Pill check in Livingstone

On 22^nd July, 2009 the Zambia country team Casco Mubanga From NZP+ Lusaka, Banza Chela from TALC Lusaka Hub and Claudio Midolo an Open Society Insitute fellow from New York City, visited the tourist capital Livingstone in southern province. The purpose of the trip was to a carryout a check on availability of essential medicines in the district , holding a focus group discussion as part of awareness of the essential medicine concept and the campaign, to carryout three interviews one with a pharmacist, a nurse and also with a patient who had experienced the stock-out.

Day one

Interview with Vivian, the district pharmacist

On the first day the team had a privilege of interview a district pharmacist. During the interview it came from the pharmacist that delivery are received from the central medical stores once in a month and there were no problems of stock outs in the district, all the requested drugs are received in the deliveries. The major challenge faced by the district pharmacy was transport to distribute medicines received to all the health facilities in the district. The lack of transport caused a lot of delays in delivery of medicines.

Interview with a Nurse Anne

This was very interesting interview, we were happy that our Nurse brought a lot of issues which really affect them, in the interview it came out that the problem of stock outs is a really problem in the public health facilities. Anne said a lot of essential medicines requested from the district pharmacy are not received ,they only received what packed from there not what they requested for, sometime they even receive drugs that have no use in their clinic like now they have a lot of drugs just packed for Buazare which they never request for. There also a great shortage of ARVs for PMTCT for women at the clinic and a serious shortage of septrin for people living with HIV. It also came out that some of the essential medicines such amoxicillin suspension are no longer stocked in clinics. Anne recommended that the old system where a pharmacist from the district following medicines and witnesses the packing of the drugs at medical stores was far much better than comparing to the new system where medical store delivery the medicines which usually have very essential medicines not included in the kits. It was also observed that the system used for ART program in clinic is very good and this system if adopted availability of essential medicines in public clinics can improve a lot.

Interview with Ida

Another interview was done with a grandmother who had taken the grandson for treatment to Libuyu clinic in Livingstone and they had experienced a stock out of amoxicillin suspension. Ida is a widow who stays in Libuyu looking after a grandchild, Ida said they went to the clinic seeking treatment and was only given a prescription of amoxicillin suspension of which she could not afford to buy the medicine. Ida said that recently there has been lack of access to medicines unlike in the old government were medicines were available in clinics.

Day two

On the next day a radio Talks show was held on Radio MOSI-O-TUNYA community Radio station which cover most parts of the province.

The panel was made up by Casco Mubanga a and Banza Chela both from the stop stock-outs country team members from Lusaka, Lloyd Bwalya the NZP+ Livingstone Coordinator while Claudio Midolo captured the event with photos and a video recording.

The Presenter Mr. Mwale asked Casco to give a background of the essential medicines concept, it was explained that the essential medicine concept was adopted by WHO member state 30 years ago which include Zambia, casco went into detail to explaining the whole concept, Mr. Banza explained the stop stock-outs campaign and the consequences of stock outs in patients while Lloyd Bwalya explained how they participated in the exit patient interviews called SMS check campaign.

In conclusion there serious stock outs of essential medicines in Livingstone and the province, programs such as PMTCT have been affected because of short supplies of some combinations of ARVs in most clinics in Livingstone. The list of stock outs include amoxicillin suspension for children, first line ARVs, Zinc 20mg tablet for children with Diarrhea others are benzathine Penicillin to mention a few.

TB/HIV Intergration workshop

On 22nd July,2009 NZP+ Lusaka held a workshop where 22 NZP+ members attended ,the last session of the workshop was a presentation on the stop stock outs campaign ,the presentation was done by casco Mubanga one of he country team member, in his presentation Casco introduced the essential medicine concept and the stock out campaign, it was mentioned that availability of essential medicines in clinics was key for opportunistic infections for people living with HIV, a discussion was held to make people understand what was a stock out, the consequences of stock outs of essential medicines and the role of the community in the stop stock outs campaign,also in the presentation Banza Chela from TALC took part in the presentations, in the same workshop Claudio a fellow from New York made another presentation on the Pill SMS week.

Claudio talked about the SMS campaign and the feedback received from other district that participated and he also echoed that this data was very useful for advocacy, he said advocacy was more meaningful with such data from the ground, in the same presentation Claudio briefly mentioned about the technical part of the SMS system, at the end Claudio shared a video interview that was done with a patient that had suffered from Malaria unofrtunately experienced a stock out of anti malaria from Chipata clinic where she went to seek for treatment, she was forced to buy the drug from the private pharmacy. The campaign was welcomed by participates who showed a lot of interested in the project and pledged full support for the campaign. Fact sheets that have been produced for the campaign were also distributed in the workshop.

