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Impact of Tamilnadu Medical Services on drug prescribing in primary health care Impact of Tamilnadu Medical Services on drug prescribing in primary health care

INTRODUCTION § An efficient health care delivery system is an important requisite to achieve INTRODUCTION § An efficient health care delivery system is an important requisite to achieve health for all. § Access to essential drugs is probably the most important element of health care delivery system.

The Government of Tamil Nadu, India realizing this, developed and implemented various strategies under The Government of Tamil Nadu, India realizing this, developed and implemented various strategies under the broad framework of Tamil Nadu Medical Services Corporation to control and monitor drug procurement, storage and distribution to the Public sector hospitals in the state.

Tamilnadu Medical Services Corporation(TNMSC) § 1994: Efforts to rationalize drug use commence and TNMSC Tamilnadu Medical Services Corporation(TNMSC) § 1994: Efforts to rationalize drug use commence and TNMSC formed; Chain of modern warehouses built § 1995: Essential drug list prepared § 1997: News Bulletin “TNMSC Times” launched § 1998: Training for Doctors and Pharmacists.

TNMSC & RUD § EDL § “TNMSC Times” § Pharmacist’s handbook § Storage under TNMSC & RUD § EDL § “TNMSC Times” § Pharmacist’s handbook § Storage under good conditions in modern warehouses § Training of pharmacists in inventory management § Distribution based on indenting by medical officers § Good quality Generic drugs at competitive rates § Inventory control at district warehouses

TNMSC Web Server H. O e-Tendering Tender Minutes Generation Form Download & Submission Suppliers TNMSC Web Server H. O e-Tendering Tender Minutes Generation Form Download & Submission Suppliers Order Placement

Order Placement Suppliers AUTOMATED BILL PASSING TNMSC Invoice MRC & Invoice Linkage MRC Warehouses Order Placement Suppliers AUTOMATED BILL PASSING TNMSC Invoice MRC & Invoice Linkage MRC Warehouses Printing of Cheques

Quality Control Samples from Visual - Physical Defects - Packing - Including Cartoon Warehouses Quality Control Samples from Visual - Physical Defects - Packing - Including Cartoon Warehouses Eliminating Common No Compromise Batches on QUALITY Sent to LAB Results thru’ E-Mail Intimate to Warehouses if failed

Stock Monitoring TNMSC H. O. In te rn et Transfer info. to Warehouses In Stock Monitoring TNMSC H. O. In te rn et Transfer info. to Warehouses In te rn et Monitor the Stocks Transfer info. sent to H. O. Warehouses Internet Warehouses

Warehouse Information System Suppliers Passbook & Order info. TNMSC H. O. Warehouse Submit Indent Warehouse Information System Suppliers Passbook & Order info. TNMSC H. O. Warehouse Submit Indent y ppl Su Issues under Budgetary Control Medical Institutions

H. O. Server CT Scan System Drug Management & Monitoring System Warehouse Information System H. O. Server CT Scan System Drug Management & Monitoring System Warehouse Information System QC Monitoring System M. I. S. Payroll & Personal Financial Accounts Automated Material Handling Construction Management Supplier Information

Impact evaluation 1) To study the impact of the TNMSC in primary care centres Impact evaluation 1) To study the impact of the TNMSC in primary care centres (PHCs) on a) availability of 15 core essential drugs; b) continuous availability of an adequate quantity of the core essential drugs; and c) rational use of drugs in PHCs; 2) to study the maintenance of quality of drugs by the TNMSC and 3) to study the control of drug expenditures by the TNMSC.

Study design § Longitudinal time series with control before and after various TNMSC interventions Study design § Longitudinal time series with control before and after various TNMSC interventions (20 PHCs Vs 20 Controls). § Time series study of government rural PHCs before and after various TNMSC interventions in 1994 -8.

RESULTS(preliminary 5 PHCs Vs 4 Controls) § Tim e series analysis is showing a RESULTS(preliminary 5 PHCs Vs 4 Controls) § Tim e series analysis is showing a positive trend in the following indicators in the intervention facilities: 1) % of key drugs available per facility per time period 2) Average number of days of stock-out per year per facility per year 3) % drugs prescribed by generic name 4) % drugs prescribed that belong to the PHC EDL (51 drugs) 5) Average cost per prescription

§ However no such trend is discernible in the following: 1)% prescriptions containing an § However no such trend is discernible in the following: 1)% prescriptions containing an antibiotic; 2)% prescriptions containing a vitamin; 3)% prescriptions containing an injection 4) average number of drugs per prescription

Results are preliminary and have to be interpreted with caution www. tnmsc. tn. nic. Results are preliminary and have to be interpreted with caution www. tnmsc. tn. nic. in www. tnmsc. com Study funded by Applied Research in Child Health through the United States Agency for International Development (USAID). Thank you