Access research feedback and next steps, Blantyre, Malawi

A three-day meeting was held in Blantyre, Malawi (13th–15th March 2006) in order to return the results of the maximizing access to essential medicines baseline study (carried out by EPN in May 2005) and to look at ways forward.

Please download:

• Malawi Access feedback meeting report [.doc 97KB] [.pdf 91KB]

The participants included doctors and hospital administrators, pharmacists, and pharmaceutical technicians. Also present were representatives of:

• MSH
• Government of Malawi Medicines and Poisons Board
• UNICEF
• CHAM (Christian Health Association of Malawi).

Facilitation and agenda

Facilitation was led by Heather Budge-Reid (consultant) under the guidance of Dr Eva Ombaka (Coordinator of EPN). Some adjustments were made to the original timetable as the workshop progressed: first, in response to the daily evaluation responses; and second, in response to the speed with which the group progressed.

A fully participative and appreciative enquiry approach was used during the process, partly based on VIPP (Visualization in Participatory Programmes), a manual prepared by UNICEF Bangladesh.

Meeting objectives

As an icebreaker and an introduction to participative techniques, the group was asked to:

• Brainstorm possible personal objectives for the meeting
• Sort these into common groups
• Prioritize their importance.

The results were:

• The way forward
• Return of results
• Skills enhancement
• Pharmaceutical issues learning
• Knowledge of EPN.

These objectives and prioritization were then fed into the monitoring and evaluation mechanism.

Please see the report for more details on M&E.

Ideas generated

At the request of EPN, the specific ideas generated at the entry point identification stage of the process are listed here. This is not a full list, as other ideas were introduced later in the group discussions around future activities, but it is believed that there is a value in capturing them here. Where similar ideas were proposed, they have not been repeated.

The main output of the workshop (a proposal for future action) is available separately from this report in the form of a project document.

• Share a pharmacist between nearby hospitals.
• More coordination between units.
• Link into district hospitals more.
• Work more with the government drug and poisons board.
• (Poor inventory system). Improve drug management by use of stock cards, training of staff, and setting of minimum and maximum levels.
• Open more health posts.
• Use more home-based care teams to overcome distance problems.
• Work with village health committees to reduce the impact of distance.
• Establish more outreach clinics to reduce the impact of distance.
• Increase the number of qualified staff.
• Monthly feedback and supervision.
• Train people in good storage practice.
• Lobby to lower entry requirements so that assistants can be upgraded to pharmaceutical technicians.
• Increased in-service training at all levels.
• Secure scholarships from government and donors.
• Government and CHAM should exchange pharmaceutical technicians – secondment.
• Government should post pharmaceutical technicians to CHAM hospitals.
• Introduce an allowance for pharmacists like the doctors get.
• Pharmacists need to be a higher priority for hospital management.
• Offer upgrading courses for pharmaceutical technicians.
• Pharmaceutical technicians should be offered a place on the new government-run course after working in a CHAM unit for two years.
• CHAM should lobby the government for a progressive grading system for staff, as per the government hospitals.
• Salary increase.
• Top-up salaries and staff loans.
• Training in customer care.
• Help improve recruitment policies, e.g., must see identification, chase up references, etc.
• Exchange visits to pharmaceutical best practice faith-based hospitals inside and outside the country.
• We need to work out a way to increase staff commitment and change attitudes.
• Increase access to training of the lower cadre of pharmaceutical assistants, with full pharmacists as teachers/sponsors/coaches.
• All DTCs to have a terms of reference.
• Train members in DTC functions.
• Strengthen DTCs.
• CHAM should supervise DTCs, as well as pharmacies, on a monthly basis.
• Introduce monitoring and evaluation policies and implement them in hospitals and clinics.
• Provide standard SOPs on all issues.
• Centralize procurement.
• Use a procurement team in each hospital covering drugs, supplies, and everything else for the hospital.
• Help in procurement of equipment, e.g., tablet counting trays, counters, etc.
• Help provide storage conditions – anti-burglar bars, sturdy shelves, cooling systems, refrigerators.
• CHAM to buy in bulk and negotiate with IDA.
• Lobby on Central Medical Stores and their problems.
• Develop a CHAM drug supply organization.
• Support the development of service agreements and their inclusion of pharmaceutical issues.
• Collect consumption figures from each CHAM unit and then give feedback.
• Need a consultant with each hospital to set up the systems and train for a limited period.
• CHAM should contract someone to help computerize systems across CHAM units.
• Adapt the government procurement programme and software so that it is not so reporting orientated.
• Lobby on tax system.
• We need to be getting publications from WHO and EPN, etc.