MeTA stakeholders workshop

NZP+ Lusaka is a member of the Zambia Medicine Alliance Transparency (MeTA) Civil Society Organizations Coalition, The coalition held a workshop on were 14 civil society organization attended, a presentation was made on the stop stock out campaign, the presented covered the concept and aims of the campaign, this presentation Casco the stop stock outs campaign country team member asked the presented to join the campaign and push government to increase access to essential medicines. All the civil society present pledged to support the campaign, in the presentation another presentation was made by Claudio Midolo the OSI fellow who was in the country to building capacity in the country team on SMS pill stock out system, website and video shooting and uploading the video on the website, in his presentation Claudio gave an overview of the technical part of the SMS system and how the data collected can used to in the media
and for advocacy. Most participate showed a lot of interested in the SMS and made suggestion on how the SMS can be improved, suggestion were noted and appreciated and some them suggestion made were incorporated in the System and data collection strategy. In this workshop the stop stock out concept was introduced and a strong networking was initiated with the 14 CSOs that were present. The stop stock outs campaign country team will continue to work these CSOs as stakeholders in the campaign

ZAMBIA Stop Stock-Out country team report

Material produced
Four fact sheets.
Essential medicines concept from WHO
Distribution system from the central medical stores
Campaign statements
Government commitments.

Media coverage
The stop stock outs campaign launch done on 8th April 2009 was covered by Radio 4, a national radio station, and Zambia National Broadcasting Corporation TV station.

Reports
World TB Day
On 24th March 2009, a joint participation of 15 Network of Zambian People Living with HIV/AIDS NZP+ members and 10 Treatment Advocacy and Literacy Campaign (TALC) members, participated in the World TB Day in Mongu district in western province of Zambia. At this event a speech was given by a TALC member who talked about the consequences of stock out of essential medicines specifically TB drugs and ARVs. Top government official present were the Deputy Minister of Health, the Provincial Minister and other top officials in the ministry.

World Health Day
The world health day took place on 7th April 2009 in Lusaka. There was another joint participation of 20 marchers of NZP+, TALC, churches, nurses, and members of the public who marched together with other line ministries and civil society organizations. The minister of health and his entourage was given the stop stock out leaflets and NZP+ Staff Casco Mubanga briefed the minister and WHO country representatives about the stock outs campaign.

Campaign Launch
The launch of the stop stock out campaign took place at Chrismar Hotel on 8th April 2009. It was attended by more than 30 people. TALC staff Chris Mumba spoke at the launch and revealed two events of stock outs of ARVs in the Eastern Province of Zambia. Casco Mubanga of NZP+ presented about essential medicines concept. The campaign was officially launched by the Director of Clinical Care Ministry of Health Dr. Simpungwe who represented the Permanent Secretary Ministry of Health.

Annual General Assembly
Casco Mubanga presented on the Stop Stock-Outs campaign at the NZP+ AGM 2009. The presentation touched on the concept of essential medicines, the stop stock out campaign and countries involved in the campaign. District coordinators from all 72 districts in Zambia were asked to support the campaign and also to take part in the SMS pill exercise scheduled for the week of 22nd to 26th of June 2009. The campaign was highly appreciated by participants including NZP+ partners.

Monitoring visits
One monitoring visits has been done in Chipata district in the Eastern province. During the visit a central provincial pharmacy was visited and the provincial pharmacist was interviewed. It was revealed that kits from medical stores are received once in a month at a given date, the real challenge being transportation to the local health facilities. Some two pharmacists interviewed from Chipata Central Hospital and at Mwami Mission hospital said that one of the causes of stock outs was lack of trained pharmacists in local health centers including the central provincial pharmacy.

Poor working conditions for rural pharmacists was said to have contributed to diversion of medicines by pharmacist which leads to stock outs. Also lack of refresher training by government in forecasting and data system management contributed to poor planning which leads to stock outs and over stocking of drugs.

The two pharmacists interviewed recommended that pharmacists in the province need to communicate in to order to have information on which facilities have stock-outs and also those that have over stocked specific medicines which can re-distributed to the facility with a stock out of that specific medicines.