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Concepts of Essential Medicines
DR. THIDA HLADeputy Director (Medical Care)
Project ManagerMyanmar Essential Medicines
ProjectDepartment of Health
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Misleading beliefs towards Essential Medicines
• Cheap medicines• Medicines for health center• Medicines for poor people• Medicines for paramedics• Medicines for general practitioners• Medicines for mild diseases, they do not work for severe diseases.• Etc.?
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Essential Medicines
(WHO Definition)
Essential Medicines are "those that
satisfy the priority health care needs of the
majority of the population".
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Therefore should be available at all times, in adequate amounts, in appro- priate dosage forms and at a price that the individual and the community can afford.
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Concepts of Essential Medicines
1. Access- equitable availability and affordability of essential medicines
2. Quality- the quality, safety and efficacy of all medicines
3. Rational Use of Medicines
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Use of a limited number of carefully
selected medicines based on agreed clinical
guidelines leads to a better supply of
medicines, to more rational prescribing and to
lower costs.
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Essential Medicines which are selected on
the basis of safe and cost-effective clinical
guidelines, give better quality of care and better
value for money.
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The procurement of fewer items in larger
quantities results in more price competition and
economics of scale.
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Quantification of medicines needs
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Why we need to quantify the medicines
need?• Armament in health services
• Available of good quality, safe and less expensive medicines all the time
• Part of a sequence of inter- dependent steps in the medicines supply management system
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Effective Medicines Supply Management
• Main components areSelectionQuantificationProcurement DistributionUse
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Quantification
• Imbalance in quantification could lead to –High inventory–Stock outs
• Stock outs lead to –Local purchases–Poor image of the facility
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Methods of quantification
1. The patient morbidity-standard treatment method(morbidity method)
2. The adjusted consumption method
(consumption method)
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Comparisons of Two Methods
Method
Advantages Disadvantages
Consu- mption
-Morbidity data not required
-Requires less detailed calculations
-Difficult to review prescribing habits
-Difficult to get consumption data for new facilities
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Comparisons of Two Methods
Method
Advantages Disadvantages
Consu- mption
-Good for hospitals (because Treatment is more complex)
-Does not encourage good morbidity recording
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Comparisons of Two Methods(cont’d)
Method
Advantages Disadvantages
Consu- mption
-Reliable if consumption is well recorded and stable
-Unreliable if there have been long stock-outs
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Comparisons of Two Methods
Method
Advantages Disadvantages
Morbi-dity
-Consumption data not required
-Good for new services
-More detailed calculation required
-Morbidity/STG required
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Comparisons of Two Methods
Method
Advantages Disadvantages
Morbi-dity
-Based on rational prescribing
-Motivate morbidity recording
-Results may differ from actual supply
-Estimate only the quantities needed to dispense to patients
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The patient morbidity – Standard treatment
method
• This method starts from two sets of data:The number of episodes of
each health problem treated by the type or types of facilities
Standard treatment schedules agreed for each health problem
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Quantity of drug specified for a standard course of treatment
No. of treatment episodes of the health problem
Total quantity of a drug required for a given health problem
X =
This calculation is repeated for each health problem and its
corresponding drugs
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• Calculate the quantity of each drug required in the next procurement period
• Adjust for expected changes in consumption pattern
• Adjust for losses• Compile decentralized
quantifications (if applicable)• Estimate costs for each drug and
total costs• Compare total costs with budget and
make adjustments
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Calculate the consumption of each drug
Opening Stock
Drugs Received
Closing stock
Consumption
+= -
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Adjust for avoidable wastage and losses
• Drugs destroyed by damp, time expired, batch seized for poor quality, unaccounted
• Should not exceed 5-10% in a well run pharmacy or store
Avoidable wastage
-Recorded consumption
=Consumption adjusted for avoidable wastage
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Estimating the safety stock
• Safety stock is the quantity of stock used on average during the average lead time from the current supplier.
For calculation:SS = LT X CA
Where SS=Safety stock
LT=Lead Time
CA=Average Consumption
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