Multi-country study of faith-based supply organizations
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Dear E-Druggers
We would like to inform you that the report "Multi-country study of
medicine supply and distribution activities of faith-based organizations
in sub-Saharan African countries" can be accessed on the website:
http://www.who.int/medicines/ under "latest publications" of the WHO
Medicines home page.
[See http://www.who.int/medicines/areas/access/EN_EPNstudy.pdf ]
This is a joint WHO/Ecumenical Pharmaceutical Network (EPN) publication
which reports on a descriptive, comparative multi-country research
project on the of 16 EPN member faith-based drug supply organizations
(DSOs) and their contribution to medicines supply in 11 Anglophone and
Francophone sub-Saharan African countries in 2003.
The study involved structured assessments on key functions of these
organizations' supply, storage and distribution systems. Specially
designed questionnaires were also used to assess how the organizations'
services are perceived by their clients, founding bodies and
governments. Peer-review on good practices through "learning by
evaluating" and by "learning how to evaluate", using paired country
assessments, was an important element of the study design.
The study produced comprehensive information about DSOs' operations and
how their services are perceived. The results confirmed that DSOs are
generally performing well, largely due to their transparent procurement
procedures, competitive prices and highly motivated staff. They have won
the trust of their customers, appreciation from ministries of health and
good relationships with their founding church bodies.
The study succeeded in showing that faith-based DSOs play a crucial role
in terms of increasing access to medicines, especially in rural and
other remote areas of Africa, and provide a complementary service where
government supply measures may fail to serve the public health system.
In such circumstances faith-based DSOs offer a "safety net" function in
the pharmaceutical supply system.
On behalf of Eva Ombaka, Coordinator EPN in Nairobi,
Marthe M Everard
Technical Officer
Policy, Access, and Rational Use (PAR)
Medicines Policy and Standards (PSM)
World Health Organization
Avenue Appia 20
CH-1211 Geneva 27
Switzerland
Tel : # 41 22 791 3835
Fax: # 41 22 791 4167
E-mail: everardm@who.int
www.who.int/medicines
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[Extracted from the report]
Executive summary
Faith-based organizations are part of the �not-for-profit� sector and play an important role in the advocacy, financing and delivery of health care, including pharmaceutical supply services in many countries. Although nongovernmental organizations� share in health service delivery and essential medicines provision varies considerably between countries, in low-income African countries it can be as much as 50% of curative services. Studies have shown that faith-based organizations contribute up to 40% of overall health care services in some places but their specific role in drug supply and procurement activities is not well documented. The research project reported here started from the hypothesis that these organizationsʹ contribution to national medicines supply systems would be as significant as their input to health care provision generally in sub-Saharan African countries. During 2003, the Ecumenical Pharmaceutical Network (EPN) collaborated with the World Health Organization (WHO), in a descriptive, comparative multi‐country study on the work of 16 EPN member faith‐based drug supply organizations (DSOs) and their contribution to medicines supply in 11 sub-Saharan African countries. The study�s approach and execution was in line with the Swedish International Development Cooperation Agency�s objective for operational research to assist decision‐makers in identifying problems and evaluating performance in health services, including the pharmaceutical sector.
Methodology
A set of four standardized questionnaires was developed to gather information about the DSOs. The study generated data on how the 16 DSOs were operating, as well as information on how their services were perceived by customers, founding church bodies and governments. A database for data generation and analysis was specially developed for this study as part of the WHO Survey Management System, and it allowed for comparative data analysis between countries and topics. Peer-review on good practices through �learning by evaluating� and by �learning how to evaluate�, using paired country assessments, was an important element of the study design. Staff from the DSO of country X visited country Y to collect data on DSO activities there, and, in a reciprocal visit, staff from country Y assessed DSO activities in country X. This experimental approach was based on the assumption that senior DSO staff had sufficient technical expertise in the area of drug supply and management to successfully assess the work of colleagues in other countries. From the outset of the study it was planned to hold a feedback meeting, which took place in June 2004. This meeting brought together all the assessors to review the results and findings. The strengths and weaknesses of the selected DSOs were identified, together with priority areas of work where collaboration among DSOs could be strengthened, and where EPN and other partners could offer support.
To improve DSO performance, all customers interviewed indicated that they needed to be offered a wider range of medicines and quantities. They wanted more information‐sharing on current prices and quantities of products in stock, and improved delivery services. All the customers indicated the need for technical assistance and supervisory visits to improve their management of medicines at health care facility level. Also requested were in‐service training courses on prescribing, dispensing and rational use of medicines, especially ARVs, and on drug supply management, quality issues, stock control and estimating drug needs. Government representatives greatly appreciated faith‐based DSOsʹ contribution to supply systems. However, they indicated room for improvement in formal reporting and collaboration between DSOs and their respective ministries of health, and for better drug donation policies. Licensing of DSOs by national drug regulatory authorities was identified as one major step towards official recognition and increased collaboration with governments.
Conclusions
From an EPN perspective, the study boosted staff morale by offering an opportunity to learn how others in similar situations overcame their problems and by sharing knowledge of good practices. The paired assessment methodology developed evaluation skills, helping to instil a sense of empowerment among EPN members and leading to ownership of the study results. The study was perceived by all participating EPN members as a first step of a process for further collaboration among Network members. Based on the characteristics of a well-functioning DSO as identified during the feedback meeting, a simplified self‐assessment tool should now be developed for annual use by DSOs. A redesigned version of the initial WHO/EPN multi-country study assessment tool could be used at longer intervals. More detailed DSO-specific capacity building tools should be developed, such as �how to� manuals on the key areas identified for improvement. Feasibility studies were recommended on local production of medicines by DSOs and on DSO drug delivery services. EPN members should be supported in accessing more information sources on supplier prices of essential medicines, including ARVs and other newly marketed essential medicines. The feedback meeting demonstrated how well DSO staff could work together to use the study results and findings and to successfully evaluate their performance. They prepared an action plan to improve their performance in priority areas, such as: quality assurance (including issues related to drug donations); training; distribution/delivery services; procurement; storage and drug management capacity; sustainability of DSO operations; and collaboration. The next step for the EPN Secretariat will be to seek external financial and technical support for the action plan and through this increase the impact and sustainability of DSOs in sub Saharan African countries. From a WHO perspective, the successful participatory and empowering process of the study is one of the key achievements of the methodology used. It has added value to the use of the results by facilitating development of a specific action plan, which in turn has helped the EPN Secretariat to prepare its proposals for donor assistance. The use of peer review during the assessments showed a new way of working for WHO, and through the EPN network, WHO can continue to provide assistance, information and guidance to a group of DSOs in many countries.
The multi country study was valued by EPN and WHO as a baseline for identifying benchmarks and enhancing good practices in drug supply management, procurement and distribution activities undertaken by faith‐based DSOs. All DSOs should now move together towards achieving �best practices� in the priority areas of work that they identified. It was agreed that a similar study should be undertaken in two to three years time in order to document the improvements made by the individual DSOs and by EPN as a network. The study succeeded in showing that faith-based DSOs play a crucial role in terms of increasing access to medicines, especially in rural and other remote areas of Africa, and provide a complementary service where government supply measures may fail to serve the public health system. In such circumstances faith-based DSOs offer a �safety net� function in the pharmaceutical supply system.