E-DRUG: ACT logisitical challenges - individual vs. 'bulk' packaging
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[Morris raises some important issues related to the logistics of supply of ACTs for public and private sectors. There are some countries where significant stocks of different packs sizes of ACTs are kept at peripheral level to cover for what might just be a few cases of malaria - having a 'bulk' pack would reduce the quantity at risk of expiry. But how about the rational use aspect and ensuring that patients get the full course if packs are made to be 'split'....? It's not a new argument but it's worth re-examining now we have more experience with ACTs. DB]
Dear e-druggers,
For many countries where malaria is endemic, it is uncommon to have challenges in maintaining adequate stocks of all pack-sizes of Artemesinin-Based Combination Therapy (ACT) with co-formulation of artemether and lumefantrine in one single tablet. The strength of each tablet is the same (120mg lumefantrine and 20mg artemether) irrespective of packaging. However, many countries have been forced to stock four pack sizes of the same product namely 6 tablets (Yellow), 12 tablets (Blue), 18 tablets (Brown), and 24 tablets (green) [for treatment of different age groups]. This packaging has provided a very distinctive support to ensure rational use of medicines and availability of products for children. We are now faced with bigger challenge as a result of this:
- The packaging has made supply chain holding cost in terms of space to go up. A medical store now requires almost twice as much space to store all range of products than if single 24 tablets packs were made available
- Health workers generally do not know the strength and content of each tablet as they are instead trained to remember the color of the pack and relate to age. This works in conventional public sector but gets complicated within private sector where market forces predominantly favor stocking of 24 tablets pack.
- In countries where reporting systems and logistics management is poor, it is often a nightmare to have an accurate estimate of the population in need of the products and consumption data remain unreliable.
A critical review indicates that this situation is not totally new. TB medicines have been using the similar fixed-dose combinations of same strength for both adults and children but with a different approach. TB medicines are packed in perforated blisters that allow for easier break off meeting the dosing needs of different patient groups.
We therefore need to ask simple questions regarding use of ACTs in different pack sizes but same formulation:
1) Is it cost-effective to have multiple packs of same formulation with an aim of managing different age brackets?
2) Is it possible to consider use of effective packing with perforations to serve all age bands?
3) What policy and regulatory changes are essential to move towards harmonization of pack sizes and as well strengthen coordination?
Regards,
Morris OKUMU
Pharmaceutical Society of Uganda
Kampala, Uganda
P. O. Box 3774; Kampala (Uganda)
ce: +256 392 966 378