PORTFOLIO COMMITTEE ON HEALTH BUDGET HEARINGS : 7 MARCH 2000

CHIEF DIRECTORATE (Cluster) : PHARMACEUTICAL SERVICES

GOAL : Full implementation of all the aspects of the National Drug Policy, NDP, 1996, Food Safety and Control Policies, all Government policies and strategies as outlined in the White Paper on the Transformation of the National Health System: 1997, Health Sector Strategic Plan: 1999-2004, related and relevant legislation, viz; New Public Service Regulatory Framework, Public Service Finance Management Act, 1999 ( Act 1 of 1999), Pharmacy Act , 1997 ( Act 88 of 1997), Pharmacy Amendment Act, (Act 1 of 2000), Medicines and Related Substances Control Amendment Act, 1997 (Act 90 of 1997), Foodstuffs, Cosmetics and Disinfectant Act, 1972 (Act 54 of 1972, and the Health Act, 1977 ( Act 63 of 1977). The following Directorates are in place to carry out this activity :-

POLICY ISSUES: GENERAL

( Medical Stores and Systems)

  1. PERFORMANCE TARGET (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 1999/00

PERFORMANCE TARGET

PRIORITY

ACHIEVED (WITH EXPLANATION)

NOT ACHIEVED (STATE REASONS WHY NOT)

  1. Publication of ex-manufacturer price list to make the prices known: 75 000 copies to be printed with an estimated financial implication of R150 000.

Medium

Partially -> The DOH in conjunction with the PSSA is looking at the implementation of EAN Barcode symbology linked to each pharmaceutical product. Ex-manufacturer prices will then be captured which will be linked to the EAN bar codes

 
  • Migration of the COMED system to Department of Health to reduce the reliance on the contractor resulting in the reduction of expenses for the system:
    • Equipment to be procured
    • Technical staff to be appointed
    • Maintenance and support
    • Training/capacity building of staff

    Very High

     

    The whole migration process is being revisited by the Cluster Manager to determine whether it addresses the problem areas in an optimal way. A Project Manager has been appointed to oversee the migration process and her terms of reference will be renegotiated in line with the Cluster Manager's findings.

    1. Train and develop staff members. External training in system related issues to successfully take over the system from the contractor.

    Very High

    This is an ongoing process. An official was trained in CNE, Visual Basic Programming 6, SQL Language and another official was trained in SQL Language and Infomaker

     

    PERFORMANCE TARGET

    PRIORITY

    ACHIEVED (WITH EXPLANATION)

    NOT ACHIEVED (STATE REASONS WHY NOT)

  • Establish a link between the QCL and the contract preparation system, to have test results available to all provinces.
  • High

    This forms part of the migration process

    Refer to 2

  • Training of personnel in:
    • Drug Supply Management: To manage drugs effectively without any unnecessary interruptions.
    • Quantification of Estimates: To supply a more effective estimate to suppliers of the projected needs.

     

     

     

    • International Tenders: To obtain drugs at the lowest possible prices.

     


    High

    High

     

     

     

     

    Medium

    Ongoing

    Training courses were held in DSM

     

     

     

    Ongoing: Suppliers have been requested to submit consumption figures on all contracts on a monthly basis. Initial planning has been done for the framework of the training programme.

    Currently there are no international tenders for pharmaceuticals as a result of legislative constraints.

     

    1. Security Systems to curb the Theft of Medicines. Currently the State loses millions of rands on the theft of medicines due to little or no security measures in place. A security system will save the State millions in future.

    Very High

     

    Differentiated marking for the large volume and high value state supplies have been introduced. The implementation of a system has been postponed in order to first ensure proper security measures and systems in facilities.

    7. To monitor drug supply in order to prevent out of stock situations which may result in a crisis if there are e.g. no TB drugs.

    Very High

    Ongoing: Provinces have been requested to submit information on priority areas on a monthly basis to monitor the stock situations.

     

     
    1. Pre-qualifications of suppliers will result in the State Tender Board being in a position to decide not to allocate a tender to a specific supplier due to the supplier not being able to supply.

