Document du projet ODM

The DSO project was developed by representatives of 16 DSOs in a participative workshop setting, in June 2004, in Nairobi, Kenya.

View or download the DSO project document [.pdf 150Kb] [.doc 441Kb]

The participants of the WHO/EPN Multi-country Study met for a feedback meeting to review the study findings and identify ways forward. Working together, they identified priority steps to increase their sustainability and capacities.

The priority areas identified by the group were as follows.

• Quality assurance
• Sustainability
• Access to medicines
• Staff and organisational training
• DSO storage and management capacities
• Collaboration
• Distribution services.

This project particularly focuses on those interventions that benefit from economies of scale by being achieved centrally, while benefiting organisations across the region and, indeed, in other resource-poor regions, with advice and information.

DSO Project Summary

Following the successful WHO/EPN Multi-country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations in Sub-Saharan African Countries, and a subsequent feedback meeting, a number of priority steps were identified. These steps aim to develop the sustainability and capacity of faith-based drug supply organisations (DSOs) that work in resource-poor environments and are key to widespread access to HIV/AIDS, malaria, and TB treatments. This project aims to carry out activities towards achieving these steps. The initial study and the feedback meeting were multi-country activities, and it is believed that the priority beneficiaries of this project will also be in multiple countries. Project title: Enhancing the capacity and sustainability of faith-based drug supply organisations

Goal:           Increasing access to medicines and positive health outcomes.

Purpose:      Enhance the capacity and sustainability of faith-based DSOs.

Objectives:

1. Increased capacity of DSOs to monitor and evaluate themselves for better feedback and management information.
2. Increased capacity of DSOs in key organisational, service, and staffing areas.
3. Increased networking between DSOs that supports information sharing and capacity development.

Activities:

[Objective 1]

• 1. Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO.

[Objective 2]

• 2. Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas.
• 3. The facilitation of processes that develop DSO staff and institutional capacities.
• 4. Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.
• 5. Identify appropriate stock management computer software options and make the information available to the DSOs.

[Objective 3]

• 6. Support DSOs’ access to information through the provision of information portal services through the EPN website.

Period:          This project is expected to be carried out over two years.

Document du projet ODM (1)

Introduction

The Ecumenical Pharmaceutical Network

Mission

Facilitating the development of compassionate, just, and sustainable health care in and through the church health care system.

Goal

The support of healthcare providers to improve patient care through proper drug policies, management, and use, especially but not exclusively through church-related health institutions or programmes.

Network objectives

• Improve the capacity of healthcare staff and managers of institutions and programmes to rationally manage, prescribe, and dispense drugs, based on the Essential Drug Concept (EDC).
• Increase awareness of pharmaceutical issues and promote policy development in church health programmes.
• Expand and strengthen national and international networking.
• Increase the selection and dissemination of key information on the Essential Drug Concept and Rational Drug Use.

Network details

The Ecumenical Pharmaceutical Network, formerly known as the Pharmaceutical Programme of the World Council of Churches (WCC), and Community Initiatives Support Services (CISS), was started as a programme in the then Christian Medical Commission (CMC) in the early 1980s. It now has a diverse range of members from North and South, comprising of Catholic and Protestant church-related donor agencies, low-cost essential drug suppliers, Joint Procurement Units and Christian Health Associations and health departments in Christian Councils and individual denominations. It works closely with other organisations, such as Health Action International (HAI), the World Health Organization (WHO), and Management Sciences for Health (MSH), as well as the International Network for Rational Use of Drugs (INRUD).

Currently, EPN has members in over 30 countries. Each year, members meet to discuss emerging drug, health, and policy development issues, and also to network. At country level, EPN has started to develop Country Focal Points (CFPs) who serve to facilitate information exchange and communication between country members and the rest of the network. CFPs also assist in organising country specific activities, and in mobilising churches in advocacy issues.

The Network currently employs three staff in the Secretariat and carries out its activities mainly through its members in the individual countries.

