1. The Case of the Catholic Pharmaceutical Service in Ghana
Improving Access to Essential Medicines through Public-Private Initiatives:
The Case of the
Catholic Pharmaceutical Service
in Ghana

2. ABSTRACT

3. Population Per Health Facility By Provider
Background
Demographic Profile
Population 18,912,079
Sex: Male: 49.5%
Female: 50.5%
Locality: Rural: 56.2%
Urban: 43.8%
Growth Rate: 2.7%
Health Status
U5 Mortality Rate /1000
Infant Mortality Rate /1000
Maternal Mortality Rate 214/100,000
Life Expectancy 58years
HIV Prevalence 3.8%
Population Per Health Facility By Provider
Government
19659
Mission/NGO
12170
Private for Profit (hospital & Clinics
62211
Private for Profit (Pharmacies+Licensed Chemical Sellers)
1962
Ghana is a tropical country situated in the West Coast of Africa
and located between latitudes 4 ˚ & 11˚ North of the equator

4. Background
Strategies to Enhance Access to Medicines (SEAM) is an initiative created by MSH to improve access to medicines in developing countries. The initiative is funded by Bill and Melinda Gates Foundation
SEAM country programs are developing and testing various models of public-private collaborations to improve access to medicines in the countries participating in the program and also to identify models that can be deployed in other countries facing similar access problems
In Ghana, the Catholic Health Service was identified as one of the two private sector institutions to implement a SEAM Program

5. Background
Faith-Based organizations provide 40% of all health services in Ghana
The Catholic Health Service, the largest body provides 75% of mission sector health delivery
Services are delivered through 31 hospitals, 66 clinics & maternity homes, 4 drug supply depots, situated mostly in rural areas in 18 autonomous dioceses throughout Ghana
Access problems identified
Availability - drugs out of stock 35% of time
Affordability - Nearly a fifth of daily wage required to treat adult malaria in mission sector
Rational use - average of 5 items on a prescription

6. Project Objectives
Improve capacity of Catholic Pharmaceutical Service to achieve better pricing and more reliable supply service
Improve quality of prescribing and dispensing services by promoting the rational use of drugs

7. Interventions
Organized meetings with Bishops, Administrators, and Hospital managers to get buy-in and consensus agreement on approaches for pooled procurement, MIS and Rational Drug Use
Established a pooled procurement model for procuring and delivering medicines to facilities, re-engineered existing structures, carried out a tender for 20 drugs, and trained facilities in inventory management

8. Catholic Health Service DTC Design ‘Learn & do’ Cyclic Approach
Interventions
Trained a team of 4 health professionals from each of 5 hospital on promoting RDU at health facility level using Drugs and Therapeutic Committees, in a ‘learn and do’ cyclic approach
Catholic Health Service DTC Design
‘Learn & do’ Cyclic Approach
Adapting
training
Material –
Local &
Int’l Experts
Selection
of Facilities
and
DTC team
Training
( 2-days)
Implementation
And Follow-up in
Health
Facility
(8 weeks)

9. Results Pre-Intervention Results for Access dimensions of
Availability, Affordability and Quality of Service
AVAILABILITY
AFFORDABILITY
RATIONAL USE
Post-Intervention Evaluation of Access Dimensions
is scheduled for Oct 2004 – Jan 2005:

10. Key Milestones
Procurement of 20 essential drugs by tender using quantities from 29 facilities yielded on average 20% savings in price
Five facilities piloting the DTC program established DTCs in their facilities after first module training
The effects of these milestones on availability, affordability and rational use of medicines will be determined in a post intervention evaluation scheduled for Oct Jan 2005

11. Implications
Building Capacity and Structures for sustainable implementation of Program
Maintenance, sustainability vrs staff attrition
Providing Technical Assistance vrs Capital Investments
Ownership of program and commitment of implementing partner

12. Implications Pooled Procurement Systems DTC Program
Ability to enforce requirements of tender contracts
Supplier’s Delivery of Goods on schedule vrs Client’s Payment for Goods on time
Timely information flow for forecasting, procurement, payment and delivery decisions
Prequalification of suppliers
DTC Program
Training
Skill development vrs information dissemination
Credible Expert Trainers, local/international
Providing support for institutional work

13. Conclusions
The project has demonstrated that where there is commitment, appropriate leadership, and ownership, group purchasing program can be implemented to make great savings
The ‘learn and do’ cyclic approach to DTC training has ensured that skills are acquired and maintained through real field experience within the environment of the practitioner
Linking the implementation of pooled procurement with DTC programs strengthens institutional capacity for sustainability