    Medium

    Ongoing:

    Provinces are submitting reports on poor performance by suppliers on a monthly basis. The information is then submitted to the State Tender Board to refer to at adjudication meetings

     
  • Realignment of tenders to be in line with the Essential Drugs List resulting in the provinces having to procure EDL drugs which will have the effects that unnecessary drugs will not be used by Government reducing the cost of drugs to the Government substantially.
  • Very High

    The majority of EDL products are available on national tender. Approximately 6% of EDL drugs are currently not available on tender as a result of unavailability in South Africa and low volume items procured directly by the provinces

     
  • Drugs on tender should be prepackaged in order to reduce wastage and insufficient packaging. This will also result in a reduction of the expenses for Government.
  • Medium

    16.272% of items on RT289 are currently available in patient ready packs

     
  • Pharmacoeconomic calculations and analysis of the most prevalent diseases in the country to establish cost effectiveness of treatment and EDL items.
  • Medium

    Ongoing:

    Pharmacoeconomic analyses have been done for PHC astma and hypertension conditions

     
  • Process modeling of current COMED systems to establish specifications for the re-write of the COMED system.
  • Very High

     

    This forms part of the migration process.

    Refer 2.

    1. PERFORMANCE TARGETS (OPERATIONAL PLANS) FOR THE 2000/01 FISCAL YEAR

    TARGET

    OBECTIVE

    PRIORITY

    TIME FRAME

    LEGISLA-TION

    CONSTRAINTS

    SOLUTIONS

    Facilitate cost effective procurement to ensure availability of essential items

    Publication of ex-manufacturer price list to make the prices known: 75 000 copies to be printed with an estimated financial implication of R150 000.

    High

    This will be an ongoing process. Initially it will be an intensive task to capture information on a database

    Possible legislative intervention to ensure cooperation

    None

    N/A

     

    To monitor drug supply in order to prevent out of stock situations which may result in a crisis if there are e.g. no TB drugs.

    Very High

    Ongoing

    None

    Unability to directly access depot databases to establish the relevant stock-levels

    Ensure direct interfaces with all depot systems to access and monitor the relevant stock levels

     

    Pre-qualifications of suppliers will result in the State Tender Board being in a position to decide not to allocate a tender to a specific supplier due to the supplier not being able to supply.

    Medium

    Ongoing

    None (Legal implication where it can be decided to pass over a tenderer as a result of poor performance in the past)

    Provinces report poor performance by supplier's although the deliveries have already been made. The stock was not registered on the system

    Provinces to ensure that stock has not been delivered before reporting on poor performance

     

    Realignment of tenders to be in line with the Essential Drugs List resulting in the provinces having to procure EDL drugs which will have the effect that unnecessary drugs will not be used by Government reducing the cost of drugs to the Government substantially.

     

    Very High

    Ongoing

    None

    *Some products are not available in SA.

    *Others are used in such small quantities that it is not feasible to go out on tender. Currently the latter is being bough out on provincial level

    *Communicate these drugs to NAPM and PMA and establish their willingness/interest to supply these products.

    *Make available a list of these drugs indicating that's should be procured at provincial level and indicate possible suppliers

     

     

    Drugs on tender should be prepackaged in order to reduce wastage and insufficient packaging. This will also result in a reduction of the expenses for Government.

     

    High

    Ongoing

    None

    Industry must be prepared in advance of the identified items. Currently there are 16.272% of items on RT289 being supplied in prepack

    Firms will gradually be requested to expand on the prepacks

     

    Pharmacoeconomic calculations and analysis of the most prevalent diseases in the country to establish cost effectiveness of treatment and EDL items.

    High

    Ongoing

    None

    Lack of trained personnel at National and Provincial levels

    Personnel to be trained in pharmacoeconomics

     

    A Pricing Committee will be appointed to look into the pricing of medicines. This will have the effect that the Government will be in a position to establish whether industry is overcharging. This can result in a reduction of expenses for Government.

    Very High

    -

    Act 90

    This part of the Act is currently pending as a result of litigation where it is stipulated that a Pricing Committee should be appointed

    Await the finalisation of the court case or establish a different committee with similar terms of reference



    International visits will be made by Pricing Committee Members in order to look at the current situation in other countries. This will also assist in the process of parallel importation.

