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Dryad

Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia

Abstract

Background: Drug and Therapeutics Committee (DTC) is a platform where a group of multi-disciplinary professionals organized in a given health facility (HF), mainly hospitals and health centers, work together to improve the health care delivery. The Ministry of Health (MOH) Ethiopia, in collaboration with Regional Health Bureau (RHB) structures, its agencies and implementing partners (IPs), invested a lot in the establishment and strengthening of DTCs in Ethiopia. The Clinton Health Access Initiative (CHAI) Ethiopia is one of the key partners of the MOH. CHAI has been implementing the Child Survival Program (CSP) since October 2015 in collaboration with the MOH and Ethiopian Pharmaceutical Supply Agency (EPSA) in four big agrarian regions of Ethiopia, namely Amhara, Oromia, SNNPR and Tigray regions. Strengthening DTCs is part of the CHAI/CSP program to improve the overall supply chain management (SCM) of child health commodities. Hence, CHAI/CSP was interested in conducting DTC-specific studies. The objectives of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major hindering factors for their functionality and impacts on the SCM system and pharmacy services.

Methods: A descriptive study design was employed with mainly qualitative data collection methods and analysis. The assessment made use of both qualitative and quantitative data, generated from primary sources through key informant interviews and from secondary sources through desk review methods. As key informants, more than 20 experts on DTCs from government organizations (MOH, central EPSA, RHBs, EPSA hubs and Ethiopian Food and Drug Administration) and IPs (WHO,

United Nations Population Fund, United States Agency for International Development (USAID)/Chemonics/ Procurement and Supply Management, USAID Transform Health in Developing Regions, USAID/AIDS/Free and United States Pharmacopeia) were interviewed. For the desk review, the assessment team reviewed available relevant national and other documents from the MOH, RHBs, Central EPSA, CHAI, WHO and partners as supporting evidence of the assessment.

Results: DTCs were introduced in Ethiopia in the early 1980’s. The mandate of DTCs has been given to four different government organizations since this time in Ethiopia. As a result, its implementation was lagging. Recently, DTCs have been given attention both by the government and its partners. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in HFs improved from 85% to 98% between 2015 and 2019 during baseline and endline assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63% in the same period. The CHAI/CSP regular bi-annual supportive supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. Moreover, a chi-square test of independence, performed to examine the relationship between training of facility heads and pharmacy heads on DTCs and the availability of a functional DTC in the same facility, revealed a significant association between the two variables at p-value <0.0001.

Recommendation: providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating body for DTC and similar structure at regional health bureaus and woreda health offices should be established.