3rd Partners Meeting on Better Medicines for Children. Update Ecumenical Pharmaceutical Network / EPN
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1 3rd Partners Meeting on Better Medicines for Children Update Ecumenical Pharmaceutical Network / EPN Albert Petersen Difäm - Tübingen EPN board chair November 2011
2 BOOK-PROJECT
3 Altogether: 1204 Hospitals 16 Countries 2088 times 3 books Hospitals schools etc 1 Cameroon CBC Chad Koyom 8 3 Ethiopia ECS 20 4 Ghana CHAG 49 5 Kenya MEDS Liberia CHAL 12 7 Malawi CHAM 56 8 Namibia CHS 12 9 Nigeria CHAN Medi Sierra Leone CHASL South-Africa St. Mary Hospital 1 12 Tanzania MEMS Tanzania medeor Uganda UPMB Zambia CHAZ Zimbabwe ZACH India CMAI ( 439)
4 EPN Surveys: Access to CM in Health Facilities Kenya / Uganda / Chad / Ghana (more to follow if funds available)
5 Multi-country study on availability and pricing of selected childrens medicines in FBO-Drug Supply Organisations
6 Participating 12 DSOs Abbreviation Name Country BUFMAR Bureau des Formations Médicales Agréés du Rwanda Rwanda CBC Cameroon Baptist Convention Cameroon CDC Catholic Drug Centre Ghana CDMU Community Development Medical Unit India CHAM Christian Health Association of Malawi Malawi CHAN Christian Health Association Nigeria Nigeria CHAZ Christian Health Association Zambia Zambia JMS Joint Medical Store Uganda MEDS Mission of Essential Drugs and Supplies Kenya MEMS Mission for Essential Medical Supplies Tanzania PEK Pharmacie Evangélique de Koyom Chad PCC Presbyterian Church in Cameroon Cameroon
7 Differences between12 DSOs Pharmac. trained staff: from 1 to 26 Price list based on NML 11 (12) Medicine offered from 43 to 412 Customers from 25 to 2000 Exporting 3 (12) Value of medicines from to
8 18 key medicines 30 dosage forms Core WHO EMLc 2011 Available? - in line with National Medicine List? -Standard Treatment Guidelines? Price?
9 Challange: Lists / Guidelines outdated Country National Medicine List Standard Treatment Guideline Cameroon 2001? Chad 2004? Ghana India 2011? Kenya Malawi Nigeria Rwanda Tanzania Uganda Zambia -?
10 Availability accoring EMLc 2011 Country DSO Theoretically Theoretically Classification available available [%] Cameroon CBC 15 83,33 High Cameroon PCC 17 94,44 High Chad PEK 10 55,56 Fairly high Ghana CDC 10 55,56 Fairly high India CDMU 11 61,11 Fairly high Kenya MEDS 16 88,89 high Malawi CHAM 8 44,44 Low Nigeria CHAN 12 66,67 Fairly high Rwanda BUFMAR 11 61,11 Fairly high Tanzania MEMS 12 66,67 Fairly high Uganda JMS ,00 high average 12,73 70,71
11 Availability accoring present NEML Country DSO Theoretically available % Classification Cameroon CBC 10 (11) 91,00 High Cameroon PCC 11 (11) 100,00 High Chad PEK 8 (10) 80,00 Fairly high Ghana CDC 12 (15) 80,00 Fairly high India CDMU 12 (16) 75,00 Fairly high Kenya MEDS 14 (16) 88,00 high Malawi CHAM 10 (14) 71,00 Fairly high Nigeria CHAN 9 (12) 75,00 Fairly high Rwanda BUFMAR 9 (13) 69,00 Fairly high Tanzania MEMS 12 (14) 86,00 High Uganda JMS 15 (15) 100,00 High total 83,18
12 Availability acc. WHO-EML and NML
13 Treatment possible according IMCI guidelines? Diarrhoea Country DSO ORS Zinc sulphate Treatment possible? Cameroon CBC - No Cameroon PCC - No Chad PEK Yes Integrated Management of Childhood Illness Ghana CDC - No India CDMU - No Kenya MEDS Yes Malawi CHAM - No Nigeria CHAN - No Rwanda BUFMAR - No Tanzania MEMS - No Uganda JMS Yes Total
