A strategy to improve skills in pharmaceutical supply management in East Africa: the regional technical resource collaboration for pharmaceutical management

<p>Abstract</p> <p>Background</p> <p>International initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative have significantly increased availability and access to medicines in some parts of the developing world. Despite this, however, skills remain limited on quantifying needs for medications and ordering, receiving and storing medications appropriately; recording medications inventories accurately; distributing medications for use appropriately; and advising patients on how to use medications appropriately. The Regional Technical Resource Collaboration for Pharmaceutical Management (RTRC) has been established to help address the problem of skills shortage in pharmaceutical management in East Africa.</p> <p>Methods</p> <p>The initiative brings together academic institutions from four East African countries to participate in skills-building activities in pharmaceutical supply management. The initiative targeted the institutions' ability to conduct assessments of pharmaceutical supply management systems and to develop and implement effective skills-building programmes for pharmaceutical supply chain management.</p> <p>Results</p> <p>Over a two-year period, the RTRC succeeded in conducting assessments of pharmaceutical supply management systems and practices in Kenya, Rwanda, Tanzania and Uganda. In 2006, the RTRC participated in a materials-development workshop in Kampala, Uganda, and contributed to the development of comprehensive HIV/AIDS pharmaceutical management training materials; these materials are now widely available in all four countries. In Tanzania and Uganda the RTRC has been involved with the training of health care workers in HIV/AIDS pharmaceutical management. In Kenya, Tanzania and Uganda the RTRC has been conducting operations research to find solutions to their countries' skills-shortage problems. Some of the interventions tested include applying and evaluating the effectiveness of a novel skills-building approach for pharmaceutical supply management.</p> <p>Conclusion</p> <p>Nurturing collaboration between regional institutions in resource-limited countries to build in-country skills in pharmaceutical supply management appears to be an effective intervention. Support from local programmes and technical assistance from organizations and institutions with the necessary expertise is critical for success, particularly at inception. The skills acquired by local institutions can be incorporated into both pre-service and in-service teaching curricula. This ensures long-term availability of skills in-country. The ability of trained institutions to mobilize their own resources for skills-building activities is crucial for the success and sustainability of these programmes.</p

Quality Control Report of Drugs Analyzed in the Drug Analysis and Research Unit during the Period 2011-2015

During the period 2011-2015, the Drug Analysis and Research Unit (DARU) analyzed 1972 drug samples. The samples consisted of 21.5% locally manufactured and 78.2% imported products while the origin of 0.3% of products was indeterminate. Samples were subjected to compendial and/or in-house analytical specifications. The overall non-compliance rate was 4.5% comprising 2.5% local products and 2.0% imports. High failure rates were recorded for uterotonics (37.5%), hemostatics (33%), anthelmintics (17%) and anticancers (10.5%) while ophthalmic, immunomodulatory, musculoskeletal and endocrine drugs all complied with the quality acceptance criteria. Erectile dysfunction drugs, received by the laboratory for the first time, all complied with specifications. The results obtained demonstrate an improvement in the quality of samples submitted to DARU when compared to previous performance

Antimicrobial Properties of Some Medicinal Plants of the Luo Community of Kenya

Background: The Luo community of Kenya rely mostly on ethno-medicine to manage human ailments. This study was set to survey, record and report the medicinal plant species they use to manage infectious conditions. Objective of this study was to screen the plants used by this community to treat microbial infections, to demonstrate their in-vitro antibacterial and antifungal activities. Methodology: Eight plants namely Lannea stuhlmanii, Carissa edulis, Combretum fragrans, Conyza sumatrensis, Ormocarpum trichocarpum, Sida cuneifolia, Plumbago zeylanica, and Rhoicissus revoilii, used by the Luo for treatment of microbial infections, were studied. Observations and semi-structured interviews were used to gather ethno-botanical data for each plant. About 3 kg of suitable specimens were harvested, with leaves pressed and preserved for identification at University of Nairobi’s Department of Botany Herbarium. Voucher specimens were also deposited at the University’s School of Pharmacy Herbarium and excess material powdered and kept dry. The pressed specimens were dried at 20 0C to 25 0C using plant blower. Their ethanolic extracts were screened for their antimicrobial activity against Candida albicans, Escherichia coli, Staphylococcus aureus and Bacillus pumulus. Results: Extracts from Conyza sumatrensis, C. fragrans, C. edulis, S. cuneifolia, R. revoilii and leaf C. sumatrensis had good activity against E. coli. Activity against B. pumulus was observed in all extracts except those of L. stuhlmanii bark and R. revoilii tubers. Good activity against S. aureus was observed with C. fragrans, S. cuneifolia and L. stuhlmanii. Rhoicissus revoilii, L. stuhlmanii, C. fragrans and C. edulis exhibited good antifungal activity against Candida albicans. Conclusion: This work partially supports the traditional antimicrobial use of the various plants, and it is hoped that the results will form the basis for further research that could lead to isolation and/or development of antibacterial and antifungal medicines for use in primary health care. The results also confirm that plants are a potential source of antimicrobial compounds. Key words: Luo; Antimicrobial; Ethanolic extracts; screenin

Building capacity in implementation science research training at the University of Nairobi.

