(WP)HSI/ICPIHIV11,4/00 I Report Series number: RS12006/GEl45 (PHL) English only
REPORT
JOINT WHO AND MSH WORKSHOP ON FORECASTING, STOCK MANAGEMENT, MONITORING AND REPORTING ON ANTIRETROVIRAL COMMODITIES 4-9 December 2006 Manila, Philippines
Convened by World Health Organization Regional Office for the Western Pacific and Management Sciences for Health
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines
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NOTE The views expressed in this report are those of the participants, trainers and resource persons in the Joint WHO and MSH Workshop on Forecasting, Stock Management, Monitoring and Reporting on Antiretroviral Commodities and do not necessarily reflect the policies of the Organization.
This report has been prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for those who participated in the Joint WHO and MSH Workshop on Forecasting, Stock Management, Monitoring and Reporting on Antiretroviral Commodities from 4 to 9 December 2006 in Manila, the Philippines.
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CONTENTS
SUMMARY 1. INTRODUCTION
1.1 Objectives................................................................................... 1.2 Participants................................................................................. 1.3 Organization of the meeting ................. , ...... ... ............ ... ...... ......... ..... 1.4 Opening ceremony. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1 1 2
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2.
PROCEEDINGS
2.1 Day 1......................................................................................... 2.2 Day 2... ............ ......................................................... ... ..............
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2.3 Day 3...... ......... ..................... ...... ..................... .......................... 2.4 Days 4, 5 and 6............................................................................. 3. CONCLUSIONS ..... , .......................................................................... .
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ANNEXES: ANNEX 1 ANNEX 2 ANNEX 3 LIST OF PARTICIPANTS TIMETABLE EV ALUA TION AND FEEDBACK
Keywords: Anti-retroviral agents! Forecasting
SUMMARY
The Joint WHO and Management Sciences for Health (MSH) Workshop on Forecasting, Stock Management, Monitoring and Reporting on Antiretroviral Commodities took place in Manila, the Philippines, from 4 to 9 December 2006. A total of 19 country participants from Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, Tuvalu and Viet Nam attended the training workshop. For logistical reasons, participants from Indonesia and Timor Leste were unable to attend. A representative from the United Nations Children's Fund briefly attended the workshop. The secretariat comprised staff from the WHO Regional Offices for South-East Asia and the Westem Pacific and the WHO country office in Viet Nam, and Technical Officers of MSH. The list of participants is appended as Annex 1. The objectives of the workshop were: (a) to share respective country/programme experiences in forecasting, stock management, monitoring and reporting ofantiretroviral (ARV) medicines and related commodities; (b) to gain an understanding of the minimum set of management tools for proper stock management, conducting of accurate forecasts, monitoring and the timely reporting of antiretroviral medicines and related commodities; and (c) to acquire the necessary competency in utilizing one or more tools for forecasting, stock management, monitoring and reporting on antiretroviral medicines. The programme consisted of presentations and plenary sessions that included sharing of country experiences; an introduction to quantification; some exercises in quantification; discussions on issues and challenges in quantification of mv commodities, including issues related to quantification of children's antiretrovirals; inventory management tools at various levels of operations; monitoring and reporting tools; and assumptions and decision-making in the art of quantification, including processes and approaches to quantification of antiretrovirals. Computer hands-on exercises were held after the introduction of forecasting and quantification tools, using Excel worksheets (for ARVs, prevention of mother-to-child transmission [PMTCT), test kits, and opportunistic infections [01s)) and Quantimed computer software, developed by MSH for the quantification of drugs, including HIV commodities. Each presentation was followed by an approximately IS-minute question-and-answer session. Participants were free to ask questions at any time during presentations. Areas covered the previous day were reviewed each morning before proceeding to the next session of the day. A complete set of training materials presented at the workshop was provided to all participants in hard copy and on CD-rom. A separate CD and the manual for the Quantimed quantification software were also given to each participant. Evaluation and feedback was received from 16 participants who, in respect to educational gains, indicated that the objectives of the workshop had been 100% met; that new skills and/or concepts had been learnt at the workshop (100%), and that these skills could be applied in their respective countries (100%), and recommended that WHO should support countries to hold similar training workshops in their respective countries, at facility level, at a later date.
1. INTRODUCTION
A critical component of the scaling up of antiretroviral therapy (AR1) is to ensure that all essential commodities, particularly antiretroviral medicines, for the required effective treatment regimens are available in sufficient quantity, are of assured quality, and are used appropriately. This requires proper and efficient stock management, including accurate forecasting, monitoring and timely reporting of antiretroviral (ARV) medicines and related commodities. However, management of antiretroviral medicines and related commodities is complex, and its various dimensions may be new to most pharmacists and staff entrusted with the work. Antiretroviral medicines are different from other medicines in several aspects. They are often new types of drugs and are expensive and, as such, their security and the accountability of their distribution and use are crucial. Besides, antiretroviral therapy requires life-long treatment with a combination of three to four antiretroviral medicines, which are often procured from different sources with different delivery lead-times. Other factors, such as a lack of historical consumption data, constantly changing treatment regimens and scale-up scenarios, an add to the complexity of managing these commodities. To ensure the uninterrupted availability of appropriate antiretroviral medicines and related commodities of assured quality to support ART scale-up programmes, staff managing these commodities require competency in forecasting, stock management, monitoring and reporting. Therefore, the Joint WHO and MSH Workshop on Forecasting, Stock Management, Monitoring and Reporting on Antiretroviral Commodities was held in Manila, the Philippines, from 4 to 9 December 2006.
