1. KNH MTC SYMPOSIUM Optimizing medicine use to improve patient outcomes Dr S Muniu

2. MEDICINES PROCUREMENT THE KNH EXPERIENCE BACKGROUND PRIOR TO 2005 Restricted budget Procurement and prescribing by brands previously Procurement methods used were not clear and subject to influence

3. Cont’d Tender management practices(PPOA act 2005 and regulations 2007)decision making was haphazard and interest oriented, TECs not a challege Few choices,20-30 suppliers mainly originator products Suppliers increased to over 100 after market liberalization by the Government

4. GAPS IDENTIFIED IN 2005 Brands prescribing and procurement Vendor influence to prescribers and procurement as there was no medicines list and no restrictions Counterfeits rampant due to parallel imports Non adherence to budget

5. Cont’d No systematic quantification Lack of transparency

6. CORRECTIVE ACTION TAKEN Review of tender specifications with clear evaluation criteria including PPOA guidelines and statutory requirements Incorporation of WHO/International guidelines and requirements especially for biological products and their equivalents PPB regulations enforcement

7. CORRECTIVE ACTION TAKEN Multidisciplinary evaluation committees Enforcement of PPOA regulations Enforcement of statutory compliance Created prescribing levels with colour coded prescriptions Creation of consumption levels and reorder levels KNH formularly

8. Cont’d Generic prescribing and controlled advertising eg elimination of postering on walls Pre Bid conferences to consult with suppliers and enhance compliance Donation and Med Repping guidelines were formulated

9. OUTCOMES/ACHIEVEMENTS Rational medicines use Budget control and regulation Elimination of counterfeits Reduction of wastage from expiries and overstocking Reduction of number of vendors and products to be evaluated to less than 60

10. Cotn’d Elimination of counterfeits, pararell importers and briefcase suppliers Restriction of management influence Support to the National regulatory body Elaborate supplier and product evaluation Instituted a recall system through our pharmacovigilance team for poor quality medicines

11. CURRENT CHALLEGES Vendors influence Non adherence to the formularly PPOA regulations too general with no consideration for hospital emergencies. Too many products registered in the country- challenges of evaluation and selection Analysis facilities too expensive

12. WAY FORWARD/THE FUTURE Implement quality management issues of mutually beneficial supplier relationships. (pre bid conferences., joint agreements and extended contracts, regulated vendoring Procurement automation policy Health Policy Vision 2030 ; Outsourcing the way to go. Pooled sourcing and procurement- MEDS. MOH. Joint Medical stores in Uganda and Tanzania, KNH- Pooled EA sourcing??

13. THANK YOU