Key performance indicators for routine monitoring of pharmacy management at United Nations High Commissioner for Refugees (UNHCR) in Jordan Open Access

Abstract

Background: Medicines and medical supplies comprise an essential building block for the delivery of healthcare services to disaster-affected and conflict-affected populations. Medicines and pharmacy systems in humanitarian settings are susceptible to mismanagement due to the sizable budgets allocated to medicines, complexity of pharmacy systems and involvement of multiple partners throughout the pharmacy management cycle of drug selection, procurement, distribution and use.  

Objective: To research current pharmacy monitoring in humanitarian settings and develop key performance indicators that trigger alerts at early stages of pharmacy mismanagement that can be collected on a monthly basis by United Nations High Commissioner for Refugees (UNHCR) Public Health staff with no pharmacy background.

Methods: The project involved five main steps including: 1) a literature review for established indicators for pharmacy monitoring, key areas in pharmacy that require monitoring and methods to design routine monitoring systems; 2) identifying the key areas in pharmacy management related to this project that need to be monitored routinely; 3) defining criteria for the indicators to be collected; 4) developing indicators and selecting relevant established indicators based on the identified key areas and the defined criteria for the second and third steps; 5) developing guidance notes to aid the assessor in collecting the indicators and interpreting the results. 

Results: Forty-four key performance indicators for monthly monitoring were compiled in the “PharMon Tool”. The indicators cover the “distribution” and “use” steps of the pharmacy management cycle which includes pharmacy records, drug shortages, storage conditions, physical arrangement and rational drug use.

Conclusion: This project will help to improve routine pharmacy monitoring at UNHCR which may help to limit mismanagement, make the best use of resources, and ensure that pharmacy systems meet their goals in providing access to medicines, ensuring quality and safety of drugs and promoting rational drug use.

Table of Contents

Chapter 1: Introduction ............................................................................................................... 1

I. Background .......................................................................................................................... 1

II. Problem statement ................................................................................................................ 2

III. Purpose statement ................................................................................................................ 3

IV. Objective ............................................................................................................................. 3

V. Significance statement ......................................................................................................... 4

Chapter 2: Methods ...................................................................................................................... 9

Step 1: Literature Review ............................................................................................................ 9

Step 2: Identification of key areas for pharmacy monitoring.................................................... 10

Step 3: Defining criteria for indicators ...................................................................................... 11

Step 4: Developing and selecting indicators ............................................................................. 11

Step 5: Developing guidance notes for each indicator .............................................................. 12

Chapter 3: Summary of Literature Review .............................................................................. 13

Overview ................................................................................................................................... 13

I. Poor pharmacy management .............................................................................................. 13

II. Established indicators for pharmacy monitoring ............................................................... 16

III. Designing a system for routine pharmacy monitoring ...................................................... 18

IV. Key areas in pharmacy that need monitoring.................................................................... 20

Chapter 4: Results and Discussion ............................................................................................ 23

Overview ................................................................................................................................... 23

I. Key areas for pharmacy monitoring .................................................................................. 23

II. Criteria for indicators ......................................................................................................... 27

III. Developing and selecting indicators for the PharMon Tool ............................................. 30

Chapter 5: Description of the PharMon Tool .......................................................................... 35

Overview ................................................................................................................................... 35

I. Field reporting component .................................................................................................... 36

A. Physical inventory .......................................................................................................... 36

B. Stock cards ..................................................................................................................... 43

C. Drug shortages................................................................................................................ 48

D. Triangulation of stock records at the pharmacy ............................................................. 51

E. Physical Arrangement .................................................................................................... 59

F. Temperature Control ...................................................................................................... 61

G. UNHCR Essential Drug List .......................................................................................... 64

II. Self-reporting ........................................................................................................................ 65

A. Stock-outs ....................................................................................................................... 65

B. Rational drug use ............................................................................................................ 66

Chapter 6: Conclusion ................................................................................................................ 70

I. Summary ............................................................................................................................ 70

II. Framework for implementation ......................................................................................... 71

III. Pilot Plan ........................................................................................................................... 72

IV. Anticipated implementation challenges ............................................................................ 73

V. Implications........................................................................................................................ 74

Annex 1: PharMon Tool.............................................................................................................. 75

Annex 2: Physical Inventory Report Template ...................................................................... 121

Annex 3: Stock Card Template ................................................................................................ 122

References ................................................................................................................................... 123

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Refugees Monitoring Key performance indicators Pharmacy Humanitarian settings
Committee Chair / Thesis Advisor	Evans, Dabney, Emory University
Committee Members	Summers, Aimee, Martin, Lara, Emory University
Partnering Agencies	CDC

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