1.1
Objectives (a) To share respective country/programme' experiences in forecasting, stock management, monitoring and reporting of antiretroviral medicines and related commodities; to gain an understanding of the minimum set of management tools for proper stock management, conducting of accurate forecasts, monitoring and the timely reporting of antiretroviral medicines and related commodities; and to acquire the necessary competency in utilizing one or more tools for forecasting, stock management, monitoring and reporting on antiretroviral medicines.
(b)
(c)
1.2
Participants
A total of 19 country participants from Cambodia, China, Fiji, Kiribati, the Lao People's Democratic Republic, Papua New Guinea, the Philippines, Tuvalu and Viet Nam attended the training workshop. For logistical reasons, participants from Indonesia and Timor Leste were unable to attend. A representative from the United Nations Children's Fund briefly attended the workshop. The secretariat comprised staff from the WHO Regional Offices for South-East Asia and the Western Pacific and the WHO country office in Viet Nam, and Technical Officers from Management Sciences for Health (MSH). The list of participants is appended as Annex I.
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1.3
Organization of the workshop
The workshop was held at the WHO Western Pacific Regional Office, Manila, t~e Philippines. Mr William Mfuko (Technical Officer, HSI, WHO Regional Office for the Western Pacific) presented the organization of the workshop for the whole week. Training sessions covered: country presentations - sharing of country experiences; an introduction to basics of quantification and some exercises in quantification; issues and challenges in quantification of HIV commodities; basic inventory management tools at various levels of operation; monitoring and reporting tools; key assumptions and decision-making in the art of quantification, including processes and approaches to quantification of ARVs; an introduction of forecasting and quantification using Excel worksheet for ARVs, prevention of mother-to-child transmission (PMTCn, test kits, and opportunistic infections (OIs), followed by hands-on exercises; and an introduction to quantification using computer software, Quantimed, developed by MSH. The training in Quantimed featured related hands-on exercises using individual country data. The timetable is appended as Annex 2. 1.4 Opening ceremony
Dr Massimo N Ghidinelli, (Regional Adviser, HSI, WHO Regional Office for the Western Pacific) welcomed the participants to Manila. He introduced Dr Shigeru Omi, WHO Regional Director for the Western Pacific Region. Dr Omi welcomed the participants and representatives of Management Sciences for Health (MSH) and delivered the opening speech. He cited benefits of accurate forecasting and quantification and advised on considering the realities of HIV commodity management, which include, among other considerations: (I) their availability in the world market; (2) procurement lead-times; and (3) the importance of being pro-active on issues related to commodity management, including: (a) proper procurement planning; (b) constant awareness of stock levels and sufficiency in meeting patient targets/needs; and (c) the need for frequent forecasting to adjust for observed/actual usage trends in order to ensure a continuous and uninterrupted supply of these commodities to programmes. On behalf of Management Sciences for Health, Mr Andrew Barraclough (Regional Technical Adviser, South-East Asia, Pharmaceutical Management, MSH) also addressed the meeting. He took note of Dr Omi's words, and accordingly emphasized the importance of effective logistics management. He noted that, for a logistician, the mantra "No Product? No Programme" is true. However, he added that it takes more than products for an effective programme and he reminded participants of the effect of the anticipated increases in HIV commodity volumes, which in some countries would more than double the current volumes for essential medicines, including TB and Malaria drugs. Thus he indicated that there is an urgent need to improve public sector supply chain management. This improvement should manifest in "tiger", efficient and responsive, management styles as opposed to the "buffalo", slow and unresponsive, management styles of the past. He concluded his remarks by indicating that improved skills would likely improve reliability and accuracy of forecasting/quantification by over 30% and stock and supply management by 25%. This, he professed, would have much greater impact on the cost-effectiveness of the procurement and supply management systems of many countries in the region. Being a training workshop, the secretariat agreed there was no need to elect a chairperson, vice-chairperson or rapporteur. It was agreed that Mr Mfuko, the responsible officer for the workshop, would take the role of master of ceremonies and supporting members of the secretariat from both WHO and MSH would serve as rapporteurs as needed to cover the proceedings ofthe workshop.
