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Minutes of the orientation meeting with CHD on the Introduction of new formulation of Zinc and Amoxicillin Date: 23/09/2011 Venue: MSH office, Kigali Note takers: - Mfizi Ephrem (Nyamagabe DP) - Nambajimana Abidan (Kibuye DH) Time Keeper: Ndarimbubye Evariste (Kayonza DP) Facilitators : - Munyambaraga Siméon (CHD) - Hezagira Emery (CHD) - Nkanika Rusaro Nenette (CHD) - Leopold Deogratias (JSI/SC4CCM, Logistics Advisor) - Nyawakira Anicet (MSH/SPS) - Mbombo Wathum Pachuto (MSH/SPS) Participants: - District Pharmacy Directors - Supervisors in charge of community health activities within District Hospitals catchment area The meeting has been started by Simeon MUNYAMBARAGA the project manager on behalf of the coordinator of the CH. After, participants have agreed upon consensually on the general expectation and norms for the meeting. Agenda Time Topic - Opening 08:00 – 08:20 - Introduction: objectives, administrative information 08:20 – 08:40 - Introduction Plan of new formulations 08:40 – 10:40 - Resupply process for CHWs + training module Introduction and presentation Overview of resupply Review of the 3 forms Resupply process Completing the Fiche de requisition communautaire (exercise) Evaluation 10:40 – 11:00 COFFEE BREAK 11:00 – 11:45 - Introduction to Pharmacovigilance and common Adverse Events of amoxicillin and zinc 11:45 – 13:00 - Rwanda Reporting System of Adverse Events and Medicine Poor Quality 13:00 – 13:30 - Closing remark 13:30 – 14:30 LUNCH 14:30 – 15:30 - Facilitators’ meeting - Secretary 1. Introduction Plan of New Formulations (Mbombo, MSH) The formulation of Amoxicillin and Zinc encountered the problem in management by CHWs such as package, humidity, dispensing half units, problems of hygiene etc. To solve those problems of management there was a wish of change of package unit and formulation. Due to the suggestions and assessment done, it has been recommended to change the formulation from Amoxicillin 250mg to 125mg, and Zinc 20mg to 10mg for better management of these products. The new formulations are presented in blisters; this will solve the problem of conservation in the community by CHWs. The reporting tool will remain the same Action to be taken: - Inform the CHWs to bring back the remaining quantity of Amoxicillin 250mg and Zinc 20mg with their stock cards to the HCs - Plan the training of Personnel in HC that will train on their behalf the representative of CHWs - Distribution of New formulation of Zinc 10mg dispersible tablets and Amoxicillin 125 mg dispersible tablets when available in country Distribution: The distribution will respect the existing channel of supply chain: RBC/MPD, District Pharmacies, Health Centers and CHWs. The Zinc 10 mg dispersible tablets are available and have been distributed since August 2011. Due to the small quantities of amoxicillin 125 mg dispersible tablets available in country, the distribution has started with 6 Districts pending the availability of sufficient quantity for distribution nation wide. The quantities to be distributed per district were allocated by the CHD. The district pharmacies have to do all subsequent requisition using the LMIS reporting tool which has include calculation formula to estimate the needs of medicines based on the consumption method and the Max/Min system. Follow up: The follow up will be done according to the existing reporting tools; LMIS for Health Facilities level, District Pharmacies and RBC/MPPD/MPD (Ex CAMERWA). CHWs will continue to report their consumption on a monthly basis using the current reporting tool. Challenges: Some of Health Centers have the tendency of using the products which would be used by CHWs within their institutions. These products have to be used within the community not at Health Center Level. 2. Resupply process for CHWs (By Deogratias, JSI/SC4CCM) The session consist of the Training of Trainers that will be able to help others Goal: Providing skills and knowledge to participants which will enable them to train the staff and CHW cell coordinator on re supply procedure At the end of the training session the trainee would be able to identify the 3 tool Use the card of calculation (Ifishi yo kubara) at community level Use requisition form at community level “Ifishi umujyanama w’ubuzima yakiraho imiti” Use the job aid The participants have received the information about the new developed tool for better management of products and supply within the community. The process of requesting and acquisition of commodities have been well explained and tools and module that will be used have been presented to the participants. Identify the responsibilities of each stakeholder in the resupply procedures Resupply process (picture) - Every month there will be a meeting of CHWs the cell level (Umudugudu), the CHWs will submit the report thus a compilation of report will be done immediately by the CHWs representative. After put together the data from all CHWs within a cell the requisition form will be filled immediately for submission at Health Center at the day of following meeting that join the Supervisor of CHWs at the Facility and the CHWS’ representatives. - Every month there will be a meeting of Supervisor in charge of Community Health at HC level and the CHWs ‘representative. The CHWs representative will bring together the drugs requisition with other report, the requisition will be submitted to the HC Pharmacy The personnel in charge of Pharmacy receive the requisition, examine them and prepare the commodities that are given to the CHW after the meeting. Discussion on filling the requisition form and other process - The requisition form is easy to fill according to the level of CHWs - At the first requisition the CHWs will receive the same initial stock - For the primo, The initial stock would not be same for the area were the prevalence of malaria is high than other where it is low - The emergency order are not accepted at community level; if a CHW encounter un problem of Stock out for any drugs, he/she will contact his/her neighbor CHW for product and wait the requisition time (the following monthly meeting) Exercise - An exercise has been done to each drug according to formula representing minimum quantity of drug to give to the CHWs - This exercise will be used by the trainers during the training Emergency order: The CHWs can borrow from the colleague and the name of the borrower will be written on the stock card. 3. Introduction to Pharmacovigilance (Phn Nyawakira Anicet, MSH) This session is presented in other to provide basic information about side effects of the drugs in general and specifically for the given products; zinc and amoxicillin. The pharmacovigilance is defined as the science and activities that are related to the detection, assessment, understanding and prevention of adverse effects or any other related problem. The detailed information of Amoxicillin and Zinc common adverse drugs reaction will be distributed to the audience. According the management of Adverse Drugs Reactions (ADR) the role of District Pharmacies will include the development and maintenance of the drugs utilization information. In Rwanda pharmacovigilance system, the reporting consists of ADR and MPQ (medical product quality). - Reporting of adverse event could be done by the physicians, nurses, pharmacist, … - Reporting of MPQ (medical product quality) would be reported by any other stakeholders that play a role in the supply chain. The sorted medical poor quality are for example the under dosage, absence of active ingredients, wrong ingredients, stability , … As the pharmacovigilance seem to be new in the system, the sensitization and implementation are continued to be done for reporting of problem that would result to the drugs utilization. The informed or trained CHW would be able to have information about the drugs he utilize for and identify the unexpected effect that would appear and report it. CLOSING REMARK After the sessions, the stakeholders from their respective districts would plan together the training of personnel that have a role in supply chain of Health commodities within the community.
"Minutes of orientation meeting with CHD on Introduction of new formulation of Zinc and Amoxicillin"