Improving Accessibility of ACT Medicines in Burundi

[Pharmacist Anitha Nduwimana at the Mutaho district pharmacy (photo credit: MSH). ]Pharmacist Anitha Nduwimana at the Mutaho district pharmacy (photo credit: MSH).

Health districts in Burundi are faced with many challenges, of which a complex requisition procedure, delays in artemisinin-based combination therapy (ACT) medicines delivery, and more frequent stock outs of ACT medicines are the most problematic.

“Before the revision of the requisition procedure of ACT medicines, Mutaho district pharmacy was facing multiple challenges, from high cost in managing the pharmacy (due to several factors such as trips to provinces and central offices for approval) to stock outs of the medicines, especially ACTs,” said Anitha Nduwimana, the Chief Pharmacist of Mutaho health district.

Initially, requisition was a complex, long, and expensive procedure. It required seven approval signatures on the purchase order before the medicines could be delivered by the Central Essential Medicines Stores (CAMEBU). Under the old system, after the order was prepared by the chief pharmacist, the requisition would be submitted first to the district’s finance officer and then to the chief medical doctor for approval. Then, at the provincial level, the same requisition had to be submitted to the medical director of the province for approval before being sent to the National Malaria Control Program (PNILP), the Global Fund/Principal Recipient (PR), and to the NMCP director for final approval; the requisition would then be submitted to the CAMEBU. Requisitioning ACTs would take 10-18 days. Stock outs were inevitable due to this long requisition process.

To tackle this issue, the Strengthening Pharmaceutical Systems (SPS) program with support of USAID, assisted PNILP with putting in place a monthly monitoring system for ACTs. The system clearly showed stock outs of ACTs at the health-district level, although enough stock was available at CAMEBU. SPS also helped key stakeholders (PNILP; Directorate of Pharmacies, Medicines, and Laboratories [DPML]; Global Fund/PR; WHO; and CAMEBU) improve ACT management by revising the requisition procedure, thereby reducing the delivery time.

The new requisition system now requires only five approval signatures (three at the district and two at the central levels) and mainly involves the district and PNILP. ACT requisition now takes 1-4 days, and the number of stock outs has tremendously decreased. In addition, SPS is advocating for a three-month security or safety stock of ACTs to reduce the transportation costs and allow district pharmacies to monitor management of ACTs at the health-facility level.