1. Use of an Indicator-Based System for Assessing, Monitoring, and Improving Pharmacy Practice Authors: Lates, J. (1); Sumbi, V. (2); Phulu, B. (1); Rushubiza, J. (1); Pereko, Dawn (2) Affiliations: 1 Ministry of Health and Social Services (MoHSS) Namibia, 2 Strengthening Pharmaceutical Systems (SPS) Presenter Jennie Lates Deputy Director: Pharmaceutical Services Ministry of Health & Social Services, Namibia

2. Background - Namibia  Population ~ 2.1 million  Ranked as upper-middle income country  High level of income inequality, with Gini co- efficient 0.7  Country has high HIV prevalence (~ 13.3%)  Large arid country in south-western Africa; 824,295 km2  Ministry of Health & Social Services (MoHSS) serves ~85% of populations’ health needs

3. Background – Public Pharmacy Services  MoHSS has a centralised supply system for pharmaceuticals to all public health facilities.  Current annual expenditure on Pharmaceuticals & related supplies is ~ US$ 50 million  Namibia has a severe, chronic shortage of trained pharmacy staff.  Three National Medicine Use surveys between 1997 and 2001 showed no significant improvement in several key indicators  There is high availability of essential medicines (>90%), but evidence of inappropriate use.  It was identified in 2002 that there was no mechanism for consistent reporting of pharmacy services.

4. Intervention Implementation of a Ministry-wide Pharmacy Management Information System (PMIS) We developed the system through wide consultation in MoHSS The system includes data collection tools, data collection & reporting schedules as well as feedback systems. At launch of PMIS we trained Regional Pharmacists on the system, who then trained their pharmacy staff Strengthened Therapeutics Committees to design & implement interventions to address gaps identified through PMIS Implementation of the system through on-going data collection, analysis and use at all levels Feedback through quarterly national PMIS feedback reports

5. Results  The PMIS was formally launched in July 2007;  All 34 hospitals in the public sector produce quarterly reports  A national database has been developed for tracking performance by all hospitals in the various areas assessed  PMIS data and results are discussed at district and regional Therapeutic Committees and interventions implemented.  Division: Pharmaceutical Services produces quarterly feedback reports that are distributed to Senior Managers as well as all Districts & Regions

6. Results (2) Indicator Description2007/82010/11 % facilities with all key items in stock 91.8%97.8% % stock cards balance same as physical stock 75.6%91.6% % days in which temperature of the main store was below 30°C 67.5%94.6% % prescriptions prescribed by generic name 62.0%87.7% % Therapeutic Committee meetings held out number planned 40.0%72.0% Notable National results from PMIS are shown below:

7. Results (3) Notable interventions and successes in the Regions include: Development of list showing brand & generic names of medicines has improved generic prescribing in Ohangwena Rational medicine use trainings carried out in Kunene region to address prescribing problems identified using PMIS data (poly- pharmacy, inappropriate antibiotic prescribing). Inventory Management Trainings conducted in Kavango have improved adherence to Standard Operating Procedures Use of PMIS workload data used to successfully motivate for additional pharmacy staff in Hardap region Based on PMIS findings Otjozondjupa Region carried out operational research on the antimicrobial resistance of UTI and designed new guidelines for the management of UTIs in their region.

8. Key Lessons to be Learned  Wide consultation is essential in the Development of any MIS in order for all stake holders to have ownership of the system  Implementation of the PMIS in MoHSS has strengthened monitoring and supervision of key aspects of pharmacy services  It has done this by providing practical tools for data collection and reporting that empowers managers at District, Regional and National level  Having a national system has raised the profile of Pharmacy issues in the MoHSS, bringing problem areas identified through PMIS to the attention of Regional & District Management teams  National level uses the results from PMIS to identify Districts and Regions needing additional support, as well as for ensuring equitable distribution of resources.

9. Implications of work done  The PMIS has had considerable positive impact on the use of medicines in Namibia in the 4 years since implementation.  These positive impacts are expected to continue and increase with time as systems are strengthened.  The Therapeutics Committees are essential to the successes shown from the PMIS; they provide a platform for discussion of problems identified as well as overseeing design & implementation of interventions.  Before implementation of PMIS Namibia was collecting information regarding pharmacy services by conducting National Medicine Use Surveys  These surveys required higher levels of staff and financial resources and no significant improvements in medicine use were being shown

10. Conclusions  The PMIS is an effective and cost efficient way of assessing medicine use situation and has resulted in improved use of medicines in Namibia.  PMIS has proved to be more beneficial than conducting National Medicines Use Surveys in terms of improved outcomes as well as reduced HR and Financial requirements  Other countries should seriously consider implementing such a Pharmacy Management Information System in order to strengthen management of pharmacy services and improve use of medicines and health outcomes

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