     

     

     

     

     

     

     

     

     

     

     

    Refer to above

       



    Perform a pilot study for the implementation of EAN symbology in order to test the viability of this medium. With EAN symbology the Department will be able to perform batch tracking and crucial product information e.g. expiry date, etc. will be contained in the symbology.

     

     

     

     

     

     

     

     

     

     

     

    Refer to security system to curb the theft of medicines

     
     

    Review tender procedures

    High

    2001

    Possible changes to Legislation

    International tenders and competitive bidding are not allowed in the current process

    Change legislation to be able to perform these activities



    Ensure proper estimates

       

    This links up with training in quantification of estimates

     
     

    Standardise Item Identification and enforce

    Very High

    2000 + ongoing

    None

    Provinces allocate different item identifiers to pharmaceuticals which makes the extrcting of standardised management reports virtually impossible

    All provinces have to standardise on the National Stock Numbers supplied by COMED

     

    Bulk Purchasing in the SADC region

    High

    2001

    Possible changes to accommodate international tenders

     

    -

     

    -

     

    Promote generic competition

    Very High

    2000 + ongoing

    Possible changes to accommodate international tendering

    International companies' products are not registered in SA.

    Not sufficient local suppliers

     

    Convince international suppliers to register their products.

    Promote local production in SA

     

    Determine donation policy in collaboration with the OSTB

    Medium

    2001

    None

    -

    -



    Facilitate good financial management in the provinces for the procurement of drugs

       

    This links up with training on Financial Management

     
     

    Implement and perform an annual procurement audit with published results

    High

    2000

    None

    Difficult to obtain data from depots

    Ensure interface between COMED and provincial depots

     

    Implement a regular reporting system on procurement performance

    High

    2000

    None

    Difficult to obtain data from depots

    Ensure interface between COMED and provincial depots

    Coordinate and facilitate training programmes in relevant processes to ensure optimal procurement

    Train and develop staff members. External training in system related issues to successfully take over the system from the contractor.

    Very High

    This is an ongoing process. An official was trained in CNE, Visual Basic Programming 6, SQL Language and another official was trained in SQL Language and Infomaker

    None

    • Finance
    • Relevantly skilled personnel

    Negotiate with SADAP for financial assistance.

    Recruit skilled personnel

     

    Training of personnel in:

    • Drug Supply Management: To manage drugs effectively without any unnecessary implements.
    • Quantification of Estimates: To supply a more effective estimate to suppliers of the needs.
    • Drug Financing: To improve drug financing for effectiveness.

     

     

     

    • International Tenders: To obtain drugs at the lowest possible prices.

     

     

    High

     

     

     

    Very High

     

     

     

    Very High

     

     

     

     

     

    Medium

     

    Ongoing

     

     

     

    Ongoing

     

     

     

    Ongoing

     

     

     

     

     

    Ongoing

     

    None

     

     

     

    None

     

     

     

    None

     

     

     

     

     

    Legislation needs to be changed in order to be able to do international tendering

     

    Only one training officer responsible for the training

     

    Relevant officials in the provinces do not have accurate estimates and usually are not aware of what their budgets are

    Relevant officials in the provinces responsible for drug procurement are not capable of effectively interpreting financial issues.

    No international tendering due to legislative constraints

     

     

    Appoint 2 more training officers

     

     

    HOPs should be timeously informed of their budget allocation and base their estimates on the allocated budget

    This will be linked with the training in Quantification of Estimates where relevant officials will be guided in proper financial management

     

    Legislation needs to be changed in order to accommodate international tenders



    Establish management information systems to provide accurate, standardised, essential and applicable information

    Establish link between QCL and Contract Preparation System to have test results available to all provinces

    Medium

     

     

    This exercise is linked with the migration process

     
     

    Security Systems to curb the Theft of Medicines. Currently the State loses millions of rands on the theft of medicines due to little or no security measures in place. A security system will save the State millions in future.

     

    Very High

    2001

    None

    Provincial facilities eg hospitals, where substantial stock levels exist, do not have basic security measures or stock control systems in place

    Basic security measures should be put in place in hospitals and stock control systems must be enforced before an overall security system can be put in place

     

    Re-write of COMED system in a modern programme in line with specifications from process model.

