Patrick Boruett, a pharmacist and DTC member at the Mater Hosptial in Nairobi, Kenya, actively participated in the Regional Drug and Therapeutics Committee Training of Trainers (DTC-TOT) course held in Uganda in 2004. He used what he had learned to successfully facilitate a DTC workshop in support of three pilot sites for DTCs in Kenya, which was held in Nairobi in December 2005. Patrick hopes that sharing his experiences will be helpful to others wishing to offer DTC courses in their countries.

In concert with the Kenya Ministry of Health (MOH) and with the support of the World Health Organization (WHO), Patrick worked with other resource persons in the country who were also trained in regional DTC courses in Kenya (2001) and Uganda (2004). The members of the organizing team included Elizabeth Ogaja, Sarah Chuchu, Atieno Ojoo, Margaret Oluka, and Patrick. Chris Forshaw, pharmaceutical adviser to the MOH, was also involved.

Workshop Highlights                                                                 

The workshop was designed to support the three provincial and district hospitals in Thika, Nakuru, and Nyamira serving as pilot sites for DTCs. Each hospital sent five workshop participants with rich experience at various levels of responsibility. Participants included a medical superintendent, medical doctors, clinical officers, pharmacists, hospital matron representatives, procurement officers, and administrative officers.

Developing the workshop gave Patrick an opportunity to put into practice the skills and knowledge he acquired at the Uganda DTC-TOT course. Four weeks before the workshop, Patrick and the organizing team began preparations that included a rapid-assessment situation analysis of the pilot hospitals, carried out by two MOH officials, which yielded information useful in developing the workshop presentations. Additionally, the resource team collected a great deal of data on medicine use at the hospitals to identify the challenges faced by each pilot site. This data included a list of medicines in stock, medicines on order, and medicines prescribed.

Data from the pilot sites was also used for VEN and ABC analysis activities during the DTC workshop session on aggregate methods, further clarifying the nature of medicine use problems at the sites. Important problems identified were therapeutic duplication and the inclusion of nonessential medicines in site formularies. In addition, some formulary lists included brand names. Workshop participants, though, agreed that generic names should be used. 

Patrick and the other team members found the DTC manual developed by WHO and MSH/RPM Plus very useful in preparing slides on establishing DTCs. Planners made sure that sessions were highly interactive and relevant to the participants’ work. Participants openly shared their previous experiences with committees that were not successful, exploring reasons for failure.

Patrick reinforced key principles in setting up DTCs, which had been covered at the Uganda course session on the functions and structure of a DTC. He tackled the development of terms of reference (TORs), highlighting key issues and components and providing three sample TORs from real hospitals in addition to those in the DTC manual. Next, each team worked together to draft TORs for their own hospital DTCs.

Additionally, teams from each pilot site developed workplans during the workshop and supervisory visits by MOH officials were planned.

Lessons Learned                        

• Keep slides simple. Patrick found he could adapt slides from the DTC TOT course, with minor modifications to make them more relevant.
  

• If possible, get data from participants’ facilities. This improves the accessibility and relevance of workshop sessions, enriching the learning experience for participants.
  
  
• If you are a facilitator, interact with participants outside of workshop sessions—for example, during tea breaks or lunchtime—and if possible, attend other sessions, including those that come earlier than your own. This approach can make it easier to blend with the group quickly and take into account topic areas that have been addressed by other facilitators.
  
  
• Select participants carefully to ensure that they can make use of the training when they return to work. For Patrick’s workshop, the teams sent from each hospital were relevant because they included core members of the DTCs to be established at the sites.
  
  
• Select multidisciplinary teams to foster collaboration and establish a rounded concept of a DTC, and design materials to be relevant for the various members.
  
  
• Get logistics right from the beginning, possibly using a checklist or spreadsheet as a planning tool. Patrick discovered lapses in coordination of activities, which resulted in delays in getting started on the first day of the workshop.