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Minutes of orientation meeting with CHD on Introduction of new formulation of Zinc and Amoxicillin


									   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)


   -   District Pharmacy Directors
   -   Supervisors in charge of community health activities within District Hospitals catchment

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.


       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
   -   Distribution of New formulation of Zinc 10mg dispersible tablets and Amoxicillin 125
       mg dispersible tablets when available in country

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

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


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


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’
   -   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)


   -   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.


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

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