RAVREDA – AMI USAID Project report, Colombia

2009

SUPPLY CHAIN MANAGEMENT OF MALARIA MEDICINES & SUPPLIES, Supervision Tool pilot test experience

in GUYANA

Regions and facilities visited

Region Facilities visited Date of two visits Persons trained Designation 1 Mabaruma Hospital,

White Water HP

April 18,2008 & August 25-27,

2008

Loretta Thomas Tiffini Gordon Lorraine Gilkes Howard Wilis

Malaria Supervisor Pharmacy Assistant Regional Health Officer MEDEX

7 Bartica Hospital, Karrau Creek, HP

Itaballi HP

April 24,2008 &August 20,2008

Dolly Clemenson Antonio Jacobis Merlene Ferrier

Lester Valentine

Malaria Supervisor Pharmacy Assistant Regional Health Officer MEDEX

9 Lethem Hospital, Karasabai HcTiger Pond, HP

April 1,2008 & August

11-13, 2008

Maurice Phillips Mary Ng-a Fook Urmilla Sandy Eugene Xavier

Malaria Supervisor Pharmacy Assistant Multipurpose Technician Regional Health Officer

Region 7 Bartica Hospital, Karrau Creek H.postItaballi H post

Region 9 Lethem Hospital,Karasabai H.postTiger Pond, H.post

Region 1 Mabaruma Hospital, White Water H post

Region 8 HospitalTumatumari,

Health Post

Republic of Guyana, Regions and places visited in the course of pilot test of supervision tool.

IDENTIFIED PROBLEMS

IDENTIFIED PROBLEMS INTERVENTION/ RECOMMENDED

Quality Assurance :Unable to determine the percentage required for recheck

Retraining required

Inventory Management No stock ledgers present

Retraining on inventory management is recommended

Treatment Book :No patient records seen Supervision of the facilities is recommended.

Reporting forms :No forms present ?

IDENTIFIED PROBLEMS

IDENTIFIED PROBLEMS INTERVENTION/ RECOMENDED

Number of Blood Smears;Most of the health facilities do not maintain a record

Inmediate intervention provision a book,

Quality Assurance: Slides are not sent for revision

An arrangement should be implemented for transport of slides for recheck, purchase slides boxes

Inventory Management: All facilities have stock ledgers but no records of medicines are maintained. Itaballi is using Issano CRIV book. Filing of CRIV’s are not done.

Retraining on inventory management is recommended,, make an arregement to each facilites ro receive the book

Treatment Book: No treatment book seen Supervision of the facilities is recommended.

Notification Records :No notification records seen (ddayly reporting form

Copies of notification records must remain at the facility, Notificataion form to RHO

9 total health facilities supervised (two visits)

• % of medicines available at the time of the visit 60 %• % of medicines in enough amount to cover requirements until next delivery

100 %• % of laboratory supplies in adequate amount until next delivery 67 %• % of all the health facilities visited that had on each and every one

medicines at the time of the visit 100 %• % of all the visited establishments that having all medicines in sufficient

amount to cover requirements until next delivery 33.3%• % of all the health facilities visited having on all the necessary supplies of

laboratory. 100 %• % of all the health facilities visited that counted on supplies of laboratory in

sufficient quantity to cover requirements until next delivery. 66.6 %

Availability and usage of medicines: Indicators

Conclusions • Indicators pilot attends revealed a low percentage because no second visit were made to 2 facilities in

region 9• Answering questionnaire amount to 1 – 1.5 hrs• Most questions require verification with documents• Application of the supervisory tool at the facility level indicates that the tool proved to be well

understood by both interviewer and interviewee, it provides the relevant data and it assists the stratification process according to needs However

• It may be difficult to apply on a routine basis due to transportation problems.• Further, it is evident that supervisory visits are inadequate in the region. This may be as a result of:-

• Lack of transportation• Lack of funding to purchase transportation services• Lack of communication between departmental heads• Failure to develop, integrate and /or implement cohesive work plans• Inadequate monitoring of CRIV requests for medicines and supplies.Submission of weekly reports i.e

• unclear directive as to where to submit weekly reports eg.7• inadequate monitoring of weekly reports submission

Strengths• The tool accurately reflect the situation in the facility and the Region• Assist in identification and solve or problem Collects data that compliments decision making• provide corrective feed back to identified problems on supervisory visit • provide opportunity for on – the job training.

RECOMMENDATIONS

• The Malaria program is now part of the Primary Health Care Services, therefore the following recommendations are proposed.

• Development of an integrated work plan.• Education of health workers at sub–regional level,

emphasis on:-– Medicines & diagnostics availability for prompt diagnosis and

treatment.– Relationship between forecasting for planned activities and

availability of Medicines & supplies.• Quality control • Increased Supervisory visits to health facilities