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MC Kits Considerations from systems perspective

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									MC Kits – Considerations from a
     systems perspective
          May 20, 2009
          Michael Stalker
Overview

• Examples from the field

• Public sector and the kit

• The role of the private sector
MCC in Nyanza, Kenya

• Research focused
• Commodities and supplies based on the RCT
• Commodities and supplies procured on a larger
  scale
• Kits assembled locally for local use
                                                                                           PER 100
                            ITEM
                                                                                           MCs

                            Liquid soap (500ml)                                               5

                            Disposable Hand Towels (serviettes)                               4

                            Hand rub                                                          4

                            Red bin liners                                                   200

                            Gloves 7.5" (packs of 50 pairs)                                   4

                            Gloves 8" (packs of 50 pairs)                                     4

                            Clean gloves (packs of 50 pairs)                                  6

                            Gauze (non sterile) (packs of 100)                                20

                            Vaseline gauze (packs of 10)                                      20

                            Sutures (3/0) (packs of 12)                                       16
Minor Theatre Consumables   Sutures 4/0 (packs of 12)                                         4

                            Surgical blades 10" (packs of 100)                                2

                            Elastic Bandage (roll of 25 mtrs)                                 0.1

                            Face masks (3-ply) (packs of 50)                                  4

                            Normal Saline                                                    100

                            Betadine 500 mls (30mls/procedure)                                20

                            Lignocaine 2% without epinephrine 30cc vials. (15mls/client)      50

                            Syringes 20 cc (packs of 50)                                      2

                            Needles G 21 (pack of 100)                                        1

                            Needles G 23 (pack of 100)                                        1

                            Water for injection (packs of 50)                                 2

                            Alcohol spray (5l)                                                0.2

                            Surgical spirit (5l)                                              0.2

                            Spray gun                                                         0.5

                            Paracetemol Tabs (packs of 100)                                   30

                            Dispensing envelopes                                             100

                            Ziplock bags (25 pieces - last 2 times)                           2

                            Client Folders and Forms                                         100

                            Diathermy tips (pack of 100)                                      0.1
One negative element

• Substandard anesthesia
   – Providers using double the dosage
   – Suppliers replace the product
   – Packagers correct the kit contents locally


• Providers still using double the dosage
Considerations for the negative element

• Quality assurance systems for kit contents

• Good manufacturing practices

• Communication/training for providers
Public Sector

• Need endorsement from MOH supporting the kit
  approach
• Bulk purchasing discounts of commodities and
  supplies
• Integration of the kits into existing logistics systems
• Integrity of the kits at the facility level
Considerations for the Public Sector

• Assembly of the kits – national or sub-national level

• Lessons learned from ARV and CT services

• Evolution of the kits – after the “catch up” phase
Private sector

• Comprehensive HIV prevention programs
• Commodities and supplies from MOH
• Standardized services
Considerations for Private Sector

• National policy on the role of the private sector

• Starter kits and re-supply kits (for some supplies)

• QA on comprehensive MC services
Summary

• More questions than answers

• Advocacy with the MOH is essential

• Lessons learned from prior investments need to
  inform our strategies

• The private sector can be an important partner

								
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