Mbabane, Swaziland – The waiting room at Mbabane Hospital is full of patients in the morning, about a quarter of them new. Each waits for his turn at the dispensing room, where a pharmacist gives him a dose of anti-retroviral (ARV) drugs and tells him when to come back for a refill.
Just a year ago this smooth-running system was not in place. Drug shortage was so frequent that the Global Fund for AIDS, Tuberculosis and Malaria, which supplies the life-prolonging medications, threatened to withdraw its assistance unless Swaziland began managing its drug supply. Swaziland’s Ministry of Health was unable to comply and turned to USAID for help.
Now 12 sites, including Mbabane Hospital, are using a computerized drug supply management system. At the ministry level, the USAID-supported Rational Pharmaceutical Services (RPM) developed management reports for the Central Medical Store.
“Before we didn’t know what we had in stock, so it was never a stable situation,” said Noncebo Gama, head pharmacist at Mbabane Hospital. “The new system is much more accurate.”
She added: “now we enter each patient as we dispense the ARVs to them and the system is much more accurate.”
Some 20,000 people die of HIV/AIDS in Swaziland annually, the country with the world’s highest prevalence of the disease. It has seen its average life expectancy shrink from 65 years in 1991, to 38 years today.
USAID, with funds from the U.S President’s Emergency Plan for AIDS Relief (PEPFAR), has been addressing the epidemic here since last year.
RPM began its work at three sites in August 2005. It rose to 12 soon after, and aims to be at 19 by the end of the year, said Jean-Paul Sallet, regional technical advisor with Management Sciences for Health, which implements RPM.
“There was a huge need for accountability in terms of quantity,” he said. “That’s a very critical thing for ARVs because they are something that can easily slip out of sight.”
“Now we are getting reports from the clinics with exactly how many ARVs they use,” Fortunate Fakudze, head pharmacist at the Ministry of Health and Social Services’ Central Medical Store. “It was a nightmare before.”
With RPM’s help, the ministry now aims to spread the computerized drug supply management system nationwide to track all medications, Fakudze added.
The project has trained Swaziland’s seven pharmacists in drug management systems. To build the cadre of pharmacists, it is also working with the Ministry of Health on creating new pharmacist positions through the civil service system. RPM is also helping revise a Pharmacy Act of 1929.
While assistance at the national level is much needed and appreciated, it is at the lower level -at the clinics- where the changes are most visible, Fakudze said.
Added Gama: “before, we didn’t have a store room – all the drugs were put in a room that wasn’t in order, so it was easy to make a mistake. But now the patients probably feel the difference – thanks to RPM, we are even about to start printing instruction labels that we can hand out with the drugs.”
About 150 to 200 patients come to Mbabane Hospital a day, each returning once every month. Across the country, some 7,000 HIV/AIDS patients receive ARVs.