    This process forms part of the migrations process. The Cluster Manager is currently investigating whether the migration process will optimally address all the issues at hand. On finalisation of the investigation the Project Manager for the Migration of COMED systems' terms of reference will be renegotiated to accommodate the changes.

    ( Essential Drugs Programme )

    1. PERFORMANCE TARGETS (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 99/00

    PERFORMANCE TARGET

    PRIORITY

    ACHIEVED (WITH EPLANATION)

    NOT ACHIEVED (REASONS)

    1. Reprint and distribution of EDL books

    High

    42 500 printed and 22 000 books distributed

    The remaining books are being distributed

    2. Develop the Essential Surgical List

    Medium

     

    Process started, input received from provinces

    3. Develop Formulary for PHC

    High

       

    4. Workshops to be conducted to communicate Essential Drugs concept to Health Workers

    High

    Workshops conducted in all provinces and in academic institutions

     

    5. Provide evidence based support for the selection of EDL

    High

    Pharmacoeconomic principles used in critical evaluation of guidelines of Hypertension, Asthma

     

    6. Develop material to educate consumers on use of medicines

    High

     

    Specialised skills required to develop material. Plans made for year 2000/2001

     

     

    7. Continue training of Drug Supply Management, Effective Prescribing Cold Chain

     

     

    High

     

     

    Training performed in DSM, Effective Prescribing and Cold Chain

     

    8. Safe and reliable methods of disposal of medical waste at PHC level

    High

    First step field trails conducted on gas and autocombustion incinerators for medical waste disposal

     

    9. Training of health workers on basic pharmacoeconomics and evidence based medicines

    High

    Process underway. Pharmaceutical Therapeutic Committees of Provinces introduced to evidence based medicines

     
           

    PERFORMANCE TARGET

    PRIORITY

    ACHIVED (WITH EXPLANATION)

    NOT ACHIEVED (REASONS)

    10. Conduct National Baseline to assess EDL implementation at hospital level

    High

     

    Process started, proposals and methodology developed

    11. Training of health workers in Rational Drug Use (RDU)

    High

    Training on promoting RDU ongoing for pharmacists, doctors and nurses

     

    12. Provide support and preparation for the review of the EDL

    High

    Submissions form public and private sector systematically collated for submission to the NEDL Committee

     

    13. Develop Bulletin for dissemination of drug information to health workers

    High

     

    Information and articles collated and process has started but no edition printed and distributed yet

    1. PERFORMANCE TARGETS (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 2000/01 FISCAL YEAR

    TARGET

    OBJECTIVE

    PRIORITY

    TIME FRAME

    LEGISLATION

    CONTRAINTS

    SOLUTIONS

    1. Determine if prescribing habits are in line with the EDL

    Conduct a National Prescribing Review

    High

    2000 – 2001

    None

    Lack of skills in conducting studies

    Close working relations with expertise in the filed

    2. Determine usage patterns of medicines and motivations by prescribers and consumers

    Conduct KAP studies

    High

    2000 – 2001

    None

    Lack of skills in conducting studies

    Outsourcing

    3. Assess if usage is according to the EDL

    Conduct analysis of top 50 drugs procured in provinces

    High

    2000 – 2001

    None

       

    4. Collaborate with stakeholders to carry out activities to promote RDU

    Identify what other stakeholders are doing in terms of RDU

     

    High

     

    2000 – 2001

     

    None

       

    5. Increase public awareness on proper use of medicines

    Develop promotional and educational material

    High

    2000 – 2001

    None

    Lack of skills in public education and health promotion

    Seek services form expert in the field

    6. Training in Drug Supply Management

    Increase in skills of personnel handling medicines

    High

    Ongoing

    None

    Provincially driven cascadal training

    Provide support and adequate resources to provinces

    7. Training in effective prescribing and promoting RDU

    Increase prescribing skills of health workers

    High

    Ongoing

    None

    Provincially driven cascadal training

    Provide support and adequate resources to provinces

    8. Promote application of EBM and PE principles to health workers

    PE and EBM to be used as tools for drug selection

    High

    Ongoing

    None

    Not enough skills in the public sector in this field

    Empower personnel at national and provincial level to train others

    9. To support decision making process in the Cluster

    Ensure optimally functional Resource Centre to provide information

    High

    Ongoing

    None

    None

    None

    10. Develop an Essential Surgical List (ESL) for PHC

    Ensure cost effective and essential equipment availability at PHC

    High

    2000- 2002

    None

     

