Medical products, vaccines, infrastructures and equipment
A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost effectiveness, and their scientifically sound and cost-effective use.
To achieve these objectives, the following are required:
- national policies, standards, guidelines and regulations that support policy;
- information on prices, international trade agreements and capacity to set and negotiate prices;
- reliable manufacturing practices and quality assessment of priority products;
- procurement, supply, storage and distribution systems that minimize leakage and other waste;
- support for rational use of essential medicines, commodities and equipment, through guidelines, strategies to assure adherence, reduce resistance, maximize patient safety and training.
Major components of the medicines market are shown in the figure.
This section on Medical products, vaccines, infrastructures and equipment is structured as follows:
The Pharmaceutical Services Division of the MoHSS comprises of the Office of the Deputy Director and three sub-divisions, namely Pharmaceutical Control and Inspection (PC&I), National Medicines Policy Co-ordination (NMPC) and Central Medical Stores (CMS). The CMS serves as the Ministry's central agency for procurement, storage and distribution of essential medicines and vaccines, and related clinical supplies for the public health sector. (MoHSS, 2008)
The roll out of ART services to all districts in Namibia has put increased pressure on the Central Medical Stores in terms of staff and storage space. (MoHSS, July 2010)
The National Drug Policy of 1998 provides comprehensive guidelines and regulations for public and private pharmaceutical sectors in line with WHO recommendations on national drug policies. This policy is currently under revision. Medicines procured, stored and distributed are those approved by the Ministry and are specified in the Namibian Essential Medicines List (Nemlist). (WHO, 2010)
The legislation controlling medicines and related substances is Act 13 of 2003 that was implemented in August 2008. Under this Act the Namibian Medicines Regulatory Council has been mandated to control medicines and related substances in Namibia. A system of registration of medicines and inspection of manufacturers and facilities where medicines are kept is in place but is hampered by shortage of staff. (MoHSS, July 2010)
Between 2005 and 2008, the establishment of the national Therapeutic Information and Pharmacovigilance Centre (TIPC) and Pharmacy Management Information System (PMIS) contributed to improved pharmacy service provision and strengthened monitoring and evaluation across the country. (MoHSS, 2008)
The MoHSS operates a centralised procurement system for medicines and medical supplies which is run by the Central Medical Stores. The Government is self‐reliant in procurement and distribution of medicines, but more cost‐effective options should be explored. (WHO, 2010)
Improving rational use of medicines has been targeted since the mid 1990s. Relevant health workers have been trained on rational use of medicines, therapeutics committees have been strengthened, three national medicine use surveys have been conducted and a comprehensive Standard Treatment Guidelines (STG) for Namibia was published in 2011.
However, irrational use of medicines remains an area of major concern. The main challenge at central level is that contracted suppliers do not supply on time. At operational level the main constraint experienced is shortage of qualified staff to provide and supervise pharmacy services. Other major constraints at operational level are shortage of appropriate space for providing pharmacy services, inappropriate use of medicines, and poor stock management. (MoHSS, July 2010)
Infrastructure and equipment is managed by the Facilities Management and Maintenance Unit in the division Information Technology & Physical Facilities Management, directorate Human Resource Management and General Services.
Namibia has a large, dispersed and complex public sector health infrastructure, including a number of support facilities such as housing, offices, central stores, laundries and training centres (about 4500 buildings). This vast infrastructure is often poorly maintained due to lack of funding, poor supervision and unclear delineation of responsibilities between MoHSS and the Ministry of Works and Transport.
A contributing factor is the lack of professional and maintenance staff for planning, managing and maintaining facilities. This deficiency affects all other sectors of health delivery. With the low priority given to capital projects in the centralised budget, and inadequate criteria for the establishment of new facilities, there are gaps and duplication in the provision of facilities in different locations. High levels of bureaucracy also create major backlogs in maintenance and new construction. (WHO, 2010; MoHSS, July 2010)
Medical equipment needs a minimum standardisation with updated standardised lists of equipment. With the introduction of expensive advanced diagnostic and treatment technology, e.g. MR and CT scanners, a solid medical technology cost-benefit analysis is required.
There is a significant increase in the use of information and communications technology applications in health care, commonly known as eHealth. eHealth is the use of digital data (transmitted, stored and retrieved electronically) to support health care, both locally and at a distance. The MoHSS plans to explore the application of eHealth to improve access to health care and minimise the shortage of qualified human resources in certain areas. (WHO, 2010)
The introduction of the Electronic Dispensing Tool into all main ART sites has also improved the efficiency of pharmacy staff by reducing the time they have to spend on manual record keeping, a lesson that could be extended to all areas. (MoHSS, July 2010)
Maintenance of equipment is a major problem although centralised and regional workshops are in place. The Namibia Institute of Pathology (NIP) functions as the national medical laboratory and is the only provider of laboratory testing for the public sector. It plays a role as a national public health laboratory; supports different types of operational research; and can contribute significantly to the provision of relevant clinical data from its integrated laboratory information system.
Laboratory capacity is constrained due to a shortage of buildings which are inadequate for the levels of testing required since the rise in HIV prevalence. The recent influenza A (2009) H1N1 pandemic underscored the need for adequate laboratory capacity. (WHO, 2010)
Blood transfusion services are organised in the Namibia Blood Transfusion Service (NAMBTS), an autonomous body with a board. The National Blood Authority is the technical/ professional body for decision making. It receives considerable funding from PEPFAR, but its function and sustainability is problematic since there is no real legal basis for it to operate.
Working in collaboration with NAMBTS and NIP, the Ministry has been able to achieve 100% voluntary unpaid blood donation. (MoHSS, 2008) Namibia has been reaching its target of 22,000 blood units to be collected for many years, which more than meets actual needs (Dr Richard N. Kamwi, 2010). The improvement in management of stocks as well as reduction in unnecessary transfusion makes collected units sufficient for needs.
Significant strides have been recorded with blood safety in the country over the past years. All blood units transfused in health facilities are screened before transfusion and less than 2% of the units are discarded because of transfusion transmissible infections (TTIs). The proportion of donors that have HIV, Hepatitis-B virus, Hepatitis-C virus and syphilis at less than 1% for all these TTI’s is negligible. Namibia formulated the National Blood Policy 2007 and follows WHO guidelines for the appropriate clinical use of blood and blood products in Namibia.
Infrastructure development and management is a high priority for the MoHSS (MoHSS, February 2009). According to the HSSR of 2008, it is imperative that the MOHSS develop an Asset Management System which can provide a framework for Facilities Management and Maintenance. A few critical and proactive steps to streamline the procedures for construction and maintenance of the health facilities must be taken (MoHSS, July 2010).
‘Improve the procurement and payment system’ features as an objective under the strategic theme of ‘Governance’. (MoHSS, February 2009) There is an urgent need to revise the current MoHSS staff establishment for pharmaceutical services. (MoHSS, 2008)
Continuous review and update of the essential medicine list is needed to ensure that it is in line with National Treatment Guidelines, and continued support to the Therapeutics Committees to improve medicine use in their regions/hospitals is needed. The MoHSS should also introduce suitable IT solutions at all hospital pharmacies to improve quantification and stock management. (MoHSS, July 2010)