CAMBODIA EXPERIENCE ON MTP MONITORING, TRAINING, PLANNING TO REDUCE INAPPROPRIATE MEDICINE

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CAMBODIA EXPERIENCE ON MTP (MONITORING,
TRAINING, PLANNING) TO REDUCE INAPPROPRIATE
MEDICINE USE IN HOSPITALS
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1-Background

• -Previous indicator-based supervision and
  monitoring program in Cambodia did not show
  significant improvement.
• -Inappropriate prescribing practices in health
  facilities
• -Intervention to improve prescribing is uneasy to
  conduct, especially in private facilities
• -Self-initiative, self-conduct, self-assessment,
  self-decision making
• -Interventions needs to be incorporated in the
  existing management system

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2- Objective

• To learn lessons from experiences in drug use
  interventions in the past
• To discuss the problem of drug use in the health
  care system
• To discuss the efforts in improving drug use
  carried out so far
• To develop the innovative strategy for rational
  drug use in the health care system.

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3-Intervention Method

• Select pilot hospitals for MTP implementation
• Assign 6 people as MTP team
• Training of MTP Team on MTP process
• Schedule the meeting to
• define problems on drugs use
• develop an innovative strategy to improve drug
  use
• define target
• monitor the implementation and evaluate the
  achievements
• National evaluation workshop

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3.1-Flow of activities in MTP
Indicator
Indicator
Indicator
M
M
M
M
M
M
P
P
P
P
P
T
T
T
T
T
InitialWorkshop
EvaluationWorkshop
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3.2-Self-monitoring vs MTP
Periodic evaluation at MOH
Self- Monitoring strategy
Indicator
Indicator
Indicator
Indicator
Indicator
Indicator
Indicator
M T P
M T P
M T P
M T P
M T P
MTP approach
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3.3-Monitoring

• - To identify the specific drug use problem
• - To select a priority problem
• - To determine indicators and data source
• - To identify the target of intervention
• When MTP has been running
• - To follow up commitments from the previous
  session
• - To measure the impact of intervention
• - To conclude the achievement

3.4-Training
- To discuss the problem agreed in the Monitoring
in more details - To collect supporting
information - To collect related scientific
information to set up the norms or standard
reference, e.g., reference books, standard
treatment guidelines, etc. - To collect
information about the intervention efforts
considered effective, and to discuss the
suitable intervention strategy to choose. - To
agree upon an intervention strategy and to
discuss the intervention steps.
3.5-Planning
- To set a target of achievement - To set
measures to achieve target, including the
sequence of activity, the program, and the
person responsible for execution. - To agree on
who is responsible for the execution of the
plan. - To facilitate communication and
coordination among MTP team members - To agree
upon schedule of the next MTP session.
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4- Experiences on using MTP

• - First phase 6 Hospitals
• - Second phase 7 Hospitals

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4-Result 1(Kandal Abs Reduction in Normal
Delivery)
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4-Result 2 (Kg Cham Reduce Abs in post Cesarean)
of patients receiving antibiotics
Reduction of the average medicine cost per
patient from 15.3 to US 6.1 (US 2000/month)
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4-Result 3(Siem Reap Reduce Abs in Traumatology)
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4-Result 4 (OM Chhey IV fluid reduction in
normal delivery)
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4-Result 5 (BB IV fluid reduction in Maternity
and Traumatology Ward)
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4-Result 6 (BB Abs reduction in Malaria)
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4-Result 6 (BB Abs Reduction in Malaria)
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5-STRONG POINTS

• MTP is strongly supported by the DG for Health
• WHO supported both, budget Technical expert to
  develop MTP in CAMBODIA.
• Existing Technical Working Group in each RH
  acting as DTC for improving the Use of Drug.
• Existing network of supervision and monitoring
  system from central to Province and OD level.
• Good cooperation with National Programs.
• Sustainable achievement

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6-WEAK POINTS

• Some hospitals have difficulty to define a real
  strategy for improving drug use
• After the end of financial support and
  intervention from central level no data will be
  collected and achievement will not be monitored
  and reported
• Time availability of MTP team member
• Transfer of some MTP team members to other
  facility
• Reduction of hospital income for drugs.

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7-Summary of result
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8-Conclusion(1)

• Flexible approach, not time-consuming, not costly
  
• Good for sensitive issues
• Interventions seems not too sophisticated
• Encourage DTC to initiate activities and internal
  experts to contribute
• A comprehensive approach, a combination of adult
  learning and managerial strategies.
• Involved stakeholders in hospital, the negative
  consequences of rational drug use could be
  discussed accordingly

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8-Conclusion(2)

• MTP can be implemented in both sector public and
  private. Its can be solve problem themselves, if
  there are any supported from PHD.
• MTP can be extended in nationwide, if they select
  the right people to be train them.
• MTP reduce health care cost, if they strictly
  monitor, supervise and providing the training to
  prescribers. So the community will be
  participation and support
• To reduce the prescribing problems and improving
  RUD for healthcare workers and patients.