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2. PROCEEDINGS
2.1 2.1.1
Day 1: Monday, 4 December 2006 Introduction
An introductory presentation was given by Mr William Mfuko to underscore the complexity of HIV management, including the life-long treatment requirement and other related matters that have to be considered when managing ARV, particularly when undertaking forecasting and quantification, warranting special attention and dedication in the management of such commodities. 2.1.2 Country experiences
The following countries shared their experiences in managing HIV commodities: Cambodia, China, Fiji, Kiribati, Papua New Guinea, the Philippines, Tuvalu and Viet Nam. The following points were noted from the presentations: (1) commitment to improve systems across the region; (2) regimens/product selection guided by national treatment guidelines and WHO guidelines; (3) varying monitoring and reporting periods and tools; and (4) challenges mentioned, among others, included: (a) lengthy supplier lead-times; (b) a lack of uniform forecasting and quantification methodologies; (c) a lack of a standard reporting mechanism between and across programmes; (d) difficulties in coordinating partners; (e) inadequate staff, in terms of numbers, qualifications and experience; (f) increased work load in view of programmes scaling up; and (g) the absence of suitable computer programme(s) to ease the burden of documentation and reporting. 2.1.3 Introduction to quantification
In this presentation and discussion, the following were highlighted and emphasized: (1) there is a need for consensus-building and agreement on quantification assumptions - across policy and implementing partners; (2) forecasting and quantification is not a one-man business; (3) some examples of partner coordination mechanisms for achieving accurate quantification assumptions were demonstrated; (4) issues related to centralized vis-ii-vis decentralized quantification were discussed; and (5) for the purposes of the training, defmitions were given for: (a) procurement period; (b) lead-time; (c) safety stock; and (d) patient months. 2.1.4 Basis for ARV selection
National treatment guidelines and WHO 2006 treatment guidelines were emphasized as the basis for all ARV regimen selections, across programmes and across countries. Other factors that influence forecasting and quantification of ARVs were discussed during this session, which concluded day I of the workshop, including: the rational selection of regimens - hence individual drugs; correct use of regimens and identification of irrational regimens; ways and approaches to address irrational regimens; and the impact on quantification. 2.2. 2.2.1 Day 2: Tuesday, 5 December 2006 Quantification methods
Consumption and morbidity methods for quantification of various drugs were elaborated and discussed. The use and limitation of each method were discussed and participants had the opportunity to perform quantification exercises using consumption, morbidity and service-level adjusted consumption methods. For accurate results, use of a combination of these methods was recommended, if data are available, because each method can serve as a means of validating the
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accuracy of the quantification results. Several terminologies were suggested, s~ch as ~ont~cts, episodes, rates, doses/day, number of days of treatment and several formulae used In quantificatIOn, (e.g. for patient months, lead-time consumption and safety-stock computation), and participants were given the opportunity to use them in practical exercises. 2.2.2 Data collection methods
Data collection methods for quantification were highlighted. These included logistics data, stocks, expiry dates, orders, receipts, patient numbers, regimes, weights and starting doses, among others. 2.2.3 Inventory management and control
Manual inventory management tools/forms to capture minimum data sets for facilitation of quantification were presented. These included: commodity ledgers, bin cards, tally cards, dispensing stock cards, internal requisitioning, daily tracking template for patient numbers on regimens, and samples of written standard operating procedures at various levels of operation. 2.2.4 Challenges in quantification
This group work session ended the second day of the workshop by further discussing and noting challenges to quantification. Discussions were organized by issues related to products, treatments, service delivery and supply-chain management. Each group discussed one of the three different issues: adult ART, paediatric ART or opportunistic infections. Issues that were raised included storage space considerations for ARV in view of scaling up; special storage conditions, such as refrigeration of paediatric doses; the need for written standard operating procedures to clearly defme operations and transfers; and the lack of data to support accurate quantification and how to deal with such situations. 2.3 Day 3: Wednesday, 6 December 2006
The training on Wednesday covered the following areas: service-level calculation for budget consideration and "what ifs". An example of how to put more patients on treatment given a fixed budget (e.g. of US$ 1 million) was used to illustrate factors that influence treatment cost and hence the number of patients to be treated. Factors mentioned included: patents, lead-time stocks, safety stocks, bureaucracy etc., and their influence on cost per patient per year, and hence the need for efficient/tiger management for HN commodities was stressed. For example, it was mentioned that reducing lead-times (both supplier and procurement approvals) may result in a significant increase in the number of patients treated. The example used demonstrated an increase of nearly 30% by cutting the lead-time and the safety stock from nine and three months, respectively, to a three-month leadtime stock and two months of safety stock. 2.3.1 Monitoring and reporting, and stock management analysis
Some templates that could aid monitoring and timely reporting (reports by regimen and product consumption) were shared with participants. Stock management analyses aimed at constantly monitoring stock performance were demonstrated. These included: the monitoring of actual usage against forecast; and expiry risk and stock sufficiency analysis, including lessons learnt from the overforecasting of second-line treatment in many programmes implementing ART for the first time. Several factors contributing to inaccurate forecasting were noted, such as standard treatment guidelines and policy changes, including market forces, unstable donor funding and the application of lead-times and safety stock considerations.
