MSH Presents Its Achievements in Pharmaceutical Management

As the Rational Pharmaceutical Management (RPM) Plus Program draws to a close, the Program Director, Dr. Douglas Keene of MSH, reviewed the successes of almost a decade of contributions to improved pharmaceutical management. He spoke at the annual conference of the Global Health Council in Washington, DC, on May 28, 2008.

Getting Help to People in Need

In countries where medicines, supplies, and equipment are urgently needed, often in remote places with difficult terrain and few roads, RPM Plus began in 2000 to help ensure access to high-quality medicines for millions of people. The program addressed gaps in all aspects of pharmaceutical management, with an emphasis on the health issues that plague developing countries—HIV & AIDS, malaria, tuberculosis, childhood illnesses, and reproductive and maternal health—and on the emergence of antimicrobial resistance. The process of getting lifesaving medicines into the hands of the people who need them begins with selection of the appropriate medicines, followed by cost-effective procurement. The process continues with supply management by trained staff using effective systems, and ends with proper use of appropriate medicines by patients. Vital health commodities include antiretrovirals to treat AIDS, contraceptives to reduce unintended pregnancies, and vaccines and other medicines to protect children from infectious diseases. They also include insecticide-treated bed nets to prevent malaria and medicines to treat tuberculosis.

Working Globally, Regionally, and Locally

To close the gaps that arise throughout the pharmaceutical management system, RPM Plus assistance took the form of global technical leadership, technical assistance to health programs and services at all levels in countries around the world, capacity-building of local organizations, and development and dissemination of guides and tools. At the global level, RPM Plus technical leadership has led to better containment of antimicrobial resistance, increased use of effective strategies to combat child mortality, updating of the first-choice treatment for malaria, and improved awareness of the crucial role of pharmaceutical management in detecting and curing tuberculosis. At the regional and country level, RPM Plus technical leadership has helped scale up treatment for people living with AIDS through its support to the US President’s Emergency Plan for AIDS Relief, among other accomplishments.

Making Strides in Africa and Latin America

In four countries—Ethiopia, Kenya, Namibia, and Rwanda—MSH supported the expansion of the number of patients receiving treatment for AIDS from 40,000 in mid-2005 to 349,000 by the end of 2007. Installation of the Antiretroviral Therapy Dispensing Tool developed by RPM Plus at 191 health centers in those countries made it possible to deliver these lifesaving medicines.

Partnerships with Universities in Africa MSH has also been supporting the development of a network of universities in East Africa to build skills in pharmaceutical management. This group, coordinated by Uganda’s Makerere University, includes Muhimbili University of Health and Allied Sciences in Tanzania, the University of Nairobi in Kenya, and the National University of Rwanda. Another regional initiative, in 14 countries of east, central, and southern Africa, has made strides in improving policies and procurement and promoting rational use of medicines. This initiative has developed a preservice curriculum on managing medicines for antiretroviral therapy programs, which has been used to teach 270 graduates in 13 universities in 6 countries.

[AIDS Meds for Ethiopia]AIDS Meds for EthiopiaIn Ethiopia, RPM Plus helped 285 public and private health care facilities build the capacity to provide antiretroviral therapy to people living with AIDS. The project trained more than 4,700 pharmacists and physicians in pharmaceutical management and helped establish reliable information systems. Through these and other activities, including renovation of 350 dispensing and storage facilities, RPM Plus contributed to a large increase in the number of patients receiving free antiretroviral medicines—from 11,660 in 2005 to 98,926 in 2008. The Kenyan Ministry of Health worked with RPM Plus and other partners to initiate the first government program for antiretroviral treatment in the country. MSH assistance to the Mission for Essential Drugs and Services (MEDS) provided the foundation for expansion of services from fewer than 10,000 patients in 2004 to more than 90,000 in 2008. MSH provided expertise to streamline the national supply chain to minimize shortages of medicines, develop procedures for commodity management, and revise national policy guidelines for laboratories. In rural regions of Tanzania, families often turn to accredited drug dispensing outlets (ADDOs) to provide care for illnesses such as malaria. MSH is helping the government integrate child health services into the ADDOs’ offerings and ensure availability of essential medicines and commodities. More than 1,300 dispensers at 750 outlets have been trained to treat sick children and refer cases of childhood illness. The malaria treatment Coartem was added to the list of medicines available in ADDOs, thus increasing access for rural residents. In support of the President’s Malaria Initiative, RPM Plus recently helped the Government of Angola to integrate the recommended treatment for malaria, artemisinin-based combination therapy (ACT), into the national supply system. In one year, the public sector treated 450,000 people with ACT. RPM Plus has also reached Latin America, with activities in Guatemala, Nicaragua, Peru, and other countries. By working with local partners, MSH introduced a new tuberculosis management system in Brazil that increased the detection rate of multidrug-resistant tuberculosis by 20 percent.

A Continuing Commitment to Strengthening Pharmaceutical Management and Systems

The progress made by RPM Plus has laid the groundwork for MSH’s new program, also funded by the US Agency for International Development. Building on the successes of the RPM Plus Program, the Strengthening Pharmaceutical Systems (SPS) Program was launched in August 2007 to continue and extend the work of RPM Plus in global technical leadership, technical assistance to programs and individuals to build their capacity, and development of tools to improve pharmaceutical management. For more information, please contact Douglas Keene, SPS Program Director, at