Apply Pharmaceutical Supply Chain

Management
Unit code HLTPHS4021121
For second (2nd) year TVET Pharmacy Student

BY Yosef T( B.Pharm)

Fitche Salale
Oct. 28-2024
1.3. Introduction to essential medicines
Introduction
Health is a fundamental human right.

 The provision of complete health care necessitates

the availability of safe, effective and affordable
drugs of the required quality, in adequate
quantity at all times.

 Moreover, the available drugs must be prescribed,

dispensed and used rationally
 …
• Access to health care, which includes access to
essential drugs, is a prerequisite for realizing that
right.
Access
– Physical availability
• the type and quantity of product or service needed
and provided
–Affordability
• users ability to pay for the products/services
– Geographical accessibility
• the location of the product/service and eventual
user
 Essential medicines
• Essential medicines
– are medicines that satisfy the priority health care needs of
the population and therefore should be available at all
times, in adequate amounts in appropriate dosage forms
and at a price the individual and the community can
afford”
Essential drugs concept
“A limited number of carefully selected drugs based on
agreed clinical guidelines leads to more rational
prescribing, to a better supply of drugs and to lower
costs”.

• It is a global concept that can be applied in any country, in the

private and public sectors and at different levels of the health care
system.
 Essential medicines
List of Essential Drugs
The WHO Model List of Essential Drugs
 The WHO Model List of Essential Drugs is a
useful reference, derived from the consensus
of recognized international experts and
updated every two to four years.

 The drugs that appear on this list are

recognized as safe, efficacious and cost
effective
 The essential drugs (then known as the
Essential Drugs Concept) was defined in
1975, and followed up in 1977, with the first
WHO Model List of Essential Drugs.
 The Model List has formed a key component
of the information required by countries, in
relation to their drug procurement and supply
programs.
 The National List of Essential Drugs -
(Ethiopia)
 The Drug Administration and Control Authority
(DACA) of Ethiopia have revised the National
Essential Drugs List (EDL) in 2004.
 The list includes 224 drugs in 20 different
categories.

 This list does not imply other drugs are not useful.
 1.2 The formulary process
The formulary process
Consists of preparing, using and updating a
– Formulary list or essential medicines list (EML)
– Formulary manual
– Standard treatment guidelines (STGs).
The formulary list or Essential medicines list
– Is a list of pharmaceutical products approved for use
in specific health care setting

E.g. National formulary list, provincial formulary list,

Hospital list
– Alphabetically and therapeutically arranged lists of
drugs
 Advantages of essential medicines list
• Prescribing
Training is more focused and simpler
More experience with fewer medicines
Non-availability of irrational treatment
Reduction of antimicrobial resistance
Focused drug information
Better recognition of ADR
• Prescribing
Training is more focused and simpler
More experience with fewer medicines
Non-availability of irrational treatment
Reduction of antimicrobial resistance
Focused drug information
 Selection criteria
– Pattern of prevalent disease
– Treatment facilities
– Training and experience of available personnel
– Financial resources
– Genetic, demographic and environmental factor
– Medicines which have sound, adequate data on
efficacy and safety (clinical studies, evidence
from general setting)
 Developing and implementing a
formulary list
STEP 1: Prioritize a list of common
problems/diseases being treated in the hospital
and determine the first choice of treatment for
each problem
STEP 2: Draft, circulate for comment, and
finalize the formulary list
STEP 3: Develop policies and guidelines for
implementation
STEP 4: Educate staff about the formulary list
and monitor implementation
 Formulary manual
• Formulary manual –is the publication that brings all
the important summary information on medicines in
the formulary list together in a manual.
• Formulary Manual –contains summary
drug information that describes medicines that
are available for use in the hospital and clinics
–Is drug centered
–Handy reference that contains selected information
relevant to prescriber, dispenser, nurse or other
health worker
 Drug information included in a comprehensive formulary

