Medicines, vaccine and supply management
The availability of medicines and vaccines is critical to the provision of quality care. The impact of training a health provider on the clinical management of common childhood illness is likely to be minimal if, after training, the health provider lacks, in his or her own health facility, the supporting means of applying what he or she has learnt, such as essential medicines, or if the sick child does not have access to those medicines.
Essential medicines need to be of assured quality, regularly available and affordable to those who need them, especially the poor and disadvantaged who are the most vulnerable to illness.
In line with the principles of the essential medicines concept, country-adapted IMCI guidelines (Integrated Management of Child Health) include a limited list of key drugs for the outpatient management of priority health conditions in children under-5. Where national essential medicine lists exist, these have been reviewed to ensure that the medicines recommended in the IMCI guidelines are also included there, for the different levels of the health care system and for use by the categories of health providers targeted by IMCI.
IMCI follow-up visits and surveys conducted in the Region have shown some improvement in availability of medicines in facilities implementing IMCI. However, they have often described also problems in availability of injectable pre-referral medicines and second-line antibiotics. Making essential medicines regularly available and at an affordable cost remains a major issue in many settings.
A more appropriate use of medicines—especially antibiotics—by IMCI-trained health providers have also been described in the Region, similarly to that shown in the IMCI multi-country evaluation. This contributes to reducing waste and improving drug availability for those cases which really need them. It ensures that limited resources are properly used, whether they are provided by the health system or come from the household.
Within the context of IMCI, Egypt developed a “drug management package” as training aid for personnel managing medicines at health facilities and district level. This has been a collaborative effort of the CAH (Child and Adolescent Health and Development) and EDB (Essential Drugs and Biologicals) programmes of the Regional office, and the Pharmaceutical department and the General Administration of Childhood Illness Programmes of the Ministry of Health and Population, Egypt.
As with medicines, vaccines also need to be regularly available, together with the equipment and supplies required to store and deliver (cold chain) and administer them (syringes, needles) properly.
The IMCI guidelines recommend routine screening for immunization status of any child taken to a health facility—whether sick or healthy, in order to increase opportunities for immunization, in line with national immunization policies.
In addition to water and medicines, the list of other supplies required for IMCI at primary health care is short. It includes basic items, such as items required to weigh the child and take his or her temperature, count the respiratory rate, prepare oral rehydration salts (ORS) solution, counsel the mother (home care counselling card) and record and report information.
The preparation of health facilities before the health providers are trained in IMCI and the systematic conduct of follow-up visits after IMCI training at the trainees’ health facilities provide the means of checking whether the supporting health system environment is in place to enable the trained health provider to deliver quality child health services. It also helps raise issues with the local district authorities for further follow-up.
Information on the availability of medicines, vaccines and other supplies is also collected during IMCI health facility surveys and described in the related reports.
Essential Medicines and Pharmaceutical Policies
Priority life-saving medicines for women and children
WHO model list of essential medicines for children
Country-adapated IMCI guidelines
List of medicines included in the IMCI guidelines by country