Vous avez suivi avec le plus grand intéret notre feuilleton "Géraldine au Bénin" et vous vous demandez ce qu'il en est ressorti.
Cette mission était la deuxiéme étape de la phase de supervision (que l'on peut résumer ainsi : quels sont les résultats des dispositifs ou actions de la phase de réalisation Previous what worked well, what is to review, what is a failure and how to make adjustments after the whole process is pérénisée).
Here are some selected excerpts from the final report of the commission given by Geraldine
But first, we're in the mood Benin:
I. Mission Objectives
Make an inventory of the operation of distribution depots Zone (DZ) and Gros Pharmacies Hospitals in the Area (PGHZ) of the Department of Borgou / Alibori: personnel, structure, retention of drugs, financial management, viability.
Provide training on software PharMeg
Evaluate use
Facing your performance with ground realities need to
Correct any discrepancies.
Develop the Management Assistance (Monitoring) are health facilities.
Highlight indicators work of DZ and PGHZ through the use of PharMeg
Raising the status of construction of new DZ, participate to the development of DZ already built, making recommendations for the management of DZ to build.
II. Partnership
The operation was organized locally by Dr. Delphin AIDEWOU, Head of Department of Pharmacies and diagnostic evaluation at the DDS Borgou / Alibori and facilitated by Dr. Razack ADONON, Development Director Health Zone. Logistics was greatly facilitated by all teams of area offices for the homestay and for journeys between cities.
IV. Achievements during this mission (excerpts)
G. General comments
• The cold chain is often not respected products as sensitive to heat (antivenom serum TT ...) are often stored in freezers (used minimum temperature) and not in the refrigerator so that the products should not freeze. In addition, power outages are not relayed by a generator and freezer temperature can rise sharply. According to our observation, the product temperature fluctuates between a temperature below 0 ° C and a temperature of 25 ° C that is to say beyond the limits set by the manufacturer. Their quality is far from guaranteed.
→ No solution possible outside the installation of a refrigerator and the establishment of effective monitoring of temperatures.
• Neither monitoring nor archiving prices sale of drugs to avoid selling at a loss (against DZ) or too expensive (to the detriment of patients).
→ Suggestion: publish a tariff with the sale price to FS and selling prices to patients by FS, the output of the catalog of CAM with reference price (annually), then notify the parties concerned by memos (via computer or handwritten) changes occurring during the year, notes that should be archived with the catalog of the year.
• Neither monitoring nor archiving average monthly consumption / maximum stock / stock security.
→ Suggestion: print once a year from PharMeg list of medications with these management indicators. Then archive the whole.
• Managers are generally of good will but they have no concept Pharmaceutical (unable to recognize the necessities, to equivalences ...), their level computer est souvent insuffisant et leurs notions de gestion de flux de médicament sont souvent incomplètes, alors que, de part sa nature particulière (toute rupture peut entrainer l’aggravation ou la mort du patient), le médicament ne puisse être géré comme une simple marchandise.
→ Par la rigueur qu’elle impose et les facilités qu’elle offre, l’informatisation de la gestion des flux est donc indispensable. PharMeg répond aux attente des gestionnaire et des équipes des bureaux de zone (coordinateurs, CAR)
• Les formations sanitaires, ont une bonne connaissance des paramètres usuels (CMM ou stocks limites) acquise grâce aux formations de Pharmaciens Sans Frontières 85, mais ne les mettent que très rarement en pratique pour passer leur commande. Le suivi que propose PharMeg « monitorage des formations sanitaires » peut donc les aider à mieux évaluer leurs be
soins, passer des commandes mieux équilibrées, réduire le taux de périmés et de ruptures. Il serait aussi possible de faire des projections des besoins du DZ à moyen terme fiables. L’accès aux médicaments de la population serait ainsi notablement facilité. →Seule la participation active des FS permettra d’atteindre cet objectif ce qui nécessite une très bonne sensibilisation de celles-ci au projet. Les résultats de PharMeg ne seront good if and only if, the necessary data supplied by the FS (and stocks day breaks) is accurate. During our visits to the FS, we realized that the days of fractures are rarely reported on REMECAR. Moreover, the determination of the stock is not simple. Indeed, each FS has a reserve of drugs (stock card) and at least one pharmacy delivery (with REMECAR). It is therefore necessary to compile more data to know the stock (card stock, plus one or more REMECAR based on the number of pharmacies) which increases the work of staff already heavily used.
• New deposits built or under construction does not take into account the number of FS-served by the filing. Indeed, their dimensions are identical, while deposits of
E 14-44 FS to serve and not the same storage needs! The shelves are provided weak and at risk of rapid subsidence (too deep, too long and with reinforcements sufficient).
Their arrangement along the wall is very functional and makes the storage of solutes (for which no range is provided!) Impossible.
Finally, the first tier of shelves is 50-60m and the board reserves therefore find themselves on the floor.
Significant work with teams was required to produce development plans for these new deposits according to their needs and improving their management.
→ Suggestion: consider when planning for future deposits attached recommendations
• Financial management is very different depending on the deposit and nothing is standard at county level or national level. It is often easy to identify as many deposits held emerging surpluses. •
PharMeg really answers the needs of teams using it and managing the flow of drugs is greatly improved with the arrival of the software.
→ But that efficiency continues, it is necessary to follow the teams and set up their training.
VI. Conclusion
If the Department's desire was to standardize the DZ in their structure, functioning and management, the goal is far from being achieved. Each
DZ has its own rules of operation. This heterogeneity does not facilitate their evaluation and monitoring. It therefore seems essential to DZ create a reference for all DZ Benin.
Supervisors of DDS do not currently have any specific assessment tool (operation, management, analysis of results) to DZ. It is therefore proposed to develop such tools to facilitate the work of teams of State or National supervision. For this it will be necessary to study the functioning of DZ in the whole country and develop specific indicators DZ.
Good management of the flow of drugs requires a long-term work to change the working methods and thus enter a virtuous circle will result in better access to medicines for people. To achieve such an outcome will require collaboration of all teams and structures related to drugs in Benin, the Central Purchase National devices to health facilities.
We always aim to generalize the use of PharMeg across DZ Benin. But to do this, you will need
• validate the feasibility of visiting every DZ.
• train Benin maintenance and training of PharMeg so that the project is sustainable and fully meets the needs teams. •
follow particular teams already working on PharMeg to better adapt the software to field requirements and continually improve by taking into account all the difficulties encountered by users.
training of trainers and installing licenses are complex operations which we must already think golds.
VII. Outlook
November or December 2009: Participation in the Days of Health organized by the MOH and includes a morning promotional PharMeg
January-February 2010: Mission an months:
• establishment of a deposit box Malanville by reference to the planned development with teams in place. •
consultation with all the different DZ Borgou-Alibori PharMeg to obtain the best possible performance.
• Improve and redefine as needed with DZ and FS conditions optimal "monitoring"
May-September 2010: In collaboration with
ISPED (Public Health Institute of Epidemiology and development of Bordeaux), conduct Mission comprehensive study of how the tog
the DZ of Benin to develop a strategy for implementation of national PharMeg and develop a scorecard of its structures for management teams. As you see, there is still much to do but we are moving much faster than the baobabs ..