Funding

The Network is mainly funded by church-related agencies such as Misereor (Germany), ICCO (Netherlands), Bread for the World (Germany), and other such supporters. Over the years, it has also been funded by EED, Service Overseas, EZE, Christian Aid, Cordaid (formerly Bilance), and Caritas Italiana. A small income is generated from partial fees paid to courses organised by EPN and through fundraising, e.g. from WHO for specific training activities. Co-funding is also provided indirectly (in-kind) through members’ input of time, travel costs, out of pocket expenses, and other such overheads.

International Board

The International Board comprises of representatives from the donor community, main sub-regions (Francophone, Anglophone, and Newly Independent States), Christian Health Associations, and Joint Procurement Units. It also has a member from the WCC. It is responsible for strategic planning, leadership, and management of the Network. The Board meets three times a year.

Introducing faith-based drug supply organisations

The ‘private not-for-profit sector’, plays an important role in pharmaceutical supply services in many countries. Faith-based organizations (FBOs) are one of the major actors in this sector. Their share in health service and essential medicine supply provision varies considerably among countries, but in low-income countries they can provide up to 50% of curative services.

The results of the WHO/EPN study indicate that, among the 16 DSOs in Sub-Sahara African countries, five (31%) started their activities in the early 1970s, four DSOs (25%) were founded during the 1980s, another four (25%) during the 1990s, and more recently two DSOs (13%) have started their activities after 2000.

The main reasons given by church organisations for initiating DSO activities are to:

• Meet medicines needs of the population they are serving through faith-based health facilities
• Respond adequately to increasing stock-outs of the government medical stores
• Manage effectively pooled procurement for various church denominations within the same country
• Extend the work of churches to reach the poor and to provide them with health care services.

In general, DSOs have become more active in medicine procurement and distribution when the public drug supply system has increasingly failed to meet the medicines needs of faith-based health facilities. See Appendix 2 for a fuller description of the DSOs and the key results from the WHO/EPN study.

Document du projet ODM (2)

Project overview

The participants of the WHO/EPN study met for a feedback meeting in Nairobi, Kenya in June 2004, to review the study findings and identify a way forward. Working together, they identified priority steps to increase their sustainability and capacities.

The priority areas identified by the group were as follows.

• Quality assurance
• Sustainability
• Access to medicines
• Staff and organisational training
• DSO storage and management capacities
• Collaboration
• Distribution services.

This project particularly focuses on those interventions that benefit from economies of scale by being achieved centrally, while benefiting organisations across the region and, indeed, in other resource-poor regions, with advice and information.

This project draws together the recommendations into a plan of action and seeks support for this work in the area of increasing the impact and sustainability of DSOs. The project has the following outline.

Goal:Increasing access to medicines and positive health outcomes.
Purpose:Enhance the capacity and sustainability of faith-based DSOs.
Objectives:

1. Increased capacity of DSOs to monitor and evaluate themselves for better feedback and management information
   
   Impact indicator
   • Re-use of the tool, comparability of data over time, usefulness of results to intervention planning.
   • Commitment of DSOs to using the tool.
     
     
2. Increased capacity of DSOs in key organisational, service, and staffing areas
   
   Impact indicator
• Increased capacity of staff and DSO institutions involved in using the capacity building tool in Key areas, verified through self-assessment and post process feed back
• DSOs re-examine their distribution approaches and are able to make well informed decisions about the most appropriate model for their environment. Verified through self-assessment and examination of case studies indicating DSO follow-up.
• DSOs re-examine their stock management computer software and are able to make well informed decisions about the most appropriate model fro their environment. Verified through self-assessment and examination of case studies indicating DSO follow-up.
  
  
3. Increased networking between DSOs that supports information sharing and capacity development
   
   Impact indicator
   • DSOs updated and responsive to new information, verified through a self-assessment survey and examples of use of information.

Activities:
[Objective 1]

1. Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO.
   
   Output indicator
   • Completion and testing of tool

[Objective 2]

1. Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas.
   
