Effectiveness of pharmacy interventions in improving availability of essential medicines at the primary healthcare level

Abstract

Summaryobjective To assess the effectiveness of pharmaceutical systems interventions in improving the availability of essential medicines at the primary care level.methods Literature search for examples of pharmaceutical systems interventions in low and middle income countries that evaluated the impact of specific interventions on medicines' availability. Qualitative and quantitative studies were included.results Seventeen studies were included, on privatisation of drug distribution, user-fees, revolving drug funds (RDFs), supervisory visitation programmes, staff training initiatives, community-directed interventions (CDIs) and disease-specific drug programmes. We found no studies on non-monetary staff incentives or the use of national pharmacy standards. Generally, the quantity and quality of evidence was low; evidence was strongest for supervisory visitation programmes and CDIs.conclusion Several interventions have the potential for improving medicines' availability without requiring large-scale international cooperation or global policy change. The absence of evidence in this field does not prove lack of effect. There is a need for more systematic studies of multi-faceted pharmaceutical interventions to improve drug availability in the context of difficult health systems, such as structured supervision of remote health facilities, CDIs, staff training, integration of disease-specific programmes, implementation of national pharmacy standards, non-monetary staff incentives and measures to ensure cost is not a barrier to access. A standardised approach to measuring the availability of essential medicines is needed.

Effectiveness of a WHO Safe Childbirth Checklist Coaching-based intervention on the availability of Essential Birth Supplies in Uttar Pradesh, India

“…While other studies have also noted variation in supply availability across Uttar Pradesh and India, the global literature is less clear on interventions to address supply gaps that do not require implementing new supply chains or direct provision of resources. A systematic review analyzing the impact of interventions on medicine availability at the primary healthcare level found a variable degree of evidence and rigor [31]. Evidence was found that supervision visits in Zimbabwe strengthened primary health centers’ stock management though had limited effect on availability [32].…”

Primary healthcare policy and governance in low-income and middle-income countries: an evidence gap map

“…Community engagement was the second most prioritised area of intervention (n=7; IE=3, SR=4)27 31–36 followed by health system model (n=7; IE=1, SR=6) 20 31 34 37–40. Two impact evaluations and four systematic reviews addressed workforce supervision as a part of the performance assessment of health workforce 33 41–45. A few systematic reviews focused on infrastructure, including purchasing of new equipment, establishment of new PHC facilities and improvement of existing infrastructure such as size and availability of consulting rooms and availability of required equipment 24 26 27.…”

“…A few systematic reviews focused on infrastructure, including purchasing of new equipment, establishment of new PHC facilities and improvement of existing infrastructure such as size and availability of consulting rooms and availability of required equipment 24 26 27. Interventions related to user fees were rare33 46; one study reported on setting lower fees for receiving PHC compared with that of secondary healthcare, and another focused on standardisation of user fees for purchasing medicines. A small number of reviews considered referral,26 user–provider communication,26 public–private partnership33 and contracting out 47…”

“…Interventions related to user fees were rare33 46; one study reported on setting lower fees for receiving PHC compared with that of secondary healthcare, and another focused on standardisation of user fees for purchasing medicines. A small number of reviews considered referral,26 user–provider communication,26 public–private partnership33 and contracting out 47…”

Enhancing Equitable Access to Assistive Technologies in Canada: Insights from Citizens and Stakeholders

“…• Two high-quality reviews and one low-quality review assessed other cost-sharing mechanisms including the introduction of co-payments and found that they led to a reduction in medication adherence and resulted in potentially adverse health effects, which may require later treatment and have an impact on emergency department admissions, nursing home admissions, and outpatient care (Gemmill, Thomson, & Mossialos, 2008;Luiza et al, 2015;Sinnott, Buckley, O'Riordan, Bradley, & Whelton, 2013). • One medium-quality review assessed possible roles for the private sector in the procurement and distribution of pharmaceuticals, finding that well-funded, private, diseasespecific programs could improve the stock management of pharmaceuticals (Nunan & Duke, 2011). • Two reviews examined the use of social franchising for the delivery of services or products and found that they were able to effectively deliver services and products to local communities and resulted in an overall increase in the utilization of services (Beyeler, York De La Cruz, & Montagu, 2013;Nachtnebel, O'Mahony, Pillai, & Hort, 2015).…”