Abstract:Background: Routine monitoring of medicine use is costly. Medicine use monitoring in most low- and middle-income countries is heavily reliant on donor support, which is not sustainable. Innovative models to close gaps in monitoring of medicine use are critical towards strengthening pharmaceutical services.Objective: To pilot an inter-institutional collaborative model for monitoring medicine use in Namibia over a three-year period, 2013–2015.Methods: An interventional analytical design that piloted an inter-ins… Show more
“…In Namibia, several medicine use surveys have suggested the inappropriate use of medicines across all levels of health care [3,4]. This is a concern as currently in Namibia over 45% of the adult population have hypertension [5], with cardiovascular diseases now a leading cause of death (21%) [5,6].…”
Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.
“…In Namibia, several medicine use surveys have suggested the inappropriate use of medicines across all levels of health care [3,4]. This is a concern as currently in Namibia over 45% of the adult population have hypertension [5], with cardiovascular diseases now a leading cause of death (21%) [5,6].…”
Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.
“…Details on the process of establishing Namibia’s first school of pharmacy is available in the program website [ 27 , 28 ]. A wide range of support to improve the quality of pre-service training for B Pharm students and pharmacist assistants was provided, including curriculum revision, recruitment of pharmacy lecturers, information technology assistance, accreditation and quality management system support [ 29 , 30 ]. Fig.…”
BackgroundMedicines use related challenges such as inadequate adherence, high levels of antimicrobial resistance and preventable adverse drug reactions have underscored the need to incorporate pharmaceutical services to help achieve desired treatment outcomes, and protect patients from inappropriate use of medicines. This situation is further constrained by insufficient numbers of pharmaceutical personnel and inappropriate skill mix. Studies have addressed individual capacity building approaches of logistics, supply chain or disease specific interventions but few have documented those involving such pharmacy assistants/professionals, or health workers/professionals charged with improving access and provision of pharmaceutical services. We examined how different training modalities have been employed and adapted to meet country-specific context and needs by a global pharmaceutical systems strengthening program in collaboration with a country’s Ministry of Health and local stakeholders.MethodsStructured, content analysis of training approaches from twelve selected countries and a survey among conveniently selected trainees in Bangladesh and Ethiopia.ResultsCase-based learning, practice and feedback, and repetitive interventions such as post-training action plan, supportive supervision and mentoring approaches are effective, evidence-based training techniques. In Ethiopia and Bangladesh, over 94% of respondents indicated that they have improved or developed skills or competencies as a result of the program’s training activities. Supportive supervision structures and mentorship have been institutionalized with appropriate management structures. National authorities have been sensitized to secure funding from domestic resources or from the global fund grants for post-training follow-up initiatives. The Pharmaceutical Leadership Development Program is an effective, case-based training modality that motivates staff to develop quality-improvement interventions and solve specific challenges. Peer-to-peer learning mechanisms than traditional didactic methods was a preferred intervention among high level government officials both within country and between countries.ConclusionInterventions must involve local institutions in the design and delivery of content for both pre-service and in-service training as well as web-based methods where feasible. Such efforts would meet the changing demand in the pharmaceutical system, and promote the ownership of the human capacity development interventions. The cost-effective partnership with universities demonstrate that competency based pre-service training will prepare the future pharmaceutical workforce with a critical foundation of knowledge and skills required to meet the growing demand for patient-centered pharmaceutical services in resource-constrained countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s40545-017-0104-z) contains supplementary material, which is available to authorized users.
“…A target of >80% of managers using data is ideal. 6,12,15,20,21,22 Quality of pharmaceutical care with respect to the model comprises dispensing medicines prescribed for the patient (target = 100%), 29 rational use of medicines supported by quality STGs, 16 compliance to NSTGs-recommended prescribing, adequate information to and counseling of patients on their medicines; dispensing medicines according to the pharmaceutical SOPs 38 MoHSS and public service who are responsible for timely procurement, quality storage, distribution, management, and efficient use of pharmaceutical supplies; recruitment, training, and retention of competent target HCWs to offer quality services.…”
Section: Sharing Feedback On the Reportmentioning
confidence: 99%
“…14,15 Implementation and surveillance of national PIS in resource-limited countries such as Namibia is largely donor-supported; this is not sustainable in terms of quality. 16,17 Thus, it is not surprising that limited utility of quality PIS data remains an important bottleneck to healthcare delivery in these settings in public healthcare. 18,19 Previously, the authors have described challenges with quality and utility of PIS data and indicators, as well as misalignment of PIS indicators with National Standard Treatment Guidelines (NSTGs) for Namibia implemented in 2011.…”
Background: Limited utility of quality health data undermines efforts to strengthen healthcare delivery, particularly in resource-limited settings. Few studies model the effective utility of quality pharmaceutical information system (PIS) data in sub-Saharan Africa, typified with weak health systems. Aim: To develop a model and guidelines for strengthening utility of quality PIS data in public healthcare in Namibia, a resource-limited setting. Methods: A qualitative model based on Dickoff et al. practice-oriented theory, Chinn and Jacobs’ systematic approach to theory, and applied consensus techniques. Data from nationwide studies on quality and utility of PIS data in public healthcare conducted between 2018 and March 2020 informed the development of the model concepts. Pharmaceutical and public health systems experts validated the final model. Results: Overall, four preliminary national studies that recruited 58 PIS focal persons at 38 public health facilities and national level informed the development of four model concepts. The model describes concepts on access, management, dissemination, and utility of quality PIS data. Activities to implement the model in practice include grass-root integration of real-time automated pharmaceutical intelligence systems to collect, consolidate, monitor, and report PIS data. Strengthening coordination, human resources, and technical capacity through support supervisory systems at grass-root facilities are key activities. PIS focal persons at health facility and national level are agents to implement these activities among recipients, that is, healthcare professionals at points of care. Guidelines for implementation of the model at point of care are included. Experts described the model as clear, simple, comprehensive, and integration of pharmaceutical intelligence systems at point of care as novel and of importance to enhance utility of quality PIS data in resource-limited settings. Conclusion: While utility of quality PIS data is limited in Namibia, advantages of the model are encouraging, toward building resilient pharmaceutical intelligence systems at grass roots in resource-limited countries, where there are not only weak health systems, but high burden of misuse of medicines.
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