   Output indicator
   • Completion and testing of tool and manuals
     
     
2. The facilitation of processes that develop DSO staff and institutional capacities.
   
   Output indicator
• Number of such activities facilitated
  
  
3. Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.
   
   Output indicator
• Document available
  
  
4. Identify appropriate stock management computer software options and make the information available to the DSOs.
   
   Output indicator
   • Document available

[Objective 3]

1. Support DSOs’ access to information through the provision of information portal services through the EPN website.
   
   Output indicators
   • EPN website constructed, regularly updated, and carrying relevant information
   • Levels of usage of the website and satisfaction of DSOs with the website.

Rationale

The project is designed to address those areas where the potential of DSOs to provide services is limited in some way. The needs assessment undertaken by the DSO group, and informed by the WHO/EPN study, is detailed fully in Appendix 1.

From this needs assessment, the group produced a list of recommended activities for the individual DSOs, the EPN Secretariat, and for WHO. The recommendations are detailed below and those specific to EPN are highlighted. The highlighted recommendations have provided the core activity areas of the project’s objectives.

Quality assurance

SOPs for quality assurance

Recommendations	Commitment/Action by:
Provide background and reference materials	WHO
Develop training on development of SOPs	EPN Secretariat
Development of SOPs at DSO level	CHAZ, CHAM, Ghana
Implementation of SOPs at DSO level	DRC, CHAM, CHAN, JMS, CHAZ, Ghana
Development of monitoring (self-audit) of use of SOPs	TZ, MEDS
Development of non-testing quality assurance SOPs	JMS, Ghana

Addressing qualified staff needs

Recommendations	Commitment/Action by
Short-term technical assistance to develop staff capacities is required from the wider sector
DSOs should employ and retain qualified staff	TZ, CHAN
DSOs to take steps to be an 'attractive' employer e.g.: Provide good working environment Institute good system of benefits Training Staff development Supporting allocating budgets for training Provide attractive uniform for staff Investigate and learn about other employer’s “attractiveness”	TZ

Quality control laboratories

Recommendations	Commitment/Action by:
Strengthen existing DSO QC labs	MEDS
Set standards for QC labs	WHO, AMFA
Map existing QC labs for collaboration	AMFA
EPN to provide updated information on issues related to QC, e.g. counterfeit drugs	EPN Secretariat
DSOs to contract QC laboratory services	TZ, DRC, CHAN
DSOs to collaborate with existing laboratories for QC, e.g. government and private	CHAM, TZ

 

Sustainability

Recommendation	Commitment/Action by:
EPN to solicit for funds from the wider sector for capacity building in planning and financial management	EPN Secretariat
EPN to facilitate the exchange of existing tools and best practice in financial management and planning.	EPN Secretariat
Equip the DSO management with planning and financial management skills	TZ, CHAN
Equip the DSO with knowledge of the revolving fund concept for sustainability	TZ, CSSC, CHAN
DSOs to involve the founding body in planning	TZ, CSSC, CHAN
DSOs and the wider sector should organise regular meetings with stakeholders	TZ, CSSC, CHAM, Ghana
EPN to develop training on collaboration techniques	EPN Secretariat

Access

Recommendations	Commitment/Action by:
Need to verify use of inventory consumption data for placing orders.	TZ, DRC, Ghana
Development of training in drug procurement management	WHO, TZ
The network supports exchanges between DSOs	EPN Secretariat
DSOs need to advocate for the reinforcement of the skills of the management committees governing them, with the goal of increasing sustainability
Advocate for DTCs and the use of EDL for placing orders	CHAM, TZ, Ghana
DSOs need to have clear understanding of various methods of financing (including Revolving Drug Funds) and the implementation of such solutions	TZ
Build-up FBO capacities to receive international funding
Study successful fundraising organisations for lesson learning
DSO negotiate with quality local suppliers for reduced prices	Ghana
Organise pooled procurements	Ghana, TZ, CHAM
Encourage local production by first carrying out a feasibility study	Ghana, CHAZ, TZ