     

     

     

     

    11. Collate submissions and seek evidence to evaluate STG

    Support the NEDL committee in the review of the EDL

    High

    2000 – 2002

    None

    Personnel not adequate to handle all submissions

    More personnel to work on drug selection

     

     

    12. Support research on NDP issues

     

     

    Collaborate with other research units to support NDP related research

     

     

    High

     

     

    Ongoing

     

     

    None

     

     

    Inadequate skills

     

     

    Work with HSR and relevant stakeholders

    13. All pharmaceutical programmes and activities to be monitored and evaluated

     

     

    Develop and put monitoring tools in place to evaluate pharmaceutical activities

     

     

     

    Ongoing

     

     

    None

     

     

    Inadequate skills

     

     

    Work closely with HSR and HIS

    1. PERFORMANCE TARGETS (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 1999/00

    PERFORMANCE TARGET

    PRIORITY

    ACHIEVED

    NOT ACHIEVED

    Regulation Drafted

    High

    Achieved but not promulgated

    SAMMDRA legal problems

    Screening implemented

    High

    Achieved - November 1999

     

    Training of Staff (Newly appointed staff)

    High

    Training still in process, a person employed on contract to train new in-house evaluators.

     

    Employment Equity

    High

    15 posts filled

    Representative status:

    Africans: 45%, Coloureds: 3%

    Indians: 3%

    Whites: 49%

     

    New system of Registration of Orthodox medicines

    High

    Achieved.

     

    New measures to curb theft of medicines –

    High

    All state medicines to be identifiable as part of tender.

     

    2. PERFORMANCE TARGETS (OPERATIONAL PLANS) FOR THE 2000/01 FISCAL YEAR

    TARGET

    PRIORITY

    TIME FRAME

    LEGISLATION

    CONSTRAINTS

    SOLUTIONS

    To establish and develop a regulatory framework for the Registration and control of Complementary Medicines

    High

           

    To put in place guidelines for the registration of Complementary Medicines

    High

           

    Establishment of an efficient system of medicine registration through the improvement of regulatory marketing approval timeframes to ensure timeous availability of generic and essential drugs.

    High

           

    To put in place a sustainable system of medicine regulation through in-house capacity building.

    High

           

    To improve the quality of medicine evaluation through implementation

    of Good evaluation Practice.

    High

           

     

    To establish processes to achieve harmonisation of medicines regulation within the SADC, AFRO and country-specific (beyond Africa) regions

    High

           

    To establish a transparent system of medicine regulation through effective communication

    High

           

    To establish an effective Post-registration variation evaluation process

    High

           

    To have an effective system of regulation for the control and conduct of Clinical trials

    High

           

    To investigate and establish a proper Pre- and Post-approval inspection system

    High

           

    To establish a licencing system and a process for issuing of permits

    High

           

    Appoint Peer In-house Review committee

    High

           

    Establish processes for harmonisation of inspection activities with other DRA’s, PIC, AFDRAN etc

    High

           

    Establishment of an effective legislation for the control of import/export/INCB and licencing

    High

           

     

    Improve control at ports of entry by harmonisation with custom & Excise/DTI/Border Control police.

     

     

    High

           

    Investigate various options for the support of QC.

    High

           

    Establish a system for QC as part of pre/post marketing surveillance.

    High

           

    To establish an effective and efficient Complaints and law Enforcement Unit.

    High

           

    To facilitate the approval process by amending the current guidelines for AMRP applications to achieve in-house evaluation.

    High

           

    Mutual Recognition Agreements established with regulatory authorities in order to facilitate AMRP process.

    High

           

    The establishment of a process for the registration of medicines and to finalise the Old Medicines Registration Programme (OMRP)

    High

           

    Establishment of the Resource Centre for the Directorate.

