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Best Practices in Medical Best Practices in Medical DonationsDonations

Logistics, Safety and Logistics, Safety and DistributionDistributionMatthew KrzystonMatthew Krzyston Chuck ClarkChuck Clark

DirectorDirector Distribution Distribution ManagerManager

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Dr. Gil IrwinDr. Gil Irwin Steve ChupaSteve Chupa

Founder/PresidentFounder/President Director of SecurityDirector of Security

Medical MissionariesMedical Missionaries J&J Worldwide Sec.J&J Worldwide Sec.

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The Common GoalThe Common Goal

All donations serve to provide valuable assistance All donations serve to provide valuable assistance to vulnerable populationsto vulnerable populations..

Disaster ReliefDisaster Relief: : Rapid, focused response to WHO list and reality on the ground Rapid, focused response to WHO list and reality on the ground Every disaster has it’s own ‘face’Every disaster has it’s own ‘face’

Response to bioterrorism will differ from tsunami reliefResponse to bioterrorism will differ from tsunami relief Missionary SupportMissionary Support: :

Assessment of professional capacity is critical. What is delivery mechanism? Assessment of professional capacity is critical. What is delivery mechanism? Without assessment - Focus on basic supplies, over the counter treatments. Without assessment - Focus on basic supplies, over the counter treatments.

Single Disease Initiatives (TB, HIV, STD, Pneumonia):Single Disease Initiatives (TB, HIV, STD, Pneumonia): Continuity is critical (3-5 year commitment). Continuity is critical (3-5 year commitment). Drug purchase may be required if break in continuity.Drug purchase may be required if break in continuity.

Institutional Support: Institutional Support: Focused on sustainable development, Requiring extensive in-country Focused on sustainable development, Requiring extensive in-country

knowledgeknowledge Pharmaceutical Benefit Initiative: USAID funded program designed to support Pharmaceutical Benefit Initiative: USAID funded program designed to support

PHC, development of mandatory health insurance in KyrgyzstanPHC, development of mandatory health insurance in Kyrgyzstan

Not everyone shares this perspective…Not everyone shares this perspective…

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Potential vs. PerceptionPotential vs. Perception

PotentialPotential‘‘Life saving assistance for Life saving assistance for

vulnerable populations’vulnerable populations’

PerceptionPerception‘‘Expired Product’, ‘Diversion’, Expired Product’, ‘Diversion’,

‘‘Dumping’, ‘Dangerous’Dumping’, ‘Dangerous’

Need best practices for Need best practices for everyoneeveryone: : NGOs, Donors, PQMDNGOs, Donors, PQMD

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PQMD’s KEY COMPONENTS PQMD’s KEY COMPONENTS OF MEDICAL DONATIONSOF MEDICAL DONATIONS

Useful NGO guidance on the following program Useful NGO guidance on the following program elements:elements:

NEEDS ASSESSMENT NEEDS ASSESSMENT APPROPRIATENESS OF THE DONATION APPROPRIATENESS OF THE DONATION QUALITY AND QUANTITY QUALITY AND QUANTITY PACKAGING PACKAGING TRANSPORTATION TRANSPORTATION UTILIZATION OF HUMAN RESOURCESUTILIZATION OF HUMAN RESOURCES EVALUATION EVALUATION

Action required from NGOs, Donors, and PQMD…Action required from NGOs, Donors, and PQMD…

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NGO ACTIONNGO ACTIONTraits of Effective DistributionsTraits of Effective Distributions

Work with MOH (no parallel systems)Work with MOH (no parallel systems) Pharmacist in selection processPharmacist in selection process Professional logistics mechanics (HOPE)Professional logistics mechanics (HOPE) Knowledgeable MD in distributionKnowledgeable MD in distribution Accountability measures built-in Accountability measures built-in Patient-focused benchmarks (not $)Patient-focused benchmarks (not $) Justified Selection - V.E.N. (Focus on Justified Selection - V.E.N. (Focus on