Training

Recommendations	Commitment/Action by:
DSOs and EPN should develop in-service training tools for Rational use of drugs Drug management Management and leadership	EPN Secretariat, Ghana TZ, CHAZ, CHAM (rational use of drugs) TZ, CHAZ (drug management).
Regional/sub-regional rational drug management courses should be facilitated and coordinated.	WHO
Funds for training of DSOs and customers should be advocated for and EPN should facilitate lesson learning	CHAM, EPN Secretariat

Storage capacities and management

Recommendation	Commitment/Action by:
EPN should provide information on good drug management storage practice to DSOs	WHO, to support EPN in the dissemination of the recent booklet on the subject.
DSOs should improve physical infrastructure and storage conditions	CHAM, Ghana
EPN should provide guidance on best practice so that DSOs can efficiently develop written SOPs for storage, inventory control, etc., in a participatory manner including all staff	CHAZ, TZ, Ghana, CHAN, CHAM EPN Secretariat
DSOs should develop DMIS, defining data collection requirements, analysis, use, and reporting.	Ghana, CHAZ, DRC, CHAM, CHAN, TZ
EPN, WHO, and DSOs should identify appropriate stock management computer software and mobilise funding and technical assistance.	EPN Secretariat
DSOs should improve communications to customers on stock position and other complementary information	DRC, Ghana, TZ, MEDS
EPN should design or identify and organise training and technical assistance on procurement.	EPN Secretariat.

Collaboration

Recommendations	Commitment/Action by:
Representatives of DSOs should increase awareness on the importance of collaboration among managers and owners of DSOs, moving their organisations from competition to cooperation	TZ, Ghana
EPN should organise networking and regular exchange visits among DSO managers	EPN Secretariat
EPN should turn EPN website into an information portal	EPN Secretariat

Distribution

Recommendations	Commitment/Action by:
A feasibility study should be undertaken by EPN that details the most common distribution models, and compares the strengths and weaknesses behind DSO distribution services and contracting out options.	EPN Secretariat, JMS

Document du projet ODM (3)

Activities for each objective

Each recommendation from the group was examined and three key objectives have been developed that address the areas in the recommendations in a cost-effective manner. For indicators, please see Section 2. The activities associated with these objectives are detailed below.

[Objective 1]

Activity 1: Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO. Such a tool would use a simplified version of the WHO/EPN study survey and use the baseline established by the original study (see Section 1.6).

Steps

• Draw up draft tool.
• Distribute to all DSO members for comment and hold a small consultation meeting to finalise draft.
• Draw up second draft
• Two-country test.
• Finalise document.
• Dissemination of tool in print and web forms.

[Objective 2]

Activity 1: Design and draw together more detailed DSO-specific capacity building tools, such as “how to” manuals, on key areas:

• Financial issues
  • Planning and financial management skills
  • Revolving drug fund concept for sustainability
  • Fundraising.
• Standard operational procedures (SOPs)
  • How to develop SOPs
  • Setting SOPs for DSO quality assurance, including control laboratories.
• Management and leadership for DSOs
  • Collaboration techniques
  • Negotiation skills.
• Drug management
  • Drug procurement management
  • Organising pooled, bulk, and joint procurements.

Steps

• Development of expert team for informing the process and peer review.
• Desk review of existing material.
• Survey of perceived ‘gaps and usability’ in material contents.
• Survey of experiences and lessons learnt by individual DSOs in the use of existing materials.
• Adaptation of any existing materials to reflect current realities, e.g., ARVs.
• Development of new materials where necessary.
• Design and upload to website and distribute in printed form.
• Provision of skills development workshops.

Activity 2: Support DSOs’ access to information through the provision of information portal services through the EPN website. Information is particularly needed that is specifically targeted at DSOs and covers:

• Counterfeit drugs
• Supplier prices of, for example, ARVs, EDL items
• Links to WHO materials relevant to DSOs.