• Introductory information
– Acknowledgment, List of approved abbreviation
– Introduction ( development of manual, intended user)
– Formulary policies and procedures
• Basic information about each medicine
– Generic name
– Dosage and strengths
– Indications, CI and precautions
– Side-effects
 ……
– Dosage schedule
– Instructions and warnings
– Drug, food, laboratory interactions
Supplementary information for medicines
– Price
– Regulatory category
– Storage guidelines
– Patient counseling information
– Labeling information
– Brand names and synonyms
Prescribing and dispensing guidelines
– Rational prescribing techniques
– Principles of prescription writing
– Guidelines for quantities to be dispensed
– Controlled drug requirements
– Adverse drug reaction reporting requirements
– Dispensing guidelines
– List of precautionary labels
– Common drug interaction tables
 Standard Treatment Guidelines (STG):
STG:
• Is also called Treatment Protocol or Clinical
Guideline
• Systematically developed statements that help
practitioner or prescriber in deciding on
appropriate treatments for specific clinical
conditions.
• It reflect consensus on the optimal treatment option
within health facility or health system
 …

o The information is disease-centered,

emphasizing the common diseases & complaints
& the various treatment alternatives
o Most guidelines indicate a treatment of first
choice
o Some include diagnostic criteria for starting
the treatment or for choosing among treatment
alternatives
– STG exist for various level of health care
E.g Hospital, health center, region, nation
 …..

* The key differences between formulary

manual & TGs is that the former is drug-
centered, concentrating on drug
information & usually not providing
comparisons of different medicines,
* whereas the latter are disease-centered,
listing treatment alternatives and indicating
treatments of choice.
 Standard Treatment Guidelines
Information on STG
– Diagnostic criteria
– Treatment of first choice
– Cost of treatment ???????
– Important CI, SE
– Important drug information, warnings and
precautions
– Referral criteria
– index
 Potential benefits of STG
For health officials
– Identify cost effective treatments for common
health problems
– Provides a bases for assessing and comparing
quality of care
– Identifies most effective therapy in terms of
quality
– It helps to combat antimicrobial resistance etc.
 Potential benefits of STG
For supply management staff
– Identifies which medicines should be available for the most commonly
treated problem

– Facilitates pre packaging of course of therapy quantities of commonly

prescribed items
For health care providers
– Provides expert consensus on most effective, economical treatment
for specific setting

– Gives provider the opportunity to concentrate on correct diagnosis

– Sets a standard for quality of care

– Makes medicine demand more predictable, so forecasting is more

reliable etc.
– Provide a basis for monitoring and supervision
 Potential benefits of STG
For patients
– Encourage adherence to treatment through
consistency among prescriber at all location
within the health care system

– Ensures most cost effective treatment are

provided
– Improves availability of medicines

– improves treatment and outcomes

 The problems associated with STGs include:
a development process
– Difficult, time-consuming,
– Requires human and financial resources
 the need to update regularly to avoid STGs
becoming obsolete
 the danger of inaccurate or incomplete guidelines
– providing wrong information to prescriber
 Steps in developing and implementing STGs
STEP 1 Identify the working group to adapt/develop the
hospital STGs.
STEP 2 Develop an overall plan for developing and
implementing the STGs
STEP 3 Identify the diseases for which STGs are needed
STEP 4 Determine the appropriate treatment
STEP 5 Determine what information should be included in the
STGs
STEP 6 Draft the STGs for comments and pilot test
STEP 7 Implement – publish, launch, disseminate, train and
supervise
STEP 8 Update
References
• MSH/ APED/ WHO. Managing Drug supply.
Connecticut: Kumarin Press Inc, 1997.
• Essential Drug List for Ethiopia, 3rd Edition (DACA
2004)
• Essential Medicines - Annual Report 2005 (WHO;
2006)
• Essential Medicines - Annual Report 2006 (WHO;
2007)

June 21, 2010 Concept of EMs 25

Summary Of content
Thanks!!!!!