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Secretariat of the Pacific Community
Supply in PICs
Snapshot from Samoa
Jason Bower and Sujita Narayan
SPC / Fiji Pharmaceutical & Biomedical Services
GF HIV / STI Pacific Multi-Country Program
25 - 29th January 2010
Secretariat of the Pacific Community
Trip Objective:
• To assist strengthening Procurement and
Supply Management capacity of National HIV
& STI programs to ensure future continuity of
pharmaceutical and laboratory supplies
Secretariat of the Pacific Community
National HIV and STI Programs
• Need coordination & communication to
ensure supplies
– Clinically, and
– Programmatically
• Samoa
– No clear National HIV and STI Program Manager
– Communication has been very inconsistent
Secretariat of the Pacific Community
Pharmacy and Lab – Kamma’s cog
Secretariat of the Pacific Community
Pharmacy – HIV Supplies
• A partnership!
– Coordinated by the Pharmacy (Samoa and FPBS)
– Stored at the STI/HIV Clinic
 Communication is required to ensure supply
– Who is taking what
– Changes to who is taking what
– Stock levels
Issues with all of the above!
• PMTCT & PEP supplies provided
– Nobody was aware
Secretariat of the Pacific Community
HIV Clinical Care
• Personnel – training has been done, but..
– No Active HIV Core Team
– Clinical doctor issues
– Nursing issues
• Child dosing – doses hadnt been increased with
increasing weight
• Medication counseling, adherence troubles
• PMTCT service delivery
• Not accessing clinical support or guidelines
• HIV patient peer support group
Secretariat of the Pacific Community
Secretariat of the Pacific Community
Secretariat of the Pacific Community
Pharmacy – STI Supplies
• A bigger partnership!
– Pharmacy, HIV/STI clinic, referral hospital, NGO clinics, and now…….
all district health centres (syndromic mx)
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Nurses not proactive, frequently reactive
Pharmacy is now supplying to NGOs, but only Azithro
Pharmacy are not supplying all STI medicines to district HCs
Procuring supplies of additional STI meds themselves
Stock management systems in place, but not being utilised
with STI meds (vertical program)
– Pharmacy drug management software not managing STI medicines
Secretariat of the Pacific Community
STI Management
• Observed issues with current method
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Mothers coming late
Not coming back again
Stigma of STI clinic
Lack of confidentiality in Health Centres
Mothers trusting husbands
Partner treatment
– Contacting partners
– Antibiotics not available in health centres on the spot
– Ability of Lab to manage more testing numbers
Secretariat of the Pacific Community
STI Management
• No National STI Management Guidelines or
Standard Treatment Guidelines
– Amoxicillin still being used for gonorrhoea
• Essential Medicines List – draft being finalised
• Syndromic mx – some trained but drugs not
available to carry it out
• NGO’s fulfilling valuable role but need better
access to treatments
Secretariat of the Pacific Community
Laboratory
• Stock management
– Frequent stock-outs, rationing
• Storage
– Not coordinated
• Training and practice support
recommended
Secretariat of the Pacific Community
Actions
• HIV program to seek to address some clinical issues
– Including redeveloping clinical advice networks
• STI supply to be integrated into normal supply systems
– BUT…with additional monitoring during upscaling
• NGOs to negotiate with NHS on STI meds supply
• Pharmacy to consider STI packs to send to district health
centres for syndromic mx
• Pharmacy to designate responsible officer for HIV / STI
• Delivery of resources to assist patient management
• Curricula of training institutions – ensure STI syndromic
management and drug management training
• Lab to work with Pharmacy to improve stock management