluids in emergency department  Overuse of injection in adult malaria treatment  Incorrect use of AB in pneumonia  Etc.

10. MTP experience - Bokeo  Bokeo provincial hospital: 100 beds  Baseline DTC data: inappropriate use of IV fluids in emergency department (78% )  MTP was set up in July, 2001: MTP plans to reduce to 25-30%  5 MTP meetings were held

11. Fig 4. Bokeo hospital % patient receiving iv fluids

12. MTP experience - Xayabury  Xayabury provincial hospital: 100 beds  Baseline DTC data: overuse of injection in malaria treatment (96% )  MTP was set up in September 2001 at internal medicine ward: MTP plans to reduce injection use to 30%  3 MTP meetings were held

13. Fig 4. Xayabury hospital % patient receiving injection for malaria

14. WORK PLAN  DTC will be set up in all provincial hospital in the year 2002  DTC workshop will be held in 5 provincial hospital (supported by Sida)  Conducting DTC & MTP monitoring & supervision at all hospital (central, regional and provincial)  Implementation of MTP in other district hospitals will request support from WHO