From 2000 to 2005, the Rational Pharmaceutical Management (RPM) Plus Program, with support from USAID/Zambia, worked with the Zambia Ministry of Health (MoH) to strengthen the country's pharmaceutical management in the areas of malaria, child health, reproductive health, and voluntary testing and counseling (VCT). This initiative built upon the work started by RPM in 1996. In 2004-2005, RPM Plus received additional funding from the U.S. President's Emergency Plan for AIDS Relief to extend our work to pharmaceutical and laboratory management in HIV/AIDS and antiretroviral therapy (ART). RPM Plus has contributed significantly to Zambia's pharmaceutical sector by supporting the development of a national essential medicines list (EML) and standard treatment guidelines, by helping establish a national formulary committee, and by developing a nationalized Management Information System for VCT and prevention of mother-to-child transmission (PMTCT). In addition, RPM Plus helped improve and strengthen pharmaceutical management through numerous other activities, including trainings in procurement, quantification, and rational use. Our successes, however, could not have been achieved without the dedication and commitment of all the partners, national and international, who worked with us in support of the overall strategy to strengthen Zambia's health sector. Project Highlights Here is a list of the accomplishments and highlights from the Zambia program:
General Pharmaceutical Management Support - Worked with the Central Board of Health (CBoH) to establish a National Drug Policy Implementation Steering Committee that developed a plan and monitored its progress towards implementation—RPM Plus contributions included linking National Drug Policy to key implementation issues, identifying key stakeholders, and developing indicators for monitoring
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| HIV/AIDS
- Training in Antiretroviral Therapy (ART) Commodity Management for Pharmacy and Laboratory
- This training increases the capacity of pharmacy and laboratory staff providing ART services. This training package has become a backbone of RPM Plus generic ART training material in pharmaceutical management.
- May be used to support the model of care recommended by the World Health Organization's (WHO) 3x5 strategy on the delivery of care by health workers
- Focuses on effective pharmaceutical management (selection, quantification, distribution, use, management support, and legal framework) to support ART programs and laboratory services
- Provides modeling of attitudes in patient care and diagnostic skills
- Training in Quantification of Antiretrovirals (ARVs)
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- Facility-based quantification develops knowledge, skills, and attitudes of trained pharmacy staff in estimating HIV/AIDS-related commodities.
- National-level quantification focuses on the methodology behind quantification in addition to the necessary considerations and assumptions required in quantifying ARVs. All these materials are available in English and French.
- Quantimed, a software program developed by RPM Plus, is designed to help determine the quantities of medicines and medical supplies required for a health program and assists in planning and budgeting. Quantimed—
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- Allows health planners and directors of essential medicines programs to calculate pharmaceutical and other health product needs. The program makes adjustments based on historical consumption patterns or by taking an epidemiological approach that uses patient service/morbidity profiles and standard treatment guidelines
- Has option for scaling up morbidity-based estimates for growing programs
- Was used in Zambia for 2006-2007 national quantification of ARVs
- Development and integration of Voluntary Counseling and Testing (VCT)/Prevention of Mother-to-Child Transmission (PMTCT) Information and Commodity Management System in National Health Management Information System
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- Provides critical data for program management and policy development, including both quantitative and qualitative information about client profiles and use of services, commodity management, and laboratory services
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- Includes indicators, standards, easy-to-use tools, user's guide, and procedures manual
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- Information flows from the service centers to respective districts, regions, and finally to the national level while existing health management information system resources are used to run and maintain the database
- Is used in more than 265 VCT sites across the country
- Development and distribution of standard operating procedures (SOPs) for ART in pharmacies and laboratories in Zambia, providing quality standards for ART services
- Zambia was the first to adopt ART SOPs for pharmacy and laboratory services.
- Currently, 6,000 pharmacy SOPs and 2,000 laboratory SOPs are distributed across the country.
- RPM Plus supported the development of the National Biomedical Safety Manual that is now a companion to the ART laboratory SOPs.
 - Development and integration of ARV Dispensing Tool in all facilities providing ART services. The ARV Dispensing Tool allows performance monitoring of ART services and provides the following information—
- Zambia was the first to adopt ART SOPs for pharmacy and laboratory services.
- Currently, 6,000 pharmacy SOPs and 2,000 laboratory SOPs are distributed across the country.
- RPM Plus supported the development of the National Biomedical Safety Manual that is now a companion to the ART laboratory SOPs.
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- Dispensing records per patient and timely reports on actual and cumulative number of patients (gender and age) enrolled at hospitals
- Trends in pharmaceuticals utilization-helps determine when and how much to order
- Report of patients missing appointments for adherence monitoring-facilitates follow-up
- Warning message when the stocks are falling low-helps avoid stock-out of ARVs
 - Information generated has been used for—
- Quantification of ARV stock requirements and scaling up of services
- Set up of referral system with home-based care
- Strengthening PMTCT services to capture PMTCT clients accessing ARVs
- Training in the operation and use of the tool was provided for more than 80 pharmacy personnel and data management specialists at the various facilities.