Steps

• Design a web space on the EPN website.
• Upload materials that already exist or provide links to other organisations’ materials.
• Production of a web-based e-newsletter for DSOs that includes information on new materials available on the site.
• Research and upload links.
• Produce instructions for further uploading.
• Promote to DSOs and the wider sector.
• Evaluate usage of the information portal.

Activity 3: The facilitation of processes that develop DSO staff and institutional capacities.

• Finding and receiving international funding.
• Carrying out feasibility studies around DSO production activities.
• Strengthening existing activities and DSO quality control laboratories through a process of evaluation and recommendations.
• Organisation and process of stakeholders involvement.
• Supporting staff and information exchange through the EPN network.

Steps

• Create a core feasibility process around DSO production activities.
• Create a core methodology for the development of DSO quality control laboratories through a process of evaluation and recommendations.
• Create a core meeting and exercise plan that supports the organisation and process of stakeholders’ involvement.
• Support staff development and lesson learning through the EPN network’s exchange visits and linking into skill development workshops.

Activity 4: Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.

Steps

• Desk review of existing distribution models.
• In-depth study through questionnaire led interviews of DSO distribution methods and their strengths and weaknesses.
• Workshop for DSO leaders during which results are presented and the group makes recommendations for DSO distribution models.
• Finalise document.
• Upload materials to the website and distribute printed copies.

[Objective 3]

Activity 1: Identify appropriate stock management computer software options and make the information available through the EPN website.

Steps

• Identification through a short survey of DSO needs for software.
• Review of commercially available software in the context of DSO needs.
• Interview survey existing DSO software systems and document strengths and weaknesses.
• Development of guidance materials for DSOs.
• Upload materials to the website and distribute printed copies.

Document du projet ODM (4)

Project logframe

Project description	Performance indicators	Means of verification	Assumptions
Goal: Increasing access to medicines and positive health outcomes			That increased access to medicines results in positive health outcomes
Purpose: Enhance the capacity and sustainability of faith-based DSOs	The capacity and sustainability of DSOs is raised	Self-assessment marked against a baseline of the EDM/EPN study	That the increased capacity of DSOs significantly increases access to medicines
Objectives:
1. Increased capacity of DSO’s to monitor and evaluate themselves for better feedback and management information	Impact indicator Re-use of tool, comparability of data over time, usefulness of results to intervention planning Impact indicator Commitment of DSOs to using the tool	Reporting and self-assessment   Reporting and self-assessment	That the results of the EDM/EPN study and feedback meeting accurately identified the priority areas for interventions
2. Increased capacity of DSOs in key organisational, service, and staffing areas	Impact indicator Increased capacity of staff and DSO institutions involved in using the capacity building tool in key areas Impact indicator DSOs re-examine their distribution approaches and are able to make well informed decisions about the most appropriate model for their environment. Impact indicator DSOs re-examine their stock management computer software and are able to make well informed decisions about the most appropriate model for their environment	Self-assessment and post-process feedback     Self-assessment and examination of case studies indicating DSO follow-up     Self-assessment and examination of case studies indicating DSO follow-up
3. Increased networking between DSOs that supports information sharing and capacity development	Impact indicator DSOs updated and responsive to new information	Self-assessment survey, examples of use of information, monitoring of web visits, and DSO contributions of information
Activities
[Objective 1] 1. Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO	Output indicator Completion and testing of tool	Reporting	That a significant number of DSOs are able to participate
[Objective 2] 2. Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas 3. The facilitation of processes that develop DSO staff and institutional capacities 4. Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options 5. Identify appropriate stock management computer software options and make the information available to the DSOs	Output indicator Completion and testing of tool and manuals     Output indicator Number of such activities facilitated Output indicator Document available       Output indicator Document available	Reporting       Reporting   Reporting         Reporting	That there are no major changes in the environment that DSOs work in that either make their participation impossible or change the nature of their needs
[Objective 3] 6. Support DSOs’ access to information through the provision of information portal services through the EPN website.	Output indicator EPN website constructed, regularly updated, and carrying relevant information Output indicator Levels of usage of the website and satisfaction of DSOs with the website	Reporting     Reporting