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science. METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training and mentoring in implementation science, builds relationships between researchers and implementers, and identifies local research priorities for implementation science. RESULTS: The curriculum content includes core material in implementation science theory, methods, and experiences. The program adopts a team mentoring and supervision approach, in which fellows are matched with mentors at the University of Nairobi and partnering institutions: University of Washington, Seattle, and University of Maryland, Baltimore. A survey of program participants showed a high degree satisfaction with most aspects of the program, including the content, duration, and attachment sites. A key strength of the fellowship program is the partnership approach, which leverages innovative use of information technology to offer diverse perspectives, and a team model for mentorship and supervision. CONCLUSIONS: As health care systems and training institutions seek new approaches to increase capacity in implementation science, the University of Nairobi Implementation Science Fellowship program can be a model for health educators and administrators who wish to develop their program and curricula

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.<p

The quality of anti-malarial medicines in Embu County, Kenya

Abstract Background Malaria is a major health problem in sub-Saharan Africa where over 90% of the world’s malaria cases occur. Artemisinin-based combination therapy (ACT) is recommended by the World Health Organization as first-line and second-line treatments for uncomplicated falciparum malaria. However, there are a growing number of reports of sub-standard and falsified anti-malarial medicines in sub-Saharan Africa. Methods A cross-sectional study was conducted in Embu County, Kenya on the quality of anti-malarial medicines available in public and private facilities. Sampling of anti-malarial medicines from public and private hospitals, health centers and pharmacies was conducted between May and June 2014. Quality control tests were performed at the Drug Analysis and Research Unit, University of Nairobi, using ultraviolet spectrophotometry and high-performance liquid chromatography. A test for microbial load was also conducted for suspension formulations. Results A total of 39 samples were collected from public and private facilities across the Embu County. A visual inspection of the medicines showed no signs of sub-standard or falsification. All ACT passed identification, assay and dissolution tests. Of 11 suspension samples collected, none failed the microbial load test although one sample had 50 colony forming units (cfu). No oral artemisinin monotherapy medicines were encountered during the survey. Amodiaquine and chloroquine monotherapy products accounted for 5% of the collected samples, despite their ban in Kenya. Two herbal anti-malarial formulations were collected during the survey. Sulfadoxine/pyrimethamine (SP) was also found to be available use for malaria treatment, not in accordance with malaria treatment guidelines. Conclusion All the anti-malarial drugs analysed in this study passed the quality control tests. This is encouraging given the high malaria burden in Kenya. Regulatory actions are required to counter SP and herbal products for malaria treatment

Antimicrobial properties of some medicinal plants of the luo community of kenya

A Poster by Dr. Apollo Maima, the Dean of the School of Pharmacy in USIU-Africa during the FIP Congress in BankokThe Luo of Kenya mostly use ethno-medicine to manage human ailments yet this knowledge remains largely un-documented. Study aim: to screen the plants for their in-vitro antimicrobial activities. Methodology: Semi-structured interviews were used to gather ethno-botanical data for each plant. Specimens were harvested, leaves preserved for identification, and Voucher specimens deposited at Nairobi University Herbarium. Plant ethanolic extracts were screened for antimicrobial activity against Candida albicans, Escherichia coli, Staphylococcus aureus and Bacillus pumulus. Standard concentrations of nystatin and chloramphenicol were used as positive controls. Different Combretum fragrans extracts were screened for activity againstE. coli and B. pumulus. Results: Extracts of Conyza sumatrensis, C. fragrans, Carrisa edulis, Sida cuneifolia, Rhoicissus revoilii had good activity against E. coli. All extracts showed activity against B. pumulus except those of Lannea stuhlmanii and R. revoilii. C. fragrans, S. cuneifolia and L. Stuhlmanii showed good activity against S. aureus. Rhoicissus revoilii, L. stuhlmanii, C. fragrans and C. edulis exhibited good anticandidal activity. Of C. fragrans extracts, ethanol had highest activity, then the methanol, ethyl acetate and chloroform extracts, in that order. Conclusion and Suggestions: This work has validated the use of a mixture of L. stuhlmanii and R. revoilii (diarrhoea and pneumonia), C. sumatrensis (pimples, tinea versicolor and tonsillitis), R. revoilii (tonsillitis), C. sumatrensis (tropical ulcers and sore throat) and C. fragrans (diarrhea). Hopefully these results will for

Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya

Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi&#8217;s low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days&#8217; wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access