On December 23rd, 2013, members discussed how the Standard Treatment Guidelines (STGs) and the development of a National Essential Medicines List (NEML) could support supply chain management staff. The challenges associated with the process, dissemination, and implementation of these guidelines were considered.This conversation was initiated by Lazarus Dery of the Ghana Health Service.
Original Message: “The Standard Treatment Guidelines (STG) are a systematic developed statements that assist prescribers in deciding on appropriate treatments for specific clinical problems.They usually reflect the consensus on the optimal treatment options within a health system and beneficially influence prescribing behaviour at all levels of care.
The development of STGs is important for health systems particularly in developing countries faced with growing health needs on one hand, and limited resources on he other. Policy makers therefore engage in designing cost effective health interventions that ensure accessible and affordable quality care for all, particularly the poor and the vulnerable groups such as pregnant women and children.
This leads to the development of a National Essential Medicines List (NEML): a document with a list if medicines derived from revised STGs of the Ministry of Health. The criteria used are based on selection of medicines for WHO Model List of Essential Medicines.Consequently medicines mentioned for treatment of health problems in the STG are included in the NEML collected from health professionals on the basis of the WHO criteria which include the following;
- Drug selection based on the results of efficacy and safety evaluations obtained in controlled trials epidemiological studies and on the performance in general use in a variety of medical settings.
- When several drugs are available for the same indication, only the drug and the pharmaceutical form that provides the more convenient benefit/ risk ratio should be selected etc.
In view of the above, the STG and NEML are able to guide supply chain staff of what to procure at the right time, at the right place and the right quantities, at a lower cost for the right diseases or conditions.
In most cases there are difficulties involve in sourcing funds to print and distribute these STGs and NEMLs. There are also problems of training to disseminate the use of the books and to pay resource persons. Hence your contribution in these fields would go a long way to improve supply chain management in Africa.”
“Supply chain staff use the STGs AND NEML because they are the one which stipulates the selection of products. In addition to the selection, the STGs and NEML are important in quantification in the following areas:
- The specification of the products to be quantified including the strength, the dosage form and the duration the medicines is used
- The duration the medicines is used also facilitates the supply planning ,whether its continuous supply or once off or seasonal
All the above are important to ensure that the six rights of Logistics are met
As indicated by Lazarus, the missing link by the Supply Chain management staff is the logistics of making sure that the STGs and NEML are available to the periphery. In as far as “no product, no program” embraced by deliver, l would also say in resource limited countries, “no STGs no Supply Chain Management” because if these are not available and are not used then supply chain management staff can do everything right, but the resources are put to waste because they will not be used.
One of the greatest weakness l have seen in SCM staff is not to mobilise funds for the formation, distribution and dissemination of STGs. Yet if commodities are not used according to STGs, there may be problem. In addition Rational medicines use facilitated if staff are following the STGs, its also important that SCM staff also focus on medicines use because the products may be there but wrongly used or not used at all.Thats means:
- Development, distribution and dissemination of STGs and NEML should the beginning of supply Chain management OFFICERS PLANNING
- Rational Medicines use should a focus point for SCM officers in order to ensure maximum utilisation of limited resources” (Forward Mudzimu, Zimbabwe)
“STGs and NEML are vital tools for continuum of care and SCM staffs need to continuously emphasize the use of a STGs in a district to be able to support supply of needed commodities. How dispute the relevance of STGs NEML supply chain management need to look the disease pattern and historical data to arrive at actual needed supplies for a facility supported by STGs.” (Mohammed Abdulkareem, IAPHL member)
“An important and critical aspect of STGs and the subsequent downstream supply chain documents such as NEML and Supply Requisitions (SRs) is the process which has been followed in their development. This process must always be documented, dated, authorized relevantly, and published in the public domain. The latter is important because, given the relatively high staff attrition rate in many settings, new professional colleagues often raise new questions which may slow down supply chain processes, if not answered authoritatively. Although it is difficult to control personal interests and experience, there is a wealth of information on STG development best practices which must be referred to.
Having controlled product selection, it is not automatic that actual supply spend will be optimized; so this must also be watched and tracked through public procurement best practices.
Finally, even where we have got the right selection and spend, we must also keep an eye on how value so-created in the medicine supply chain is actually translated into desired treatment outcomes, i.e. quality of service. This then feeds into the upstream chain (STG, NEML, SR) again, to continue the process in a sustainable way – much easier said/written than done!
I would also like to mention from experience that, in addition to dissemination of STGs and NEMLs, it is very helpful to actually monitor if/how STGs and EMLs are used in routine field work.” (Murtada Sesay, Sierra Leone)
“When adhered to strictly by clinicians, STGS and NEML could support supply chain management staff, however clinicians often deviate from the STGs and go ahead to prescribe drugs outside STGs when they receive some form of gratications from Reps. of pharmaceutical companies whose drugs may not be in the STGs, leading to lots of wastage and expires.” (Ekiuwa Eribo, IAPHL member)
“Over the years and with the support of various actors (and we must applaud WHO in particular), EMLs are in place for many countries. Even the processes around updating these are known to the stakeholders. However, implementation particularly in public health programs leaves the implementation side hanging. This is mainly because downstream, the financing is limited, and someone has to take the tough decision of determining which commodities take priority. It is therefore important that these essential medicines lists are further VEN classified to guide at implementation level.” (Eric Nabuguzi, Uganda)