1. Community Based Approaches to Reduce Medication Stock outs Sonak Pastakia, PharmD, MPH Assistant Professor, Purdue University College of Pharmacy USAID-AMPATH Partnership

2. Access to Quality Medicines Up to 70% of essential medicines can be stocked out in public health facilities In Kenya, almost 30% of drugs have been found to be counterfeit

3. Community Revolving Fund Pharmacies AMPATH Community Revolving Fund Pharmacy Patients One Time Donation Supervises running of CRFPs Ensure transparency Facilitate procurement Drugs sold to patients Community involved in management Restocked using funds from sales Run by government staff Ensure sustainability by paying for drugs Waiver system for very poor patients

4. Features of the RFP model Acts as a backup to MOH in case of stock outs Slightly higher priced than MOH Prices lower than in the private sector Community ownership Fee waivers for indigent patients Minimal operating costs

5. Pilot RFP program RFP model implemented in 3 sites within the AMPATH catchment area over 1 year Mini RFPs in 10 dispensaries – mainly supporting hypertension and diabetes care Availability of essential medicines has improved from 30% to 90% Number of patients servedQ2 2011Q3 2011Q4 2011Q1 2012Total Mosoriot 1,154 1,932 2,846 2,606 8,538 Turbo 1,382 2,516 2,717 6,615 Eldoret 2,695 Total 1,154 3,314 5,362 8,017 17,847 Avg Patients / Week 89 255 412 617

6. Pilot RFP program Avg Co-pay per PatientQ2 2011Q3 2011Q4 2011Q1 2012Overall Mosoriot $ 1.55 $ 0.75 $ 1.07 $ 1.45 $ 1.18 Turbo $ 1.69 $ 0.76 $ 1.12 $ 1.10 Eldoret $ 1.40 Total $ 1.55 $ 1.14 $ 0.93 $ 1.32 $ 1.18 Income Statement SummaryQ2 2011Q3 2011Q4 2011Q1 2012Total Revenues $ 1,784 $ 3,774 $ 4,960 $ 10,598 $ 21,117 Cost of goods sold $ (1,718) $ (3,310) $ (4,510) $ (8,527) $(18,065) Gross Profit $ 66 $ 464 $ 451 $ 2,071 $ 3,052 Expenses $ (38) $ (54) $ (100) $ (54) $ (245) Net Income $ 29 $ 411 $ 351 $ 2,017 $ 2,807 Gross margin %4%12%9%20%14% Profit margin %2%11%7%19%13%

8. Challenges Reliable staffing at the health facilities Infrastructure – Accessibility to some sites is challenging due to poor roads and availability of transport – Informatics – a pilot system will be introduced in the next month Security of drug product and cash collected Changing the mind set of patients accustomed to free medications

9. Future plans Expand to all AMPATH sites – additional seed funds are needed Replicate the model for other services including laboratory tests Publish preliminary data on the success of the program Engage key decision makers in government to explore ways of implementing the model in all health facilities in the country Make use of mobile technology for inventory management and banking

10. Proposed informatics system

11. Acknowledgements Abbott/Abbott Fund Pfizer Global Health Fellows program – Phillippe Grandin Eli Lilly and Company Celgene Corporation Purdue University College of Pharmacy Indiana University School of Medicine

12. Thank You