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2.3.2
Assumptions and decision-making: the art of quantification
It ~as further mentioned that qu~tification is more of an "art" than a science. Consequently, to perfect thiS art one has to observe certam rules, among which were stressed: consensus gathering in maki~g assumptions, critical forecasting/quantification decisions, a teamwork approach, crosscheckmg of numbers/results offorecasts, and using existing data to adjust forecasts. 2.3.3 Process of and approach to ARV medicines quantification
This session further noted that "old fashioned" direct calculations, using consumption and morbidity methods, do not work very well for ARV under life-long/chronic illness and scale-up scenarios. There is a need to reduce calculations to basic and easy-to-understand elements such as: (a) Q = [Population" Frequency" Treatment], where Q = quantity of a product required, in base units; (b) visuaUgraphic representation of the scaling-up scenario; and (c) patient months = P ,. [en (n + 1))/2] concept; where: P = average number of patients added each month; and n = the number of months covered. The importance of grouping data by facility and population/patient group, and the determination of treatment protocols by considering their effect on treatment and cost, etc (e.g. generics vis-a-vis branded, fixed-dose-combinations vis-it-vis single dosage forms) were emphasized. 2.3.4 Introduction to spreadsheet tools
The course on this day ended with the introduction to quantification using spreadsheets (facility-level based), stressing the importance of some knowledge of Excel and an ability to define clearly new/existing patients against patients already on ARV and their various usage assumptions for both adult and pediatric ARV quantification, including the quantification of PMTCT drugs. The spreadsheet templates introduced also included templates for drugs for treating opportunistic infections (015) associated with HIV infection and HIV test kits using serial and parallel testing procedures. 2.4 Day 4,5 and 6: Thursday, Friday and Saturday: 7, 8 and 9 December 2006
Thursday, Friday and Saturday were dedicated to hand-on exercises and practices on Excel worksheets and Quantimed, the computer software developed by MSH to ease quantification calculations of various commodities, including HIV commodities. The morning of Thursday was used for a hands-on session on the Excel worksheets introduced the previous day. Participants were again taken through the individual panels of the worksheets, indicating to them how various calculations are performed to arrive at a certain number of patients on a specific regimen and the number of patients on a specific product and hence the calculation of quantities required for the defined period of forecast. Participants, with the support of tutors, were requested to customize the Excel worksheet to their programme's specific data, in terms of regimens and ratio of patients on a particular type of regimen and product. From the afternoon of Thursday, participants were introduced to Quantimed, including handson installation of the software on computers. Using real data from two countries, participants were shown how Quantimed could simplifY the computation of complex formulae, putting consensus assumptions into perspective, thus making quantification much easier than doing it manually. The software can generate several useful reports that could be shared with other stakeholders and/or transferred to Excel worksheet for further generation of tailored reports.
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2.4.1
Quantification issues/matching available funds with forecast quantities
The last session of the workshop discussed ways to reduce cost in order to match available budgets. Some of the ways discussed included: (1) choice of generic ag~inst branded me?ications, where feasible; (2) fixed-dose combinations against single-dose formulations; and (3) cuttmg down the amount of lead-time and safety stock, etc. 2.4.2 Copies of workshop material
In additional to the workshop binder, electronic copies of all workshop materials were distributed, on CD-Rom, to all participants. A separate CD-Rom and the manual for the quantification software, Quantimed, were also provided to each participant.
2.4.3
Workshop evaluation and feedback
Participants were given the opportunity to evaluate the workshop and provide feedback. Results ofthe evaluation and feedback are summarized below and presented in detail in Annex 3. Evaluation and feedback was received from 16 participants who, in respect to educational gains, indicated that the objectives of the workshop were met (100%); that new skills and/or concepts have been learnt at the workshop (100%) and that these skills could be applied in their respective countries (100%). In respect of the workshop process and outcome; while 100% said they were able to express their ideas and problems during the workshop, only 88% thought there was sufficient time and opportunities to exchange knowledge and experience with other participants. Lack of time was attributed by the rest (about 12%) to have been a bottleneck in the exchange of knowledge and experience with other participants.
All were satisfied with all the working papers provided; 96% indicated that all the materials presented at the workshop are suitable for wider distribution. While 94% were satisfied with the methods of introduction and presentation of different topics as well as the discussions that were pursued after the plenary/presentation sessions and at group exercise, 100% were satisfied with the hands-on exercises (forecasting/quantification using Excel and Quantimed), although some indicated that more time was needed and that the Excel hands-on (one participant indicated) should have focused more on establishing formulae rather than Excel skills. In respect of the organization of the workshop flow, while 88% were fully satisfied, a few thought that a few more days would have been beneficial.
Participants were (100%) fully satisfied with the administrative aspect of the workshop; namely travel arrangements, accommodation, per diem, meeting facilities, secretariat support etc. On the overall 100% of the participants/respondents to the feedback and evaluation of the workshop concluded that the workshop had benefited them a lot; and 94% of them suggested that such workshops should be held regularly, with the support of WHO, at country level.
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3. CONCLUSIONS
Participants formulated the following conclusions: (I) It would be useful if national governments were to initiate and oversee the development of a separate tool for HIV commodities quantification and for specific training to be conducted at the facility level. (2) It would also be beneficial if the tools presented at the workshop were to be adapted to country-specific contexts, including translation into local languages. (3) It is necessary to provide incentives to motivate the staff managing HIV commodities, as well as those dedicated to HIV/AIDS management. (4) It would be helpful if WHOIMSH were to take the lead in coordination with ministries of health to apply quantification, stock management, monitoring and reporting tools to facility level and in following up on whether what has been learnt at the workshop is implemented at country level. (5) It would also be useful if WHOIMSH were to support individual countries, at their request, in undertaking TOT training in forecasting, stock management, monitoring and reporting on HIV commodities for central and provincial staff. (6) Design and implementation of similar training in the area of HIV commodities procurement would be very useful. (7) It would be beneficial if a forum were to be organized by WHOIMSH for sharing of experiences and data related to HIV commodities procurement and management across countries.
