Strategic Pharmaceutical Management Information System for TB in the Dominican Republic
Medicinal and pharmaceutical public health interventions have less impact when shortages or losses occur. Health program supply managers frequently find themselves seeking the answers to two questions: (1) How many months' supply of medicines do I have in my warehouse? and (2) Is it time for me to begin my procurement process?
To assist managers in finding responses to these questions, the USAID-supported Strengthening Pharmaceutical Systems (SPS) program, led by Management Sciences for Health (MSH), has been providing technical assistance to the Dominican Republic's National Tuberculosis Program (PNTB) since 2008. Managers learn how to monitor central warehouse supply status by calculating, on a quarterly basis, the results for a single indicator: availability, expressed in months, as a function of consumption. (Availability, expressed in months, as a function of consumption, is equal to the amount on hand divided by average monthly consumption.)
Quarterly analysis of this indicator has made it possible to improve medicine availability in the health service network, thereby preventing shortages.
Intervention and Results
In 2007, the Dominican Republic experienced a shortage of antimalarial medicines throughout its entire health services network. The shortage was attributable to purchase orders not being placed until after safety stocks had been exhausted. The underlying cause -- subsequently identified -- was the absence of a supply management information system that would aid in planning pharmaceutical procurement and distribution.
In recent years, the Dominican Republic’s health system has been undergoing a process of reform that is hoped will spearhead a move away from a system of centralized administration to a system for the management of Regional Health Centers, and from multiple systems for the provision of medicines and pharmaceutical supplies to a single integrated system.
In July 2010, the Ministry of Public Health (MoH) approved the implementation of an Integrated Pharmaceutical Management System known as Sistema Único de Gestión de Medicamentos e Insumos (SUGEMI). SUGEMI’s work plan calls for the rollout of an information system for managing pharmaceuticals. To provide an immediate option for addressing the lack of information needed to effectively manage supply, the MoH decided to implement a strategic information system (SIS), too, based on the prior experience of the PNTB. This SIS would make available information for decision-making purposes and encourage a culture of supply information management that would support implementation of the SUGEMI information system over time.
The SIS calculates an indicator for determining the availability of a group of antituberculosis and antiretroviral medicines, as well as tracer medicines for general use. Every three months, regional warehouses and a sample of supervised care-providing facilities complete a form that enables them to determine the number of months for which they have on hand an adequate supply of medicines and, in this way, take appropriate steps to prevent shortages at the local level. This information is also forwarded to the central level, where it is consolidated with similar information from the central warehouses to obtain an indicator of availability at the national level.
Using this system, a central-level manager can manage a variety of scenarios. Determining how many months' supply of pharmaceuticals and related supplies are on hand at each level and in the country as a whole by gathering information for a single basic indicator makes it possible to prevent shortages, either by scheduling purchases on a timely basis or by redistributing stock on hand.