Essential)Essential)

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PQMD ACTIONPQMD ACTIONPromoting ExcellencePromoting Excellence

NGO Inclusiveness NGO Inclusiveness Growth of PQMD will serve to advance Growth of PQMD will serve to advance

best practicesbest practices

Advocate for Advocate for DonorDonor best practices best practices Program threats can be reduced, and Program threats can be reduced, and

efficacy enhanced, through improved efficacy enhanced, through improved donor practices donor practices

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DONOR ACTIONDONOR ACTIONDiminish Threat - Magnify Diminish Threat - Magnify

EfficacyEfficacy

Adopt Demand-driven giving policy Adopt Demand-driven giving policy Filling more requests for essential drugsFilling more requests for essential drugs Generous DatingGenerous Dating Give until it hurts….?Give until it hurts….?

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FOUS ON SELECTIONFOUS ON SELECTION

V.E.N.V.E.N. VVitalital = Life saving medicines, targeted to urgent needs in = Life saving medicines, targeted to urgent needs in

hospital settings at tertiary and secondary health system hospital settings at tertiary and secondary health system levels. levels. Examples: I.C.U. drugs, cancer drugs, anesthesiaExamples: I.C.U. drugs, cancer drugs, anesthesia

EEssentialssential = Important for chronic disease management, = Important for chronic disease management, because interruption of treatment may lead to life-because interruption of treatment may lead to life-threatening complications. Critical for reducing threatening complications. Critical for reducing hospitalization by providing good quality medical service at hospitalization by providing good quality medical service at the PHC level. the PHC level. Examples: some antibiotics, anti-hypertensiveExamples: some antibiotics, anti-hypertensive

NNecessaryecessary = Medicines that address symptoms, but do not = Medicines that address symptoms, but do not treat disease/illness. treat disease/illness. Examples: oral analgesics, anti-diureticsExamples: oral analgesics, anti-diuretics

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FOCUS ON SELECTIONFOCUS ON SELECTIONBest Option: Essential Best Option: Essential

MedicinesMedicinesDonations of essential medicines are Donations of essential medicines are ‘always’ appropriate, providing the most ‘always’ appropriate, providing the most effective assistance to both beneficiaries effective assistance to both beneficiaries and the healthcare system as a whole. and the healthcare system as a whole.

Favored by WHO and MOH: Country EDL is on Favored by WHO and MOH: Country EDL is on file with every MOH - Generic EDL issued by file with every MOH - Generic EDL issued by WHOWHO

Vital Meds: Require training, fewer Vital Meds: Require training, fewer beneficiaries, threat of non-use/wastebeneficiaries, threat of non-use/waste

Necessary Meds: Raise questions about cost Necessary Meds: Raise questions about cost benefit vs. local purchasebenefit vs. local purchase

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POTENTIAL VS. PERCEPTIONPOTENTIAL VS. PERCEPTION Action Required…Action Required…

NGO Action NGO Action Professionalism – Best PracticesProfessionalism – Best Practices

PQMD ActionPQMD Action NGO Inclusiveness vs. Elitism NGO Inclusiveness vs. Elitism

Donor Action Donor Action Reduce Threat: Supply-driven vs. Demand-Reduce Threat: Supply-driven vs. Demand-

drivendriven

EveryoneEveryone Promote achievements and support one anotherPromote achievements and support one another

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Reality CheckReality Check

If If NGOsNGOs are unable to adhere to are unable to adhere to guidelines, they should bow outguidelines, they should bow out Professionalism counts, NGO size does notProfessionalism counts, NGO size does not

If If DonorsDonors maintain supply-driven policies, maintain supply-driven policies, they should not expect positive pressthey should not expect positive press

If If PQMDPQMD does not promote inclusiveness does not promote inclusiveness and higher standards, standards will stalland higher standards, standards will stall