    High

           

    1. PERFORMANCE TARGETS (OPERATIONAL PLANS) AND ACHIEVEMENTS FOR 1999/00

    PERFORMANCE TARGET

    PRIORITY

    ACHIEVED (WITH EXPLANATION

    NOT ACHIEVED (STATE REASONS WHY NOT

    1. To attend and actively participate in sessions of Codex committees, coordinate the Codex activities of other components and Departments, disser Codex documentation and react to Codex enquiries and requests for comment.

    High

    Partially achieved. Financial restraints prevented full participation in Codex activities. Financial and human resource prevented an optimal service to all stakeholders.

     

    2. To submit at least six sets of regulations/draft regulations to the Legal Unit and to write at least three guideline documents.

    High

    Achieved. Numerous regulations and relevant documents were produced in terms of the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act 54 of 1972), and the Health Act, 1977 (Act 63 of 1977).

     

    3. To perform at least 10 toxicological evaluations.

    High

    Achieved. All the applications were evaluated and the necessary recommendations relating to registration were made to the National Department of Agriculture.

     

    4. To facilitate the implementation and maintenance of food import control at at least five inland border posts and to update the Standard Operating Procedures on Food Import Control; and to participate in the activities of the Market Access Working Group of the Agricultural Committee of the RSA/USA Binational Commission (BNC).

    High

    This was only partially achieved. Budgetary and human resource constraints within the national Department as well as within the provinces prevented food import control from being carried out in an optimum manner.

     

    5. To involve all nine provinces in a coordinated annual monitoring programme of six sampling runs and to conduct at least three special monitoring projects.

    Medium

    The target was achieved. All the "sampling runs" that had been planned were executed.

     

    6. To commence implementation of a Food and Agriculture Organization (FAO) Technical Cooperation programme (TCP) Project "Improving the Safety of Street Foods in South Africa."

    Medium

     

    The target was not entirely achieved due to a delay in the approval of the Food and Agriculture Organization Technical Cooperation Programme project. This has however been obtained and the project has commenced.

    7.To arrange and/or address six congresses/symposia/ workshops, visit six provinces, address meetings of 6 Food Control Committees and 2 Meetings of the National Environmental Health Forum and to produce at least two information documents.

    Medium

    This was achieved to a large degree. Provincial and local authorities were visited, and presentations were made to various symposiums and other occasions. Budgetary and human resource constraints however prevented optimal liaison with all stakeholders, as well as the production of information material.

     

    8. To update where necessary Personnel performance Management System (PPMS) document for the Directorate as well as the Job Descriptions for all members and to have each staff member attend at least two courses, and the professional officers in addition to attend at least two congresses, seminars or workshops.

    Medium

    This was achieved to a large degree. The staff of the Directorate attended many courses and some were busy with formal study. The attendance of some congresses had to be curtailed due to budgetary constraints.

     

    2. PERFORMANCE TARGETS (OPERATIONAL PLANS) FOR THE 2000/01 FISCAL YEAR

    TARGET

    OBJECTIVE

    PRIORITY

    TIME FRAME

    LEGISLATION

    CONSTRAINTS

    SOLUTIONS

    1. To submit nine sets of regulations/draft regulations to the legal Unit and to write six guideline documents.

    1. To write regulations, policy documents and guidelines on food safety, food standards, food hygiene, food labelling and related matters.

    High

    1999/2000 targets were met

    Involves legislation

    Constraints are finances for publication of regulations in the Government Gazette, as well as insufficient human resources to address all priorities.

    The human resource constraints facing the Directorate are being addressed by a work-study investigation that is being undertaken currently

    2. To perform at least 10 toxicological evaluations.

    2. To evaluate agricultural and stock remedies, other agricultural chemicals when requested, as well as food produced by means of biotechnology; and to classify agricultural and stock remedies

    High

    1999/2000 targets were achieved.

    Residue limits are published as regulations.

    No constraints are envisaged.

     

     

     

     

     

     

     

     

    3. To authorize local authorities and analysts, to approve the sale of irradiated food, and to ensure efficient food import control.

     

     

     

     

     

     

     

    3.To help ensure that the Department’s statutory obligations regarding the administration of food control legislation are met.

