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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) • • • • • 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 – – – – – – 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