» More on RPM Plus' work in HIV/AIDS To the Top
| Malaria - Malaria Policy Development and Implementation
» More on RPM Plus' work in Malaria To the Top Tuberculosis (TB) - Provided support to the National TB Global Facility Review Missions from 2003 to 2005. As a result, Zambia accessed WHO Global TB Drug Facility (GDF) first-line anti-TB medicines.
» More on RPM Plus' work in TB To the Top Reproductive Health - Provided technical assistance to the MoH in the selection and quantification of medicines for sexually transmitted infections (STIs) using the cost-estimate strategy (CES)—the Assessment of Commodity Needs for Integrated Reproductive Health Report [PDF - 415 KB] has become a reference document in costing the reproductive health program in Zambia. Continuing this work, RPM Plus provided technical assistance in the quantification of reproductive health commodities and costing of the reproductive health policy.
- RPM Plus conducted a baseline assessment of district-level hospitals and surrounding clinics [PDF - 278 KB] to determine pharmaceutical management issues affecting active management of the third stage of labor for the prevention of post-partum hemorrhage (PPH) in Zambia. This work was part of a USAID Special Initiative to Reduce PPH in partnership with the Intra Health PRIME II project, the JHPIEGO Maternal and Neonatal Health program, and the American College of Nurse-Midwives. Other countries included in this study were Mali, Benin, and Ethiopia.
- As part of the USAID Regional HIV/AIDS Program for Southern Africa Corridors of Hope initiative, RPM Plus conducted an Assessment of Quality of Services and Pharmaceutical Management for STIs at health facilities at Corridors of Hope program sites in Zambia and Zimbabwe. Additional countries assessed by other project partners were Lesotho, South Africa, and Swaziland.
» More on RPM Plus' work in Reproductive Health To the Top Child Health - Community Drug Management for Childhood Illnesses (C-DMCI) Assessment Tool [PDF - 1.3 MB] was developed, tested, and finalized in Lusaka and Petauke districts—the tool helps countries assess their community practices in the management of medicines for childhood illnesses.
- C-DMCI tool was adapted to assess the availability and use of medicines for malaria in the community for children less than five years of age. Using the adapted tool, a C-DMCI Assessment of Malaria in Children [PDF - 746 KB] was conducted in 2003 to—
- Identify the strengths and weaknesses of community drug management for childhood malaria in the five districts surveyed
- Guide the development of interventions, planning of activities for C-DMCI for malaria, and even national drug policies targeting childhood illnesses
The findings may be used for malaria management and child survival, policy development, and programming.
» More on RPM Plus' work in Child Health To the Top Antimicrobial Resistance (AMR) - Helped establish the Alliance for Prudent Use of Antibiotics (APUA) Zambia Chapter. The chapter promotes prudent use of antibiotics, facilitates promotion of rational drug use (PRDU) meetings for both private and public sector, and conducts research on rational use of medicines for decision making.
- In partnership with Change/Academy for Educational Development, APUA, Applied Research on Child Health project, and the Harvard Drug Policy Group, RPM Plus supports a country-level strategy for advocacy and containment of antimicrobial resistance with the objective of catalyzing a response by local stakeholders to build and coordinate realistic strategies to contain AMR. Achievements under this strategy included—
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- Establishing 10-member AMR advocacy working group
- Holding first national AMR stakeholders' "Call for Action" meeting in November 2004
- Developing print and radio campaigns promoting appropriate antibiotic use
- Conducting in-service training for health professionals on AMR topics
- Working with physicians to review standard treatment guidelines, and promote adherence
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- Drafted workbook for Building Local Support for Containing Local Drug Resistance
» More on RPM Plus' work in Antimicrobial Resistance To the Top
Promoting Rational Use
| - Supported and facilitated national and regional PRDU workshops. The workshops' primary objective is for participants to increase their capacity to critically analyze drug use practices and develop strategic interventions to promote rational use of medicines in their practice areas.
- Supported and facilitated national and regional Drugs and Therapeutics Committees (DTC) and workshops where public sector pharmacists, Lusaka Urban District Health Management Team DTC, and the Zambia National Formulary Committee learned how to make DTCs functional and effective in promoting rational use of medicines.
- Working with the Lusaka Urban District Health Management Team Drugs and Therapeutics Committee, RPM Plus conducted a Drug Supply and Use Review Survey [PDF - 517 KB] to evaluate systems supporting drug availability and utilization. Two years after interventions were initiated, a follow-up survey was conducted to assess their impact in the district.
» More on RPM Plus' work in Rational Drug Use For more information about RPM Plus work in Zambia, please contact us.
Related Information » Latest RPM Plus activities » Full details of RPM Plus project work in Zambia are available in the RPM Plus Close-Out Presentation [PDF - 789 KB] and the Zambia final report [PDF - 2.6 MB] To the Top
 | This work is funded by the President's Emergency Plan for AIDS Relief through USAID
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