14 Treatment possible according IMCI guidelines? Pneumonia Country DSO Cotrimoxaz ol Ampicillin Gentamicin Ceftriaxone Treatment possible? Cameroon CBC Yes Cameroon PCC Yes Chad PEK Yes Ghana CDC - No India CDMU Yes Kenya MEDS - No Malawi CHAM Yes Nigeria CHAN - - No Rwanda BUFMAR - No Tanzania MEMS Yes Uganda JMS Yes Total
15 Treatment possible according National Guidelines? Pneumonia Ghana 2010 Kenya 2009 Rwanda 2007 Uganda 2010 Tanzania 2007 Malawi 2009 Nigeria 2008 Amoxicillin < 2 month: Penicillin+Gentam icin Amoxicillin Cotrimoxazol Cotrimoxazol Amoxicillin Amoxiclav Treatment possible possible possible possible possible possible possible
16 High availability Offered by all DSOs Amoxicillin oral liquid 125mg/5ml//50mg/5ml Amoxicillin solid oral dosage form 250mg/500mg Oral Rehydration Salt Gentamicin Injection 10mg/20mg/40mg/80mg
17 High availability Offered by 9/11 DSOs Ciprofloxacin tablets 500mg Cotrimoxazol tablets 120mg/480mg Ampicillin powder for injection 500mg/1g Benzylpenicillin powder for injection 600mg/3g Ceftriaxone powder for injection 250mg/500mg/1g Phenoxymethylpenicillin tablets 250mg
18 Fairly High availability Amoxicillin + Clavulanic acid tablets 375mg/625mg 6/11DSOs Procainbenzylpenicillin powder for Injection 1g/3g 6/11 DSOs Cotrimoxazol oral liquid 240mg/5ml 8/11 DSOs Artemether Oily Injection 40mg/80mg//ml 6/11 DSOs Artemether + Lumefantrine 20mg + 120mg tablets 7/11 DSOs Doxycycline caps/tabs 100mg 7/11 DSOs Sulfadoxine + Pyrimethamine tablets 500mg+25mg 8/11 DSOs
19 Low availability Amoxicillin + Clavulanic Acid oral liquid various dasoages > 4/11 DSOs Ciprofloxacin solution for IV infusion2mg/ml 4/11 DSOs Artemether + Lumefantrine dispersible tablets 20mg+120mg 4/11 DSOs
20 Low availability Artesunate Injection 1/11 DSOs Artesunate rectal dosage form 1/11 DSOs Artemisinin combination tabs 4/11 DSOs Zinc sulphate tablets 20mg 3/11 DSOs
21 MSH median price per unit in 2010 BUFMAR CBC CDMU MEDS MEMS JMS CDC CHAM CHAN PEK median ratio per medicines Ratio of the DSO price to MSH median price Generic name/dosage Amoxicillin 125mg/5ml Sus Amoxicillin 250mg tab Amoxicillin 500mg tab Ampicillin 1000mg Injection Ceftriaxone 1000mg Injection Ciprofloxacine 500mg tab Cotrimoxazol 240mg/5ml Sus Cotrimoxazol 480mg tab ORS 1l Phenoxymethylpenicillin 250mg tab Doxycyclin 100mg cap 0,003 1,848 2,394 0,758 0,667 0,879 0,727 1,212 1,242 1,182 17,727 0,014 1,007 1,589 3,794 0,667 1,184 0,539 0,872 1,383 1,596 0,024 0,602 1,906 3,893 0,770 1,873 1,176 1,344 0,128 1,255 2,267 1,697 0,835 1,653 0,292 5,438 1,329 1,780 0,993 3,340 1,635 8,769 2,611 0,024 1,295 5,068 3,924 0,907 0,755 0,523 2,025 3,540 1,806 0,002 2,286 4,143 1,000 1,381 0,905 1,000 1,952 2,000 2,476 0,007 1,056 1,549 1,338 0,803 0,972 0,831 1,408 1,127 0,887 1,521 0,035 2,740 3,571 5,949 2,103 0,903 1,786 1,737 3,229 9,383 0,011 1,252 2,937 0,739 0,946 0,784 1,180 1,423 1,577 0,010 0,865 2,663 1,288 0,712 0,923 0,721 0,673 1,212 1,197 1,184 1,344 1,653 2,196 1,806 1,952 1,092 2,740 1,216 0,894 Max. 2,740 5,438 5,949 1,329 2,103 0,993 3,340 1,952 8,769 17,727 2,740 Min. 0,603 1,549 0,758 0,667 0,714 0,523 0,835 0,673 0,887 1,191 0,894 Median 1,254 2,663 3,794 0,770 1,078 0,784 1,408 1,313 1,510 1,806 1,344
22 Stock-Outs I 7 6 In 10 out of 11 participating DSOs stock-outs occured CDC CBC CHAN JMS MEMS Koyom PCC MEDS BUFMAR CHAM CDMU
23 Way forward: > Filling the gaps > Moving prices further down, e.g.pooled procurment > Strengthening networking/information among DSOs and between DSOs < >facilities > Strenghtening DSOs by using them
24 Thank you for listening www.
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