ANNEXl
LIST OF PARTICIPANTS, OBSERVERSIREPRESENTATIVES AND SECRETARIAT
PARTICIPANTS
CAMBODIA
Dr Ma S·ophann, Deputy Director of Central Medical Stores, Ministry of Health, No 3, Street 139, Sangkat Veal Vong Khan 7 Makara, Phnom Penh. Telefax: (855 23) 426 861. Email: cmsmoh@online.com.kh Mr Tep Keila, Deputy Chief of Essential Drug Bureau of the Department of Drugs and Food, Ministry of Health, No 8, Street 109, Phnom Penh. Telefax: (85523) 880969. Email: teRkeila@online.com.khorteRkeila@yahoo.com
CHINA
Dr Li Dachuan, Section Chief, Division of Medical Quality Evaluation and Management, Department of Medical Administration, Ministry of Health, No I, Nanlu Xizhimenwai, Beijing 10050. Tel: (8610) 6879 2211. Fax: (8610) 6879 2513. Email: Li dachuan@hotmail.com Dr Cui Van, Programme Officer, National Centre for AIDS/SID Prevention and Control, China Centre for Disease Control, No 27 Nanwei Road, Xuan Wu District, Beijing 100050. Tel: (8610) 6303 9081. Email: ycui@chinaaids.cn Dr Zhao Van, Assistant Researcher, Division of Treatment and Care, National Centre for AIDS/STD, Prevention and Control, China Centre for Disease Control, No 27 Nanwei Road, Xuan Wu District, Beijing 100050. Tel: (8610) 6303 4075. Fax: (8610) 63035072. Email: zhaoyanmgl@yahoo.com.cn
FIJI
Dr Sopbaganine Ty Ali, Senior Medical Officer in charge of Reproductive Health Clinic, Ministry of Health, Robuell Road, Suva. Tel: (679) 947 4939. Email: nin6085@gmail.com Mr Apolosi Tamani Vosanibola, Regional HIV/AIDS Procurement Officer, Fiji Pharmaceutical Services, Suva. Tel: (679) 3388000. Fax: (679) 3388003. Email: avosanibola@health.gov:
KIRIBATI
Ms Kaonre Tiia, Acting Director of Phannacy, Phannacy Department, Ministry of Health and Medical Services, Nawerewere, Tarawa. Tel: (686) 28100. Fax: (686) 28568. Email: kaonrepharmacy@yahoo.com Ms Bounsong Manolin, Deputy Chief of Administration Division, Food and Drug Department, Ministry of Health, Vientiane. Tel: (85621) 214013-14. Fax: (85621) 214 015. Email: drug@laotel.com Ms Bangehongphanith Ketmala, Centre for HIV/AIDS and STI (CHAS), Ministry of Health, Km 3, Thadeua Road, Vientiane. Tel: (85621) 315500. Fax: (85621) 353505. Email: ketbanchong@yahoo.com
LAOS
PAPUA NEW GUINEA
Mr Allan Kango, ChiefPhannacist, Port Moresby General Hospital, Private Mail Bag, Boroko, NCD. Tel: (675) 324 8245. Fax: (675) 323 6629. Email: agkango2004@yahoo.com Ms Imelda Villaraza, Head, Phannacy Department, Research Institute for Tropical Medicines (RITM) Alabang, Muntinlupa City. Tel: (632) 807 2628-32. Fax: (632) 8422245. Email: imeldagvillaraza@yahoo.com.ph Ms Leona Verdan Magsino, Phannacist IV, San Lazaro Hospital, Phannacy Department, Quiricada St., Sta. Cruz, Manila. Tel: (632) 309 9538. Email: baby-Imagsino@yahoo.com
PHILIPPINES
TUVALU
Dr Denniszon Mendoza, Consultant Anaesthetist, Princess Margaret Hospital, Ministry of Health, Funafuti. Tel: (00688) 20741. Email: denniszonmendoza@yahoo.com Dr Nguyen Tien Lam, Medical Officer, National Institute of Infectious and Tropical Diseases, 28 Graiphong Road, Dongda District, Ha Noi. Tel: (844) 5764088. Fax: (844) 576 4305. Email: bslambm@yahoo.com Dr Nguyen Quoe Tip, Medical Officer, Viet Nam Administration of HIV I AIDS Control, 1573 Nui Truc Street, Ba Dinh District, Ha Noi. Tel: (844) 736 7131. Fax: (844) 846 5732. Email: tipvaac@grnail.com
VIETNAM
VIET NAM (continued)
Mr Luu Ho Thanh Tuan, PEPFAR Programme Officer, Care and Treatment Division, Viet Nam Administration ofHIV/AIDS Control, Ministry of HeaIth, 138A Giang Vo Street, Ha Noi. Tel: (844) 736 7144. Fax: (844) 846 5732. Email: Ihtt75@gmail.com
OBSERVER I REPRESENTATIVE
UNITED NATIONS CHILDREN'S FUND
Ms Aye Aye Mon, Programme Officer United Nations Children's Fund, 31 Yuchengco Tower RCBC Plaza, 6819 Ayala Avenue, 1200 Makati City. Fax: (632) 8101453.
