Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

CAMBODIAto manage on their own in emergency situations, by “borrowing” medicines andsupplies from other AIDS treatment clinics.The Center for Medical Supplies (CMS) manages drug delivery in general, includingfor ARVs. The agency’s ability to meet its supply responsibilities is hindered at timesby the inability of local health care staff to properly estimate drug needs. Theyordinarily submit letters to the national program three months in advance to askfor drugs, but sometimes they underestimate or incorrectly predict the number ofpatients that will start or change treatments.The bureaucracy surrounding Global Fund procedures and protocols alsocontributes to stock-outs. For example, the PR sometimes cannot process drugrequests because it must wait for agreement and approval from the Global Fund.Such approval could take up to six months, and the delay is often extended becauseof other factors regarding tendering and shipping.RecommendationsAssure the quality of pharmaceuticals:• Set up local—and independent, if possible—quality controllaboratories.• Draft and distribute a manual on quality control laboratorymanagement.• Improve regulatory controls and legislation, with particular attentionpaid to devising measures against counterfeited drugs.• Improve enforcement of laws and regulations.• Intensify the joint efforts of WHO and the pharmaceutical industry toassure quality.• Check expiry date: If no expiry date is given, one should be requestedfrom the manufacturer or supplier. A file stating the expiry date shouldbe used.The capacity of CMS staff on drug management and distribution issuesshould be improved.An enabling environment should be created to combat drug stock-outissues. This would entail the MoH providing a platform for local healthproviders to talk openly about the health system in the country context.The WHO must work harder to control and provide technical assistanceon drug stock-out and quality issues.68