April 28th is World Day for Safety and Health at Work. It’s a day meant to call attention to occupational safety and health, including ramping up efforts to support sustainable development and limiting health and safety hazards.
In the arena of neglected tropical disease control and elimination, where affected countries need to distribute massive quantities of preventative and curative medicines to large segments of the population, poor management of the drug supply chain can present health risks for both humans and the environment. That’s because complex, geographically dispersed national NTD programs must deliver millions of doses of various medications to tens of millions of citizens while responding to the many challenges presented by their countries’ own unique circumstances.
To help national ministries of health to manage their NTD drug supply chain as efficiently and safely as possible, USAID’s END in Africa project (2010–2018) asked its partner John Snow Inc. (JSI) to develop customizable standard operating procedures (SOPs) for managing both NTD medicines and associated waste in various West African countries.
NTD Programs: Not Your Typical National Public Health Program
National NTD programs use medicines somewhat differently than other national public health programs. For example, NTD medicines are handled somewhat uniquely in that they are generally dispensed during mass drug administration campaigns (MDA) rather than at routine health clinic services. In addition, leftover medicines are returned following distribution campaigns and must be accounted for and consolidated.
To ensure these differences were taken into account, the END in Africa team analyzed the findings of supply chain management assessments in each country, identified common themes around SCM needs, and defined the procedures that would be of greatest use to the END in Africa countries. As part of this exercise, the END in Africa team created a set of SOPs that effectively addressed supply chain and drug management situations routinely encountered by NTD program staff. The procedures had to comply with generally accepted health commodity management standards, such as first-to-expire, first-out inventory control, while helping countries to upgrade their supply chain and drug management procedures to meet higher standards for transparency and accountability.
Different Countries, Different Policies
However, the team knew that the SOPs would be of limited use if they failed to take into account individual country realities, such as variations in national NTD policies, health program administrative structures, geography, climate, national drug regulations, and health system management. These variations made customization essential.
Rather than reinventing the wheel for each country, the END in Africa team used generic drug supply chain management SOPs to start the customization process, which eliminated the need to redesign entire SCM systems or implement major changes. This enabled the END in Africa team to make minor improvements and adjust the existing system to increase its applicability and usefulness for each country.
Putting the SOPs into Practice
To help countries comply with their new NTD drug supply chain management SOPs, the END in Africa team included a set of resources along with the procedures, which laid out essential actions, defined key terms, and provided tips to improve performance, a customizable diagram showing the flow of materials and information through the health system, and additional resources to further assist health workers with improving NTD drug safety.
They also worked collaboratively with each country’s NTD program to facilitate the SOP adaptation and adoption processes and to train country NTD teams and partners on their use. The team also field-tested the SOPs in each country and made minor revisions to the SOPs in each country, according to the findings of these field tests. Finally, the team developed training curricula and materials for national NTD programs to include in their own NTD training manuals, so that each country could take charge of training new national staff.
SOP Benefits Extend Beyond NTD Programs
As countries began using the SOPs, the END in Africa team observed that using the SOPs strengthened the capacity of national NTD program staff in supply chain management of NTD medicines and improved NTD program waste management practices. However, the benefits of using the SOPs have extended beyond national NTD programs. As health ministry staff became more familiar with the use of the NTD SCM SOPs, national health system staff in other areas began to note the potential to use the SOPs for other national health promotion programs, as well.
Currently, USAID’s Act to End NTDs | West program (2018–2023) is working with NTD program and ministry of health staff in 11 countries in West and Central Africa to continue to advance their drug procurement, storage, and management skills as well as to ensure that national NTD programs utilize proper environmental and waste management practices.
However, the goal of the Act | West program is even more ambitious than the goal under the previous END in Africa project — to ensure long-term national NTD program sustainability and ultimately, self-reliance in NTD control. To work toward this goal, Act | West is helping countries to mainstream national NTD activities, including NTD drug SCM procedures, into national health systems. As NTD activities become increasing mainstreamed into national health systems and more MOH staff become accustomed to using NTD drug SCM SOPs, more opportunities will arise to adopt the SOPs to improve health and safety practices in other national public health promotion programs, as well.
Resources for Health and Safety at Work
MDA Waste Management Tip Sheet for Community Drug Distributors