SECRETARIAT
WHOlWestern Pacific Region
Dr Massimo Ghidinelli, Regional Adviser HNIAIDS and STI Unit, World Health Organization Regional Office for the Western Pacific United Nations Avenue, 1000 Manila, Philippines Tel: (632) 528 9714. Fax: (632) 521 1036 E-mail: ghidinellim@wpro.who.int Mr William Mfuko, Technical Officer, AMOS, HNIAIDS and STI Unit, World Health Organization Regional Office for the Western Pacific United Nations Avenue, 1000 Manill!, Philippines. Tel: (632) 5289719. Fax: (632) 521 1036. E-mail: mfukow@wpro.who.int Ms Vanchinsuren Lkhagvadorj, Technical Officer, Phannaceuticals (PHA Unit), World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manill!, Philippines. Tel: (632) 528 9846. Fax: (632) 521 1036. Email: lkhagyadorjv@wpro.who.int Mr Jun Yoshida, Technical Officer, Pharmaceuticals (PHA Unit), World Health Organization Regional Office for the Western Pacific, United Nations Avenue, 1000 Manill!, Philippines. Tel: (632) 528 9849. Fax: (632) 521 1036. Email: yoshidaj@wpro.who.int
WHOlPapua New Guinea
Mr Chaals Ossom, Technical Officer, HNIAIDS World Health Organization, P.O. Box 5896 Boroko, NeD, Papua New Guinea. Tel: (675) 3257827. Fax: (675) 325 0568. Email: ossomc@png.wpro.who.int
WHONietNam
Dr Masami Fujita, Medical Officer, HN/AIDS World Health Organization, 63 Tran Hung Dao Street Hoan Kiem District, Ha Noi, Socialist Republic of Viet Nam. Tel: (844) 9433734. Fax: (844) 943 3740. Email: fujitam@vtn.wpro.who.int
WHO/South East Asia Region
Ms Catberina Timmermans, Biregional SEAROIWPRO Technical Officer, World Health Organization World Health House, Indraprastha Estate Mahatma Gandhi Road, New Delhi 110002, India. Tel: (0091) 1123370804. Fax: (0091) 1122370197. Email: timmermansc@wpro.who.int or timmermansk@searo.who.int Ms Laila Akhlagbi, Senior Programme Associate, Management Sciences for Health, 4301 N. Fairfax Drive, Suite 400, Arlington, V A 22203, United States of America. Tel: (703) 524 6575. Fax: (703) 524 7898. Email: lakhlaghi@msh.org Mr Tran Dat, Senior Programme Associate, Management Sciences for Health, 4301 N. Fairfax Drive, Suite 400, Arlington, VA 22203, United States of America. Tel: (703) 524 6575. Fax: (703) 524 7898. Email: dtran@msh.org Ms Chinwe OwuDna, Senior Programme Associate, Management Sciences for Health, 4301 N. Fairfax Drive, Suite 400, Arlington, VA 22203, United States of America. Tel: (703) 524 6575. Fax: (703) 524 7898. Email: cowunna@msh.org Mr Andrew Barraclough, Regional Technical Advisor, South-East Asia, Pharmaceutical Management, Management Sciences for Health, Unit 104,30 Nguyen Du Ha Noi, Viet Nam. Tel: (844) 945 4561. Fax: (844) 9454563. Email: abarraclough@msh.org Ms Nguyen Tbi Thuy, Programme Associate, Management Sciences for Health, Unit 104, 30 Nguyen Du Ha Noi, Viet Nam. Tel: (844) 9454561. Fax: (844) 945 4563. Email: thuynguyen@msh.org
Management Sciences for Health
ANNEX 2
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TIMETABLE ·
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1IDnday." December
Tuesday, S December Review 01 prevtous day's adIvi1Ies Quantlllcalion methods and exercises: morbidity
WadnescMy. • December Revtew 01 previous day's adMIies InvenkllY management and control: manual tools (conUnued) • AI d'lSpenslng level and related dispensing pl1lCllces
Thursday, 7 December
Friday, B December
s.turday. • Dtl;ember
Regls1rafion
Review 01 pnMous day's activities Introduction to spreadsheet tools (continued) • HIV tesI kI1s • Drugs lcropporlJJnistic Infections
Review 01 pnMous day's activI1Ies 9.
Review of previous day's adIviIIes Hands-on training on Quantined
0900
1. Opening ceremony • Regional Directo(s opening remarks • Representallve from MSlfs openilg remarb • Introduction 01 pertlcipants • AdmInistratiVe announCernenIs
Introduction 10 Quantimed
2. ObjectNes and organization of the workshop
1000 1015 3. PresSlltafion: Why are anfiretrovltals conSIdered different from convenIilnaJ drugs?
