Concepts of Essential Medicines

DR. THIDA HLADeputy Director (Medical Care)

Project ManagerMyanmar Essential Medicines

ProjectDepartment of Health

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.?

Essential Medicines

(WHO Definition)

Essential Medicines are "those that

satisfy the priority health care needs of the

majority of the population".

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.

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

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.

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.

The procurement of fewer items in larger

quantities results in more price competition and

economics of scale.

Quantification of medicines needs

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

Effective Medicines Supply Management

• Main components areSelectionQuantificationProcurement DistributionUse

Quantification

• Imbalance in quantification could lead to –High inventory–Stock outs

• Stock outs lead to –Local purchases–Poor image of the facility

Methods of quantification

1. The patient morbidity-standard treatment method(morbidity method)

2. The adjusted consumption method

(consumption method)

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

Comparisons of Two Methods

Method

Advantages Disadvantages

Consu- mption

-Good for hospitals (because Treatment is more complex)

-Does not encourage good morbidity recording

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

Comparisons of Two Methods

Method

Advantages Disadvantages

Morbi-dity

-Consumption data not required

-Good for new services

-More detailed calculation required

-Morbidity/STG required

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

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

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

• 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

Calculate the consumption of each drug

Opening Stock

Drugs Received

Closing stock

Consumption

+= -

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

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