Laiford at work in Mbang’ombe 1 Health Center drugstore
Mbang’ombe 1 Health Center is in the back yard of Lilongwe International Airport. In terms of access to quality health services however, the facility might as well be far from Lilongwe. At approximately 50 km from the Lilongwe District Health Office and Central Medical Stores, the facility serves a rural community. It has one clinician, four nurses, 11 Health Surveillance Assistants (HSAs) and several support staff who serve over 5,000 households, a total population of 24,762 people. The facility has never had pharmacy personnel.
Laiford Nandolo is one of the two HSAs that help manage the drugstore in the absence of a trained Pharmacy Assistant. Although Laiford has over 10 years of experience as a health worker, most of his drugstore clerk experience has been on the job without formal training, except a one-day training he received back in 2014.
But something changed in early 2017 – Laiford and another HSA joined the Pharmacy Assistant Mentorship Training Program. This mentorship program utilized Pharmacy Assistants, who are formally trained in pharmacy management and dispensing, to support nearby facilities like the Mbang’ombe 1 Health Center who do not have pharmacy personnel. Laiford began receiving on-the-job training one day per month for 6 months from a Pharmacy Assistant named Aaron Sendeza, posted at Lumbadzi health Center, 16 km from Mbang’ombe.
Phramacy assistant Aaron Sendeza dispensing at Lumbadzi Health Center
Aaron was in the first cohort of the Pharmacy Assistant Training Program, when the program was reintroduced to cover the pharmacy personnel gap in health centers throughout the country. He graduated in 2015 and was deployed by Ministry of Health to Lumbadzi Health Center. In 2017, Aaron joined the mentorship program supporting two other facilities in addition to Mbang’ombe, spending one day at each facility per month.
“Although structured, the Pharmacy Assistant Mentorship Program is able to progressively respond to facility-specific needs in terms of medicines and information management, as the training takes place at the mentee facility” says Aaron.
This program has visible impact. “My job is now easier” says Laiford, the HSA who has been working in the pharmacy department at Mbang’ombe 1 Health Center for the last 8 years. “I can track product stocks better, notice when stocks are running low, and can submit orders or inquire from other nearby facilities”.
“There has been change at the drugstore, it is better managed, it is visibly neat, and better organised. Now all transactions on requisitions are recorded on file… not just on stock cards. This makes our reporting better”.
The Health Centre In-Charge for Mbang’ombe, Obadia Chilambo, agrees with him: “There has been change at the drugstore, it is better managed, it is visibly neat, and better organised. Now all transactions on requisitions are recorded on file… not just on stock cards. This makes our reporting better”. Timely and accurate reporting significantly improves medicine management in Malawi, impacting overstocks, drug expiration and stockouts. In turn, this affects overall access and quality of health service delivery for patients.
Most of the health centers across the country do not have a Pharmacy Assistant working there or visiting as a mentor. The Pharmacy Assistant Mentorship Program has been piloted precisely because of this need. The program helps health workers who have been put in charge of the drug store out of necessity get up to speed on basic yet critical pharmacy-related functions. This initial mentorship program took place in three districts (Lilongwe, Ntcheu and Kasungu), with four Pharmacy Assistant mentors like Aaron volunteering their time to 12 nearby health centers. Despite the short amount of time mentors and mentees spent together, some encouraging positive results were seen at the end of the 6-month program, which has since been expanded. Those positive results included: a significant improvement in overall storeroom management, better availability of stock cards for various medicines and medical supplies, better recording of data from stock cards onto the national reports, and a slight reduction in stockouts for key commodities.
“Unlike in the past, stockouts are not as frequent at our health facility,” says Laiford, “we only stock out if there is no stock at the national level, district hospital or nearby facilities.”