Analytical summary - Medical products, vaccines, infrastructures and equipment
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With regard to access to affordable medical products and health technologies, there has been a huge investment in drug and medical products procurement with over US$ 13 million spent by donors on procuring drugs and medical products for the Free Health Care Initiative. The Government of Sierra Leone has spent billions of leones more on the procurement of cost recovery drugs.
Despite this large investment, the recent service availability and assessment report shows that, on average, facilities had only about 35% of the required essential drugs in stock. Some progress was made in reviewing the essential drugs and consumables lists for 2010, which ensured the availability of quality and medical consumables and equipment in health facilities.
Logistics Management Information System and CHANNEL software have been developed to track drug distribution. In addition, the Ministry of Health and Sanitation is soon to establish a National Pharmaceutical Procurement Unit, which will function as a central body to procure drugs, medical consumables and health equipment.
Up to 70% of medicines and related supplies are provided by the private sector because the Central Medical Stores face a number of challenges. These include:
- shortage of qualified staff and logistics
- inadequate funding
- lack of a national medicines’ management information system
- inadequate storage facilities
- the existence of parallel supply systems.
Added to these issues, the medical products that reach health facilities are inefficiently utilized owing to a lack of operational guidelines, tools and appropriate training.
The existing laboratory service has inadequately trained staff, is inadequately equipped and has no system for providing quality assurance for the tests conducted. This situation is exacerbated by the lack of a National Public Health Laboratory. In addition to the Pharmacy Board of Sierra Leone, there are other structures in place to assist regulation of pharmaceutical products and related matters. These regulatory bodies have developed guidelines for drug supplies and drug donations, which are being adhered to, albeit with difficulty in monitoring the quality of donations.
There is a National Medicines Policy, which stipulates guidelines for procurement of pharmaceutical and related products. Through the National Medicines Policy, the Ministry of Health and Sanitation is trying to ensure that medicines are prescribed, dispensed and used rationally to optimize the therapeutic benefit to the patient, reduce loss or wastage and hazards arising from irrational practices.
Funding for vaccines is provided by the Government, GAVI Alliance and other partners, while vaccine procurement is supported by the United Nations Children’s Fund and WHO. There is a viable cold chain, supervised and maintained by the Department of Child Health and the Expanded Programme on Immunization. However, there is a need for improved management capacity as well as storage space to accommodate the increasing quantity of cold chain equipment; for example, the number of refrigerators has increased from 750 in 2009 to 1120 in 2010.
The Global Fund to Fight AIDS, Tuberculosis and Malaria supports provision of safe blood. The National Blood Transfusion Service is still hospital based, although it is coordinated by the National Safe Blood Services. A full 100% of blood units are screened for HIV, syphilis and hepatitis C and all blood units that test positive are discarded. In the service availability and readiness assessment conducted in 2011, only a third of hospitals had adequate blood-typing capacity and only half had access to safe blood. Half of hospitals also experienced blood shortages.
A recent health sector performance assessment highlighted the following issues:
- CHANNEL software was used to keep track of drug distribution;
- stock out of fast-moving drugs, such as antimalarial drugs, paracetamol, etc., was reported at all peripheral health units;
- there was frequent stock out of Free Health Care Initiative drugs;
- drugs supervision in the peripheral health units was not regularly carried out;
- there were records of drug distribution but no proper documentation for drug utilization from health facilities;
- there was no pharmaceutical management information board or system in place;
- there was weak logistic management systems for drugs and supplies;
- there was weak technical expertise at national level to provide necessary support;
- there were poor distribution systems for drugs, especially from district health management teams to peripheral health units;
- there were substandard medical stores at all levels;
- there were difficulties in acquiring the appropriate technology and expertise adapted to suit Sierra Leone;
- there was an inadequate number of skilled staff at the central medical stores and district medical stores;
- there was a delay in the establishment of the National Pharmaceutical Procurement Unit.
- ↑ 1.0 1.1 1.2 Sierra Leone service assessment and readiness assessment (pdf 4.9Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2011
- ↑ 2.0 2.1 Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010
- ↑ Guidelines for the donation of medicines, medical supplies and equipment to Sierra Leone (pdf 1.76Mb). Government of Sierra Leone, Ministry of Health and Sanitation, 2004