COFFEE Quan1lflcaUon methods and exercises: consumption Overview 01 antiretrovirai drug marl<et and quan1lflcation 7. - Monftoring and reporting tools • ConsumpUon reporting by product • Consumpllon IlIpOIting by regimens • other related stock management analyses and reporIs Assumplions and decision making: the art of quantification -LUNCII Counby praaentalions (continued) 5. Introduction to Ouan1lflcatlon Issues and challenges in quan1ifylng needs of antiretrovnl and opporlmlstic infection medicines Process and 8ppi'OIIches to antiretrovilal drug quantlllcation
BREAK Introduction to spreadsheet tools (continued) Hands-on training on Quantimed (con~nued)
.
Hands-on tralni1g on Quanlimed (conti1Ued)
4. Counby presentations: Experiences In managing antiratrovlrat commodities
1230
B REA K
.
1330
Introduction to fore<:as1irgIquantification exerdse: hands-on traini'g on spreadsheet tool BREAK Hands-on training on spraedsheet tools Presentation and discussion on hands-on exercise
Hands-on training on Quantined (continued)
Hands-on trainilg on Quantlmed
(continued)
1500 1515 Introduction 10 Quantification (continued) Basic CXlIICepts of antiretrovirai therapy:
COFFEE Quantifying antiretmvial needs for children Data ooIIeCIioo for antiratroviral quantificallon 6. Introduction In Inventol)' management and control: manual tools • At malnIbuIk sIDra level 8. Introduction III spreadsheet tools • Antiretrovlrals • Pravenfion of mother-tcH:h11d
Hand!Hl/1 training on Quantlmed(continued)
Revtew 01 expectation and WOII<shop
evakJalion
basis for selection and quanllftcalion
transmIsslon
10.
Closing ceremony
1730 1830
End of day 1 JSecretariat meeting Welcome Recepllon
End of day 21 Secretariat meeting
End of day 31 Secretariat maeting
End of day 41 Seaetatlal meeting "
End of day 51 SeaetariaI mae1Ing
End of day 61 Seaeta!tat maeting
ANNEX 3 EVALUATION AND FEEDBACK JOINT WHO AND MSH WORKSHOP ON FORECASTING, STOCK MANAGEMENT, MONITORING AND REPORTING ON ANTIRETROVIRAL COMMODITIES WORKSHOP EVALUATION RESULTS (Raw scores; unedited) %
Yes Education gains 1.1. Were the following objectives met? (a) to share respective country/programme experiences in forecasting, stock management, monitoring and reponing of antiretroviral medicines and related commodities; (b) to gain an understanding of the minimum set of management tools for proper stock management, conducting accurate Forecasts, monitoring and the timely reponing of antiretroviral medicines and related commodities; and (c) to acquire the necessary competency in utilizing one or more tools for forecasting, stock management, monitoring and reporting on antiretroviral medicines and related commodities If !!Q, pl~ase
No
Not Scored
Yes
No
Not Scored
Comments
16
0
0
100%
0%
0%
x3 nonrespondent
16
0
0
100%
0%
0%
x3 nonrespondent
16
0
0
100%
0%
0%
x3 nonrespondent
describe:
1.2 Have new skills or concepts been learnt at the workshop? 1.3 Can these skills and concepts be applied in your country? 2 Process and outcome 2.1 Were you able to express your ideas or problems at the workshop? 2.2 Was there enough opponunity to exchange knowledge and experience with other panicipants? If response to any of the above is no, give comments as appropriate: .. (i) Lack of time to interact more with each other e.g. sharing; (ii) The time given, from Monday to Saturday was very limited to participants to get to know each other very well; just communicated personally. during break times. 2.3 Were you satisfied with all working papers provided? If no, please explain for specific paper(s): 2.4 Specify which of the working papers distributed for the workshop are suitable for wider distribution: (l) Everything is applicable; (ii) Tools for quantifications, momtoring and reporting tools, Excel spreadsheet tools for quantification; (iii) SOP modules; (iv) Some reponing forms; (v) Quantimed; (vi) All the different forms in reporting; (vi) Challenges of ART management; (vii) Introduction to quantification
16 16
0 0
0 0
100% 100%
0% 0%
0% 0%
x3 nonrespondem x3 nonrespondent
16 14
0 1
0 1
100% 88%
0% 6%
0% 6%
x3 nonrespondent x3 nonrespondent
16
0
0
100%
0%
0%
x3 nonrespondent
2.5 Were methods of introduction and presentation of different topics satisfactory? If no, explain your response: 2.6 Were you fully satisfied with discussions (a) at the plenary/presentation session?
15
1
0
94%
6%
0%
x3 nonresoondent
16 15
0 1
0 0
100% 94%
0% 6%
0% 0%
(b) at the group exercises and discussions? If no, please explain:
x3 nonresoondent x3 nonresoondent
Were you fully satisfied with the hands-on sessions? If n, please explain: The hands"on session on spreadsheet should be more focusing on establishing formulas rather than excel skills 3 Organization of the workshop Were the duration and scheduling of different activities lectures, group discussions, hands-on training, etc. - satisfactory? Ifno, please describe: (i) More time needed; very limited time in hands~on training; (ii) The session, on spreadsheet. shonld be more interactive Administrative aspect Are organizing or administrative arrangements for travel, accommodation, per diem, meeting room, secretarial suppon and interpretation satisfactory? If!!Q, please describe: Your overall conclusion Do you feel that (a) You have, benefited from the training? very much x 1 respondent If no, please explain:
2.7.
