How One Pharmacist Can Make a Difference: Transforming Ethiopia’s Pharmaceutical Sector

How One Pharmacist Can Make a Difference: Transforming Ethiopia’s Pharmaceutical Sector

{Photo credit: Warren Zelman.}Photo credit: Warren Zelman.

This post originally appeared on the Frontline Health Workers Coalition blog.

Ayelew Adinew was working as a pharmacist in a large public hospital in Addis Ababa, Ethiopia. He looked around and saw that the 100-year old pharmaceutical system was broken.

There was no transparent and accountable system for providing the information needed for effective monitoring and auditing of pharmaceuticals and other commodities. There was not sufficient documentation to track consumption, inventory discrepancies, wastage, product over-stock or under-stock. There were no procedures to ensure the availability of essential medicines. The regulations were outdated and there was no enforcement of the relevant regulations in place to protect the safety of clients, ensure proper utilization of resources, and deter professional malpractice.

Physically, the pharmacy space was too small with no separate area for patient counseling. Essential equipment was missing and there was no transport for procurement. Managing medicines transactions had not been systematized; therefore the dysfunctional work flow was a deterrent to timely service delivery, convenience for clients, and the efficiency of the service provider. The pharmacy system clearly needed reform.

Ayelew Adinew stood on the frontlines of the pharmacy. He could see the fundamental transformation that was needed to fix Ethiopia’s broken pharmaceutical system. Ayelew decided that he could be a more effective agent of change in the public health sector and was hired as a technical specialist for the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. SIAPS, led by Management Sciences for Health, is a global health project that uses a systems-strengthening methodology to assure the availability of quality pharmaceutical products and effective pharmaceutical services. The end result is better health outcomes.

At SIAPS, Ayelew believed he would have the support to develop the tools needed to transform Ethiopia’s pharmacies into modern, well-functioning facilities that are auditable and accountable. SIAPS senior management, along with the technical staff, immediately recognized the value of Ayelew’s vision and gave him the support he needed to go forward with this transformative undertaking. According to Ayelew:

I was igniting the fire, SIAPS was adding the fuel.

Working with spreadsheets, Ayelew began to break down each of the steps in all of the processes of a working pharmacy. Ayelew mapped out the flow of medicines and supplies through a health facility system. He created new tools and forms such as vouchers, sales tickets, and dispensing registers to organize and record the information. The next phase was testing the new system.

Debre Markos Hospital is a large referral hospital located in one of the regional states. There, this new system was piloted and given the name, Auditable Pharmaceutical Transactions and Services (APTS). The pharmacy and accounting staff, including cashiers and auditors, were training on the APTS system.

Today, there is legislation in four regions requiring APTS implementation in all pharmacies. Also, the Federal Ministry of Health has signed a directive that covers the entire country requiring implementation of APTS.

One pharmacist, Ayelew Adinew, had a vision for fixing a broken pharmaceutical system that fell far short of serving the people of Ethiopia. With the help of his colleagues at USAID-funded SIAPS, the generosity of the American people, and the support of Ethiopia’s Ministry of Health and other partners in the government, Ayelew was able to rise to the level of a public health champion. Everyone wins.

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Gashaw Shiferaw
Congratulations Ayalew! As I know him, he is one the dedicated pharmacists in the country. He is the role model, genuine champion equip with professionalism! No one stop him except himself!! Congrats again!!
Ayalew Adinew
Thank you Annette for writing this information, behind this success, there are a teamworks and good leadership. There are many professionals who exerted their effort for APTS. I want to congratulate Dr Negussu Mekonnen, Hailu Tadeg and Edmealem Ejigu for their overall outstanding consultation and guidance they provided me for APTS implementation and Hall Laure for her meticulous editorial work of the APTS guide. All STAs and RTAs should also be congratulated for their unreserved effort they committed in their regions The Regional Health Bureau, Finance and Economic Development, Legal Audit bureaus, the Federal Ministry of Finance & Economic Development and above all the Federal Ministry of Health has been leading implementation, scale-up and legalization of the system. Let me start congratulating those who failed with me when the system was started; Dr Ameha, CEO of St Peter Hospital and Ato Asnake CEO of Bishoftu Hospital. That time, we thought that we failed, but we didn’t because we learned experience. Let me also congratulate champions: Ato Edmealem Admasu and Ato Shegaw from RHB and Ato Tariku, Chalachew and Habitamu for developing software for APTS. Ato Mezemir, wro Sewnet from ALERT and lawyers (Ato Merhatsidik, Ato Abere, Ato Asmamaw from Amhara) and Ato Belayneh and Ato Kifle from Southern nations, Mr Fewzi from Harari, Mr Mahadi from Diredawa, Mr Solomon from Addis Ababa RHB and Dr Abraham and Mr Regassa from FMOH should be congratulated. I cannot finish mentioning champions, really they are many. Congra all those including who are not mentioned here. This indicates that APTS is the result of a team work. In eight consultative workshops, various professionals; pharmacists, auditors, accountants, human resource managers, lawyers and CEOs of hospitals contributed their opinions. Therefore, at this point, the Federal Ministry of Health and Minstry of Finance , the Regional health Boreas and Finance bureaus are the owners of APTS. Successes are the result of good leadership and teamwork!! Congratulations all.
awoke lakew
I know MSH while I was in North Shewa, congratulations! i have initiated to write this comment after reading from google says how one pharmacist can make a difference . In this week, APTS is being implemented in ALERT Hospital, in which I am currently working. The pharmacy has been renovated in a fascinating way. The pharmacy has got entrance and exit and several windows. It was with two windows before this system, through which medicines were dispensed in a difficult manner and drug use counselling /information/were hardly reached to patients. Now I saw several counters in which pharmacists consult patients being face to face. This is a big change. Waw it is APTS! I saw labels also which says counselor, biller, and evaluator. I advise pharmacists, to work hard following footsteps of MSH. Dear MSH management. From this exercise, I realized that, the MSH management should be the best one. In this country, we do not acknowledge people. Thank you so much, all of you are champions, and the management is champion. Congratulations MSH and congratulations Ayalew for being the best performer. Thanks Dr. Awoke Lakew, MD, MPH, ALERT Hospital, physician

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