     

     

     

     

     

     

     

    High

     

     

     

     

     

     

     

    No specific target was set the previous year.

    This target includes the execution of all the routine tasks involved in administering the Acts mentioned, for example authorization of analysts.

     

     

     

     

     

     

     

    This involves the administration of legislation.

     

     

     

     

     

     

     

    No constraints are envisaged.

     

    4. To evaluate existing South African dietary studies and to plan a further consumption survey if necessary.

    4. To determine exposure to chemical contaminants in food.

    Medium

    No target was set for the previous year.

    Legislation is indirectly involved.

    Budgetary and human resource constraints may delay the process.

     

    5. To involve all nine provinces in a coordinated annual monitoring programme of six sampling runs.

    5. To introduce, coordinate and evaluate general as well as more specific food monitoring programmes for the whole country.

    Medium

    The previous year’s targets were met.

    Legislation is indirectly involved: compliance with regulatory standards is monitored.

    There should be no constraints to the programme as planned.

     

     

     

     

     

    6. To visit six provinces, address meetings of 6 Food Control Committees and to produce at least one information document.

     

     

     

     

    6. To proactively as well as reactively render support to the provincial health authorities and to inform, educate and communicate (IEC) food safety and related matters to all clients of the Directorate.

     

     

     

     

    Medium

     

     

     

     

    The target was not completely met last year.

     

     

     

     

    This involves legislation indirectly.

    Budgetary and human resource constraints prevent optimal achievements of this target.

     

    7. To update the Personnel Performance Management System (PPMS document for the Directorate as well as the Job Descriptions for all members and to have each staff member attend at least two courses, and the professional officers in addition to attend at least two congresses, seminars or workshops.

    7. To ensure, by means of information, education and communication (IEC), that the staff of the Directorate: Food Control are empowered to function optimally in the execution of their professional as well as administrative support tasks relating to food control.

    Medium

    The target was met to a large degree last year.

    Legislation is not directly involved.

    Budgetary constraints prevent optimal empowerment of the staff.

     

    8. To train 20 officers and 100 vendors and to conduct a consumer education programme.

    8. To implement the FAO TCP Project "Improving Street Foods in South Africa".

    Medium

    Was not achieved last year due to a delay in the approval and commencement of the project.

    Legislation is not involved.

    No constraints are envisaged.

     

    9. To attend and actively participate in Codex activities, coordinate Codex activities of other components, disseminate documentation and react to enquiries.

    9. To coordinate and participate in South Africa’s Codex-related activities.

    High

    Not optimally achieved last year due to budgetary and human resource constraints.

    Legislation is indirectly involved.

    Budgetary, human resource and computer technology constraints are relevant.

    The project discussed below will help address the constraints.

    10. To hold two national seminars and three technical workshops and to create an effective Codex information system.

    10To implement the FAO TCP Project "Strengthening the National Codex Committee".

    High

    There was no target for last year.

    Legislation is not directly involved.

    No constraints are envisaged.

     

    11. To develop a comprehensive policy document in respect of the new national food control system.

    11. To participate, together with other stake- holders, in the development of a new national food control system.

    High

    No targets were set during the previous year.

    This will lead to the rationalization of legislation.

    No constraints are envisaged.

    Successful completion of this project will help resolve many of the constraints that are currently experienced.

    SPECIFIC POLICY AREA

    Drug policy

    In the public sector all COMED tenders(national tenders) are published with generic specifications and not brand names. The majority of items on tender are EDL items.

    As a result of the implementation of Act 90 being pended as a result of litigation, the Pricing Committee cannot be established, as it was specifically mentioned in the above Act.

    On the largest national tender, RT289 (Solid Dosage Forms - Tablets), of the 500 differently strengthened items, 110 item prices could be compared to 1999 MSH international prices. 81 of the 110 international prices were less than South African Tender prices of which 47 of the 81 cases, the international prices were less more than 100% of the South African tender price.

    The Tender Board's requirement is that tender offers should at least be 20% lower than the wholesale price. It not the State Tender Board investigates the matter with the supplier.

    Generic Substitution

    means that tendering, procurement and dispensing are done according to

    generic names. Prescribers are encouraged to use generic names at all times.

