Improving Service Delivery and Accountability through Drug and Therapeutics Committees: The Case of Bishoftu General Hospital
Dagnachew Hailemariam has worked at Bishoftu General Hospital for six years. The hospital, located 45 km south of Addis Ababa in the town of Bishoftu, is state owned and provides services to between 400 and 500 patients per day. Likewise, the hospital pharmacy receives orders for around 400 to 500 prescriptions per day.
“Six years ago, we were operating in the dark,” Hailemariam, now the hospital’s head pharmacist, recalls:
We had no procurement system for medicines, which means we bought medicines that were not essential. Many of those expired and disposing of them was a challenge. On the other hand, we ran out of essential and even vital medications—stock-outs that could have resulted in loss of life. At that time, we relied a lot on guesswork.
Since 2009, the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS) and its predecessor, Strengthening Pharmaceutical Systems (SPS)—both implemented by Management Sciences for Health (MSH)—have provided support to Bishoftu General Hospital in establishing and strengthening a Drug and Therapeutic Committee. This committee works closely with the hospital management to ensure that patients are provided with the best, most cost-effective care possible by addressing issues such as availability and rational use of medicines.
Through the systems and guidelines put in place with the help of the hospital’s Drug and Therapeutic Committee, which was established in 2009, the hospital has decreased the expiry rate from 20 percent in 2009 to 4.5 percent in 2015—significantly cutting medication costs and increasing patient satisfaction from 55 percent to 90 percent in the same period.
“We have come a long way,” Hailemariam says:
We have our own drug list now; and we use the ABC/VEN reconciliation mechanism by which we determine which drugs are needed the most and which drugs we should order in large amounts.
The system is computerized now—all the information we need is at our fingertips. A few years ago, we followed a tiresome and unreliable system of counting and tracking bin cards and prescription information manually.
Hailemariam says the establishment and improvement of systems related to medicine selection, prioritization, procurement, prescribing, dispensing, and use has also helped him on a personal level. “I can take accountability for what I do now since there is a system that enables me to do that,” he says. “I can handle complaints, respond to inquiries, and carry out my duties with confidence.”
Desalegn Baysa, the chief executive officer of the hospital, says one of the major achievements of the Drug and Therapeutic Committee is the establishment of systems of accountability for individuals and teams. This has led to considerable changes in the quality of health care service delivery due to improved availability and accessibility of pharmaceutical products, Baysa says.
Through the continued assistance of USAID/SIAPS, the Drug and Therapeutic Committee of Bishoftu hospital established a Drug Information Service (DIS), which provides unbiased information on medicines to both practitioners and patients. The committee also created a system of standardizing prescription and published guidelines in support of rational use of medicines. Baysa says:
Our hospital has become the health care provider of choice for many people in and around the town because of the progress we’ve made in the last few years. We hope to do more in the coming years in collaboration with USAID/SIAPS.