Transforming Ethiopia's Health System with Data-Driven Pharmaceutical Services
The US Agency for International Development (USAID)-funded Systems for Increasing Access to Pharmaceuticals and Services (SIAPS) Program has partnered with the Government of Ethiopia to bring a 100-year-old pharmaceutical management system into the 21st century. The Auditable Pharmacy Transactions and Services (APTS) is a package of data-driven interventions that ultimately result in a continuous supply of essential medicines, optimal budget utilization, and improved pharmacy services. The system has worked so well that in July 2011, the Amhara Region in Ethiopia legislated the implementation of APTS in every hospital throughout the region.
Transforming Ethiopia’s Public Health System through Partnerships
During the past 20 years, Ethiopia’s public health system has undergone a remarkable transformation. Although physicians are in short supply, the number of other health professionals such as health officers, nurses, midwives, and health extension workers have significantly increased in the past five years. Since 2003, the number of pharmacists has increased almost tenfold—from 172 to 1,343 in 2012. The number of pharmacy technicians has doubled from 1,171 to 2,029 during the same time period. Preventive, promotive, and curative health services have improved and access to health services has increased tremendously given the country’s commitment to serving Ethiopia’s largely rural population. Overall coverage in 2000 was estimated to be 89.6 percent, a 25.6 percent increase from 1996 (World Health Organization, Ethiopia Country Pharmaceutical Profile and NPO, 2012).
Although there is still much work to be done, Ethiopia’s public health system is moving forward to meet the needs of Africa’s second largest country. One reason for Ethiopia’s successful transformation is the importance the government attaches to forging successful partnerships with donors and stakeholders.
The SIAPS program, and its predecessor program, Strengthening Pharmaceutical Systems (SPS), has forged a successful partnership with the Government of Ethiopia to transform its antiquated pharmaceutical system. USAID/SIAPS not only works with the Ministry of Health at the federal level, but with the Regional Health Bureaus and the Regional Finance and Audit Bureaus as well.
Auditable Pharmacy Transactions and Services (APTS) and drug and therapeutics committees (DTCs) are the best opportunity and initiatives to improve facility level drug management and availability.
~His Excellency Dr. Kesetebirhan Admasu, Ethiopian Minister of Health
Transforming Ethiopia’s Pharmaceutical System and Services
One of the most important areas of collaboration between the Government and SIAPS is making pharmaceutical transactions and services transparent and accountable. Up until recently, pharmaceutical records were based on a system developed 100 years ago and did not even remotely address the needs today’s pharmaceutical practices. The system was so entrenched in the pharmaceutical sector that only after years of engagement and advocacy was there a consensus for change.
A breakthrough came in 2010 when SIAPS worked with the Ministry of Health to write the chapter on pharmacy services for the Hospital Reform Implementation Guidelines (EHRIG). To implement the new pharmacy standards laid out in EHRIG, SIAPS developed APTS—a series of interventions to modernize the way pharmacies do business. APTS ensured accountability and transparency at all points of pharmacy transactions, information management, finance, and services.
SIAPS piloted APTS at the Debre Marcos Hospital in the Amhara Region. SIAPS, in collaboration with the Amhara Regional Health Bureau, worked with pharmacy and accounting staff to completely revamp the old system through APTS to set up a comprehensive, data-driven system that links patient records, stock inventory, distribution, storage, and procurement. APTS can also be used to evaluate the services provided by the facility.
The following are some preliminary results from supervisory visits at the Debre Marcos Hospital:
- A new medicines list takes into account the disease pattern and health needs of the catchment population.
- Implementing an ABC value analysis and identifying medicine use problems has made the procurement and use of medicines evidence-based.
- The percentage of medicines procured according to the hospital-specific medicines list increased from 35.4 percent to 97.5 percent.
- Products both at the store and dispensary can now be physically inventoried continuously.
- Financial resources available for medicines procurement increased by 89.1 percent between June 2010/11 and June 2011/12 due to the high turnover of medicines and the substantial retention of income from medicines sales.
- Internal and external audit reports indicate that wastage of medicines due to misuse, theft, and pilferage has significantly decreased.
- Expiry of medicines was reduced dramatically. Since December 2011, expiry of medicines has consistently been below 2 percent, the most recent figure being 0.5 percent.
- The availability of indicator medicines has increased over time to 100 percent.
- A robust system that ensures transparent and accountable transactions is in place, enabling effective auditing.
- Outpatient pharmacies were reorganized and workflow and dispensing counseling services have improved.
- Improved patient satisfaction with services provided has reached 85 percent in 2012.
- Initiation of pharmaceutical care services for patients with chronic illnesses in a separate private counseling and dispensing room resulted in improved documentation and adherence to treatment.
Promoting National Ownership through Successful Partnerships
The Ethiopian Government has taken the concept of partnership to a level that promotes national ownership and, in turn, sustainability. Recognizing the power of collaborative partnerships to meet the challenges of development, the Government has structured its Health Sector Development Program to maximize coordination with its partners and stakeholders, building on their collective strengths and resources. The Government of Ethiopia has succeeded in both driving the development of the country’s health sector while embracing the assistance of the international community and domestic partners.
Today, USAID/SIAPS is scaling up the use of APTS in hospitals throughout other regions—including the Amhara, Tigray, Addis Ababa, Oromia, and the Southern Nations and Nationalities Peoples Region. It is expected that these regions will legislate APTS implementation, following the precedent set by the Amhara Region.
The SIAPS Program is led by Management Sciences for Health (MSH) with four core partners and a group of specialized resource partners. In 2013, the SIAPS Ethiopia team won an innovation award from MSH for its work in helping to transform Ethiopia’s pharmacy sector.