    RDU means providing the correct drug to the correct person in the correct

    dose at the correct place at all times. This involves different areas of activity:

    Implementation of the EDL at hospital level

    The EDL/STGs for hospital level separated into Adult and Paediatric Guidelines, have been distributed widely both in the public and private sectors. The aim is to have a copy for each prescriber for easy reference and guidance.

    The Pharmacy and Therapeutics Committees provincially, regionally and in hospitals are engaged in selecting the most appropriate and essential drugs given their different disease profiles, but within the framework of the nationally developed EDL. This will ensure that facilities procure what they can afford as a priority. Provinces have launched the EDL to promote an increase in awareness of the essential drugs concept. Tertiary Institutions are being encouraged to change their curriculum to include the NDP principles as well as the EDL concept.

    Procurement, distribution and utilisation of drugs in the public sector

    Progress report on:

    Procurement:

    A virtual tendering process is followed whereby the national office coordinates all the actions up to the point where the contracts get awarded to successful tenderers. A contract circular is then drawn up with detail of the product, national stock number, successful tenderer, price, participating authorities, lead times, percentage preference, trade name and catalogue number.

    On finalisation of the contract circular it is downloaded to the provinces where they procure on these contracts.

    Specifications on the tender documents are generic and not by trade names. Most of the EDL items are available on contract wit the exception of approximately 6% which are either currently not available in South Africa or only bought in small quantities on provincial buy outs.

    Distribution of drugs from suppliers to institutions is currently by means of wholesale depots operated by the provinces.

    Theft of drugs at depots/hospitals/clinics –

    Once this conference has established whether or not there is a need to revise the activity of medicine distribution the following key areas will receive attention:

    Theft of drugs at depots

    Hospital systems

    An investigation was performed in 1999 to establish whether major hospital pharmacies in the provinces utilised computerised pharmacy information systems to obtain useful management information for strategic planning.

    Methodology:

    Hospital

    Useful information

    Groote Schuur

    Yes

    Tygerberg

    Yes

    Kimberley

    Yes

    Umtata

    No

    King Edward

    No

    Edendale

    Yes

    Pelonomi

    No

    Universitas

    Yes

    Chris Hani Baragwanath

    Johannesburg General

    No

    Pretoria Academic

    Yes

    Sebokeng

    No

    Tembisa

    No

    Philadelphia

    Yes

    Pietersburg

    Yes

    Bophelong

    No

    Klerksdorp

    Yes

    Bophelong

    No

    Constraints:

    Summary of the results:

    1. Western Cape:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Groote Schuur

    yes

    ‘Cystec’

    no

    ?

    Tygerberg

    no

    N/a

    N/a

    N/a

    N/a = not applicable

    2. Northern Cape:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Kimberley

    no

    N/a

    N/a

    N/a

     

    3. Eastern Cape:

    None.

    4. KwaZulu Natal:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Edendale

    Yes. In Pharmacy Bulk Store

    ‘Planknet’

    no

    ?

    5. Free State:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Universitas

    yes

    ‘Meditech’

    no

    ?

    6. Gauteng:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Pretoria Academic

    Yes. Not in use. No personnel to enter info into system

    ‘Unisys’

    N/a

    N/a

    7. Mpumalanga:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Philadelphia

    yes

    ?. Vuna System

    no

    ?

    8. Northern Province:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Pietersburg

    Yes. For inventory control only

    ‘Unidata"

    no

    ?

    9. North West:

    Hospital

    Results

    Comp. Hospital Pharm. System?

    Name of computer system

    Linked to the Hospital system?

    Useful monthly reports?

    Klerksdorp

    no

    N/a

    N/a

    N/a

      1. Three different Financial Systems are currently in place in the RSA
      2. 6 of the 9 respondents indicated to utilise a Computerised Information System (CIS)
      3. All the above-mentioned Systems had different names
      4. None of the above-mentioned Systems were linked to the Hospital System
      5. None of the respondents could verify that useful monthly reports could be generated by the relevant system

    5 of the 9 respondents indicated to have obtained their CIS by means of a provincial tender

    Monitoring prescribing patterns by clinicians