Abstract
Background
In recent years, Ethiopia’s Federal Ministry of Health (FMOH) has made tremendous efforts to improve the quality of health services at the hospital level, as laid out in the Ethiopian Hospital Reform Implementation Guide.1 However, frequent stock-outs of essential medicines and poor quality of pharmacy services pose challenges to achieving the desired level of success in hospital improvement.
A 2003 assessment of Ethiopia’s pharmaceutical sector showed that the average duration of stock-outs of essential medicines was 99.2 days in the last year in public health facilities and regional drug stores. The accumulation of medicines that were of limited utility to the catchment population led to expiry and wastage of limited resources, with expired medicines in health facilities reportedly as high as 8%. It was also observed that 43% of medicines dispensed to patients in health facilities were inadequately labeled, and 33% of patients who received medicines did not know how to take them correctly.2 In addition, according to the fourth National Health Sector Development Program (2010/11–2014/15), the antibiotic prescribing rate was 58% and antibiotic use in the treatment of non-pneumonia acute respiratory tract infection was 61%, both of which indicate deviation from recommended norms.3
Many of these problems were attributable to poor governance in the pharmaceutical sector. Specifically, a lack of transparency and accountability left pharmaceutical transactions and services vulnerable to mismanagement, including poor planning, decision making, prescribing and dispensing, and reporting, which compromised both the availability and use of medicines. The FMOH—with support from USAID’s Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program and its predecessor, the Strengthening Pharmaceutical Systems Program—designed an innovative and comprehensive package of interventions referred to as Auditable Pharmaceutical Transactions and Service (APTS) to increase transparency and accountability, thereby contributing to a continuous supply of essential medicines, optimal budget utilization, and improved pharmacy services.
