2. Improving Access to Essential Medicines through Public-Private Initiatives: The Case of the Catholic Pharmaceutical Service in Ghana

4. Background  Faith-Based organizations in Ghana  Provides 40% of all health services in Ghana  Catholic Health Service, the largest body provides 75% of mission sector health delivery  Catholic Health Services  Delivered through 31 hospitals, 66 clinics & maternity homes, 4 drug supply depots,  Situated mostly in rural areas in 18 autonomous dioceses  Access problems identified  Availability - drugs out of stock 35% of time  Affordability - Nearly a fifth of daily wage required to treat adult malaria in mission sector  Rational use - average of 5 items on a prescription

5. Project Objectives  Improve capacity of Catholic Pharmaceutical Service to achieve better pricing and more reliable supply service  Improve quality of prescribing and dispensing services by promoting the rational use of drugs

6. Key Interventions  Advocacy to get buy-in and consensus agreement on approaches for interventions  Baseline Survey on access dimensions of availability, affordability, quality of services  Re-engineered existing structures for pooled procurement system  Restricted competitive bidding as a means of procurement  Training in inventory management for facilities committed to pooled procurement

7. Interventions  Trained a team of 4 health professionals from each of 5 hospital on promoting RDU at health facility level using Drugs and Therapeutic Committees, in a ‘learn and do’ cyclic approach Adapting training Material – Local & Int’l Experts Selection of Facilities and DTC team Training ( 2-days) Implementation And Follow-up in Health Facility (8 weeks) Catholic Health Service DTC Design ‘Learn & do’ Cyclic Approach

8. Key Milestones  Procurement of essential drugs by tender has been instituted.  First Tender for 20 items yielded an average of 20% savings on price  DTC established in five facilities  Has specific mandate to promote the rational use of drugs

9. Lessons  Consensus building on implementation approaches critical for success  Prequalifying suppliers assures quality of products supplied  Procurement by tender provides significant savings  “Learn and do” cyclic approach to delivering DTC training effective in imparting skills to overburdened health professionals

10. Implications 1.Building Capacity and Structures for sustainable implementation of Program  Maintenance, sustainability vrs staff attrition  Providing Technical Assistance vrs Capital Investments  Ownership of program and commitment of implementing partner

11. Implications 2.Pooled Procurement Systems  Ability to enforce requirements of tender contracts  Supplier’s Delivery of Goods on schedule vrs Client’s Payment for Goods on time  Timely information flow for forecasting, procurement, payment and delivery decisions 3.DTC Program  Training  Skill development vrs information dissemination  Credible Expert Trainers, local/international  Providing support for institutional work

12. Future Studies  How to build capacity for sustainable implementation of programs  Ensuring equitable pricing of essential medicines  The effectiveness of DTCs as a vehicle for promoting RDU