MSH's RPM Plus child survival team has developed tools to assess strengths and weaknesses of pharmaceutical management in support of child health. These tools can be adapted to address specific needs and provide structured approaches to strengthen pharmaceutical systems. Pharmaceuticals are essential to reduce child mortality and morbidity but also to permit health workers to carry out their work effectively and to create confidence in the health care system.
Having assessed the strengths and weaknesses of the pharmaceutical management system for childhood illness, the next and essential steps of RPM Plus systematic approach are to identify priority problem areas with stakeholders, explore reasons for the problems and select interventions, and develop and implement improvement strategies.
Drug Management for Childhood Illnesses (DMCI)
The DMCI tool assesses the strengths and weaknesses of pharmaceutical management on a national level primarily in the public sector pharmaceutical system from a nationwide sample of facilities from central storage facilities to peripheral curative facilities.
Information is gathered on selection and procurement of pharmaceuticals at central level, availability of pharmaceuticals at storage and curative facilities, and use of pharmaceuticals in public curative facilities and private pharmacies.
Data collected from review of stock cards and prescriptions, observations of patient consultations, exit interviews with caregivers, and simulated purchases are used to calculate a series of indicators from which the priority problems can be identified.
To date DMCI assessments have been conducted in Guinea, Senegal, Uganda, and Zambia.
Community Drug Management for Childhood Illnesses (C-DMCI)
Recognizing that many caregivers seek medicines outside of the public sector and any interventions implemented only in the public sector would have limited impact, RPM Plus in collaboration with AED and the Drug Policy Research Group of Harvard Medical School, developed an assessment tool to study medicine availability and use in the community for childhood illnesses (the C-DMCI). Sampling information, indicators and questionnaires for a "malaria only" assessment are also provided in the manual.
The indicator-based tool assesses medicine use and availability at community level and the practices of caregivers as well as of key providers of medicines
The assessment tool is designed to be relatively easy to use by local health managers and the data are designed to be collected by lay data collectors, such as school teachers, using structured interviews with providers and sellers of medicines as well as with caregivers of recently sick children.
The childhood illness version of the community assessment tool was used in Senegal, Peru and DRC.
- Senegal Assessment: Community Drug Management for Childhood Illnesses 2002
- Peru Assessment: Community Availability and Use of Medicines for Childhood Illnesses (Loreto and La Libertad Regions) 2003
- DRC Assessment: Community Drug Management for Childhood Illness 2006
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The C-DMCI has also been used in Cambodia to assess community drug management for childhood illnesses (report in progress) and the malaria version of the tool was used on the Cambodia—Thai border (2002) and in Zambia (2003) (reports pending). In Rwanda, tools from the C-DMCI were adapted to use during the evaluation of the home-based management of malaria (HBM) program for children under five.
- External Evaluation of the Pilot Phase of the HBM of Malaria Program in Rwanda 2007
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Other Tools under Development
- Managing Medicines and Supplies in Child Survival Programs—An Action-Oriented Program Guide for Child Survival Program Managers
Developed collaboratively by RPM Plus and BASICS, for program managers who are involved in IMCI, malaria, acute respiratory infection, diarrhea, or nutrition programs, this "how-to" guide leads managers through the steps involved in improving the management of medicines and supplies. It contains simple ways to collect information and evidence of supply problems with suggestions of observations to make and how to advocate or intervene to improve pharmaceutical management for child survival.
- District DMCI Monitoring Tool
The District DMCI tool is being developed by adapting and simplifying the DMCI, to allow district managers to determine the strengths and weaknesses of their pharmaceutical management system using a simple tool to establish a baseline for selected indicators and monitor availability and or use of medicines. The tool could also be used to assess the impact of the interventions.
- Improving Community Use of Medicines in the Management of Child Illness: A Guide to Developing Interventions
A guide of evidence-based interventions to improve pharmaceutical management for child health in public and private sector and at household level. The guide will orient planners at all levels (central, regional, and district) in the process of selecting interventions and will give clear steps on how to implement evidence-based interventions in their context.
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