"Mind the GAPPD": Improve Medicines Management for Pneumonia and Diarrhea

"Mind the GAPPD": Improve Medicines Management for Pneumonia and Diarrhea

We know what works to save the lives of children under five years old: We know which antibiotic to give for treating pneumonia, for example. Yet only 31% of children with suspected pneumonia receive antibiotics. And two million children die from pneumonia and diarrhea each year.

The first-ever simultaneous effort to protect children from pneumonia and diarrhea, the integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD), launched on Friday, April 12, 2013. Developed by the World Health Organization (WHO) and UNICEF, GAPPD is intended to mobilize support and catalyze actions in the world’s poorest regions with a goal to “end preventable child deaths from pneumonia and diarrhea by 2025”---a feat that is achievable, according to WHO and UNICEF. MSH endorses the plan, which advocates for coordinated and integrated country-level implementation of evidence-based interventions to prevent and treat pneumonia and diarrhea in under-five children.

But, many of the countries with highest mortality from pneumonia and diarrhea have weak supply chains and pharmaceutical systems. Therefore, a key challenge in the implementation of these evidence-based interventions is consistent availability and appropriate use of quality medicines to treat pneumonia and diarrhea (amoxicillin dispersible tablets, ORS and zinc) at the user level.

We need to improve medicine delivery strategies.

GAPPD on demand, supply, and how to improve medicines management

The GAPPD includes advice for countries to generate demand and ensure supply of these commodities, and highlights key actions for selected interventions.

Among these are supply chain actions that should not be overlooked (even though they do not appear until Annex 2).

Under the intervention: “To attain 90% access to appropriate pneumonia and diarrhea case management (with 80% coverage in every district)”, a key activity is cited as: “Ensure supplies/commodities are in place for case management at all levels, including referral levels, and stockpiled where appropriate”. This is crucial and can be broken down into actions at different levels.

According to Annex 2 of the GAPPD (PDF), the policy and decision-making level actions include:

  • Review/update policy/legislation related to supplies/commodities for case management, focusing on appropriateness of commodities for management of pneumonia and diarrhea;
  • Review/update procedures for quantification/procurement/distribution of supplies/commodities related to pneumonia and diarrhea from central to implementation to community level;
  • Define technical specifications for commodities, for example, dispersible, in blisters;
  • Quantify needs; and
  • Identify bottle-necks and take measures to resolve them.

The GAPPD also recommends these implementation-level actions in Annex 2:

  • Set up systems to supervise and monitor availability of supplies at facility/community level;
  • Identify bottle-necks at district/local levels and take measures to resolve them;
  • As needed, train/re-train supply officers; and
  • Train [community health workers] and other relevant community-level workers in medicine management.

While many of these recommended actions sound intuitive, their implementation is often quite challenging. Each of them needs to be considered through a health-systems lens to ensure that the implications and requirements for financing, human resources, information, services and governance are examined and addressed.

If proper attention is not given to pharmaceutical management practices and systems, the commodities necessary to protect, prevent and treat diarrhea and pneumonia will not be available, and children will continue to die.

Beth Yeager contributed to this post.

Jane Briggs and Beth Yeager are principal technical advisors in the Center for Pharmaceutical Management at MSH.

Read the full GAPPD report and summaries at DefeatDD.org.

Editor's note

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