Analytical summary - Medical products, vaccines, infrastructures and equipment
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As is usual for postconflict countries, Liberia is affected by a multitude of problems related to the management and use of medicines at all levels of the health care delivery system. Since good heath, by extension, is crucial to the quality, availability, good management and rational use of medicines, it becomes imperative to design appropriate strategies that can address these issues.
The National Drug Policy of Liberia provides a comprehensive framework for the development of all components of the national pharmaceutical sector with a perspective for the coming 10 years, but with monitoring and periodic reviews. It is designed to address the problems relating to accessibility, affordability, availability, supply chain management, rational use of medicines and others and is an integral part of the National Health Policy, which is part of the national comprehensive socioeconomic development plan.
The Ministry of Health and Social Welfare is committed to the provision of accessible health services of good quality and to the fair distribution of these services to all citizens.
Critical to the National Drug Policy are three important policy documents: the Essential Medicine List, the National Formulary and the National Therapeutic Guidelines. The Ministry has made significant progress in updating these three policy documents.
The existing Essential Medicine List was revised in 2007 to correspond with the Basic Package of Health Services; however, some medicines listed on the list are obsolete and the revision is incomplete. Standard treatment guidelines have been revised for those services provided by mid-level health professionals, but a complete revision for all services associated with the Basic Package of Health Services has not been completed.
The 2010 Liberian Medicines and Health Products Regulatory Authority Act established the legal framework for pharmaceuticals in Liberia; however, the Act did not establish pharmaceutical regulations to accompany the authority.
A 10-year Supply Chain Master Plan has been developed to improve drug supply and reporting. The Government of Liberia provides drugs for facilities that it supports exclusively, while bilateral donors pay for drugs at facilities supported through nongovernmental organizations and some faith-based hospitals manage their own drugs importation.
Also, vertical programme donors (GAVI Alliance; Global Fund to fight AIDS, Tuberculosis and Malaria; President's Malaria Initiative) pay for drugs that are provided free to all facilities. Although the Supply Chain Master Plan envisages that eventually the National Drug Service will be the predominant drug procurement mechanism, currently each source of funds uses its own procurement channel.
The 2011 Emergency obstetric care survey reported that 60% of the 304 health facilities surveyed provided pharmacy services on a 24-hour a day and 7 days a week basis, and 70% of hospitals and 57% of health centres provided 24-hour services. All hospitals and health centres used the first-in, first-out system to ensure that older stocks were dispensed before newer ones.
All hospitals and clinics had safeguards in place to prevent the dispensing of expired drugs. A few clinics (1%) did not use the first-in, first-out system and a few health centres (2%) could dispense expired drugs in error.
All hospitals had proper storage cabinets and shelves to protect drugs from moisture, heat and infestation (see photo). However, improper storage conditions were found in a few health centres (2%) and clinics (3%). Only 26% of all facilities had functioning electronic/gas refrigerators and 64% had solar refrigerators. Drugs requiring refrigeration were adequately stored in only 93% of hospitals, 81% of health centres and 71% of clinics.