16
0
0
100%
0%
0%
x3 nonresDondent
14
2
0
88%
13%
0%
x3 nonresoondent
4
16
0
0
100%
0%
0%
x3 nonresoondent
5
16
0
0
100%
0%
0%
x3 nonresDondent
(b) Such workshops should be held regularly?
IS
1 0 0
0 0 I
94% 100% 94%
6% 0% 0%
0% 0% 6%
(c)Was your attendance wonhwhile to you personally? (d) Was your participation wonhwhile to your country or program? Comments (if any): (i)I thirik asa pharmacistJ don't have enough time because of our workIoad;my,focus is mainly in dispensing; manually we're doing m~niiqring, .reponingan4physical coum tQ find om the stOcldeyeL Our clerk'is responsible for entering the data in the computerE Whatldo is to giveth~infonnationtotype; (ii) As a pharniacist,Ibaveno enough time to give since we are 'more on dispensing,.:.-" ',monitoring and reponing. Procurement is' not our fuJli:tions,aswell3.s ,seeingpatientfortieatment.
16 IS
x3 nonresoondent x3 nonresoondent x3 Donresoondent
6
AIe there any better ways that could have been used to achieve the workshop objectives? If yes, please describe briefly:
o
0%
Ix3 non-
(i) Bxcelient workshop; (ii) Separate tool kit for quantification iraining for facilities; (iii) To build up a tool for ARV in Viet Nam; (iv) Use effective tool to manage IDV commodities; (v) SitevisiiS; (vi) Longer periods for hands-on training for Quantimed and to have PC each; (vii) The computers and working papers, hands-on facilitate to understand well all sessions (1)
1
What follow-up activities, if any would you recommend? (a) by national government (i) Separate tool kit for quantification training for facilities; (ii) To build upatool for ARV inVietnam; (iii) Use effective tool to manage 'IDVcommodities; (iv)M&E,planning;: training and transferring and coordination; (v) Check aU the ART requirement for the patients by MoH experts (?) (vi) There should be support from the government; (vii) Government could/should make a systematic approach on reporting of ARVrnanagement in health facilities.and NGOs clinics to manage the data _ make easy to coUecl. data to study or analyses for future; (vii) The government should do something to motivate the staff for attempt to apply ... following all these sessions; (viii) Using Quantimed at Central Level; train on manual tools and introduction for provincial level (b) by WHO · (i) Coordination with MoH, MSH to apply .tools to facilities; (ii) To. establish if participants implement what bas been learned in their reSpective countries;· (iii) Provide technical support to countries; (iv) M&E, Training on ToT for Forecasting, Stock MaiJagemeni for Central and provincial health staff; Technical Support); (v) Continuous support from you and regular communication to all countries; (vi) More workshOps and tnlining; (vii) Plan for a schedule of training to be involved in procurement of ARVs (viii) We may need to refer some questions .10 WHO ,or MSH after returning home; (viii) WHO should · provide more information related to ARVs rnanagementto progranimes pf countries if any data or any information. or .exverjeneefromany country are better of soinechanging.of r~ommeildations (?);;(ix) WHO should create workshop once or · iWiceayear iftbere will be new changes on ARVs .' ': riiime~1quantification; (xl Further workshops'to disseminate the cilDcejiisandtools for quantification
(c)
by other agencies (specify type) -
'(i)Cooperation and coordinationin planning; (ii)M&E; Technical & financial support fOr transferring and training; (iii) · .AssistaDcefrom NGO's and various organizations e.g, PAFPH, GFATM,TDF; (iv) NGOs, stakeholders, donors should share their~xPeri~Ilcesand information to programs IDV/AIDS care to i1evejopwhat practice in the country (7); (v) NGO should apply following QuantimedUser's Guide of MSH for easy. discussing betWeen' government staff and them on quantification, stock · management, forecasting and reporting (?); (vi) Sponsor and support training on quantification within country
How many meetings/workshops - WHO and others - have you attended in your professional capacity outside your country over 8 the last twelve months? •This is my first time 0 7 44% 1& . (b) 1 4 25% (c) 2-3 4 25% (e) >3 1 6% .' Total 16 100% '.
.
'.
10
I
Attendance rate
# invited # attended
22 17 Planned 2 3 2 2 '
100% 77% Actual 2 3 2 0 1
10 1 2
Attendance by country cambodia
3
China I Fiji I
.
'.
.
;
4 5 6 7 8 9
Indonesia : Kiribati Laos I" , ......... . .
..
.
1 '. .
2 1
Micronesia (Federated States of); PNGI. '. .,;". '. ..... Philippines Timor Leste: Tuvalu' VietNam '. ;-, . ' I ; .
.
..•
,
10 11
I"" .
....
.
L Total
12
2 2 2 I 2 22
2 0 2 2 0 1
4 19
86%