Commodities Subgroup Amoxicillin & Gentamicin Meeting - Shared screen with speaker view
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Patricia Jodrey, USAID CH team lead
Samantha Durdock, R4D
Jane Briggs USAID MTaPS program implemented by MSH and partners
Montse Renom, MNCH specialist, UNICEF
Hi all. Felix Lam, Clinton Health Access Initiative
Angela Anene Okolo
I am Angela Okolo from the Federal Medical Center, Asaba,Delta State, Nigeria
Jennifer Chavez, Global Health Supply Chain - Procurement and Supply Management project
Beth Yeager, Promoting the Quality of Medicines Plus Program, implemented by USP
Hi all. Ankur Sooden, Senior Advisor -Private sector engagement in USAID SAMVEG project, JSI India.
Joseph Monehin, Senior Child Health Specialist, USAID Washington/Co-Chair, Newborn and Child Health Commodities sub-group, CHTF.
Hello to all. Lauren Herzog, USAID MTaPS program.
Hello everyone! Dyness Kasungami, CH Task Force Secretariat/JSI. Thank you for joining this meeting.
Joshua Bress, NoviGuide—software for clinical decision support in newborns
John Borrazzo, in new (to me) roles, now Child Health Director at USAID's MCGL Project and also Lead Advisor, Child Health at Save the Children/U.S. Glad to join this sub-group. Apologies in advance that I will have to drop off halfway through.
Patrick Gaparayi, Unit lead, country engagement and policy, UNICEF Supply Division
Greetings everyone. Anna Cunningham, Adara Development.
Angela Anene Okolo
Angela Okolo is a practicing Neonatologist in FMC Asaba Nigeria
Hullo everyone Prudence Hamade from Malaria Consortium
Hello everyone, Leah Greenspan-Sr. Newborn Advisor for USAID at HQ and Neonatologist
Greetings & Happy New Year to all. Megan Christensen, Coordinator-Community Health Roadmap, UNICEF HQ.
Chia-Ying Lin, R4D
Steve Wall, Save the Children
Uzoma Ajanwenyi Joseph
Dr Uzoma Ajanwenyi Joseph Fmc Asaba Nigeria
Magdalena Serpa, Palladium
Apologies that I need to sign off immediately for another meeting. Using a bottlenecks /root causes good approach. One caveat: I think we need to beware the power of a first draft. The idea of using a series of consultations to advance our collective thinking is great, and we need to be sure to here diverse country voices. If these three areas are actually or perceived to be very well developed, then that may inhibit the broad input this needs. We might discover useful connections to broader systems issues and investments. We also have to recognize that to have impact, numerous bottlenecks will need to be addressed - that's fundamental to a bottleneck approach.
How is the supply chain organised and who is responsible for collecting the data across different government department like malaria maternal and child health etc Who asks for resourses from Ministry of finance
Keith Hummel Senior Supply Chain Advisor MCHN USAID
@John borrazo, thanks for your comment. In our opinion this are actually surface root causes which would need to be further discussed to really find the real roots of the problem. To find it we aim to involve country level staff, field experts, moh/national health staff. Only by identifying the deep root of the problems we may actually be able to advice the design of effective strategies.
Great question, @prudence hamade. I think it's often country-dependent. From my experience there's usually a dedicated division/department within the Ministry of Health or national medical stores responsible for this. However, for MNCH products - which are often grouped under essential medicines - data quality and availability is often an issue compared to program commodities which tend to receive greater donor support to improve supply chain data and management
Is registration different from pre qualification?
A product may be unregistered but have received a waiver for import while the registration process proceeds. Is the information triangulated
@Chinwoke: Pre qualification also is specific to the site of the manufacturer
Registration is too
Or should be.
Not to any other site that the manufacturer may have
who is responsible for registration the producer or the country registration process
The manufacturer requests registration with the national medicines regulatory authority
The regulatory authority will request a dossier on the product (requirements are typically posted on the regulatory website)
Prudence: The producer or the representative in the country has to want to enter the market, and the regulatory authority has to have the adequate processes to conduct the registration and check quality
@chinwoke isiguzo when we think of registration vs. pre-qualification, another important point is most countries require a product to be registered in their country in order for the national medical stores to procure. So, a product could be prequalified by WHO, but the manufacturer would need to register the product in country in order for the national medical store to procure it
so, it depends on both
HOWEVER, sometimes products are procured and not even registered in the country -- this is particularly the case where sub-national procurement is happening
Link to the Google Sheet: https://docs.google.com/spreadsheets/d/13iwME5z0pkGZwYb3szY5eFSWMrMS0zIfgjFvTm_e9E0/edit#gid=0
In countries where MC is working and especially looking at misuse of antibiotics and AMR people often obtain antibiotics from unregistered providers and they may buy only one or two capsules /tablets They may also save drugs for use or share antibiotics with other family members
Although the Global Fund supports HSS it will not supply antibiotics or ORS for iCCM programmes
Thanks all. Agree that these are all key bottlenecks to increase access to amox. A few thoughts: A key challenge is that we don't have great data on access to amox at the moment. Is there something we can do to address this?
A couple of interesting studies that I've come across recently that might be relevant to this discussion:EMPIC RCT on CHW use of amoxhttps://gh.bmj.com/content/7/1/e006405.fullGBD estimates of Abx usagehttps://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00280-1/fulltext#seccestitle10
It maybe worth mentioning that some of the studies into prescribing behaviors and drug use for pneumonia that take a deep-dive might not be done at a very large scale. Such work may still be important to understand the finer issues around use of Antibiotics for childhood pneumonia.
Agreed, Jane. It's helpful to organize into these 3 categories as a starting point to provide a rough framework and then certainly adjustments can be made if needed
Felix, lack of quality data is a valid point. Are you (or anyone else here) aware of any studies on data quality at the facility level as well?
From our small experience, getting data about access starts with capturing prescriber data. We did this by embedding drug-dose calculations into comprehensive digital assessments. At the moment drug-doses are calculated, users can also provide feedback about stock. The drug-dose calculation is a great and under-appreciated data source.
thanks Prudence - any comments on access to gentamicin injection- pediatric formulation or use of 80mg/2ml?
Thanks for this enlightening discussion. I need to drop off to join another meeting.
Just to add that qualitative data will be very much welcome!
Thanks, All! Thanks for organizing Jane, moderating Joseph, and coordinating Sita
Thank you so much everyone
Register for the members meeting here: https://jsi.zoom.us/meeting/register/tJMsceyuqDMjGtw6lvNf2q1Qn5s3Zj0eyuzj