THE TRANSFER

OF
PHARMACEUTICAL SERVICES

TO THE
NATIONAL HEALTH FUND
NHF



CABINET DECISION
Creation of a new entity- NHFP

An Interim organizational structure

Abolition of 131 Pharmacy and 101
Technician posts

The transfer of the responsibility and
delivery of Pharmacy Services from the
Regional Health Authorities



RATIONALE
Auditor
Generals Report
Weak Inventory
Mgmt Systems
Inability to attract
Pharmacist
Weak Management
Systems


Other
Issues
NHFP


STRUCTURE OF NHFP


MAJOR OBJECTIVES
INCREASE REVENUE FLOW
Transform the pharmacy service in the public sector
Modernise all aspects of the pharmacy service including the infrastructure and systems
Close the gap in the unmet needs of patients
Increasing the number of skilled professionals working in the public sector pharmacy
Contribute to the improvement in the health outcomes of the population
Expanding the number of access points at the level of primary health care
Pharmacists

Pharmacy
Technicians
Staffing
Total
Staff
500
Staffing
Supply Chain
64
Pharmacy Services
436
TOTAL
500
110
165

Modernise all
aspects of the
pharmacy
service
including the
infrastructure
and systems
Expanding the
number of
access points at
the level of
primary health
care
Revenue
Enhancement
OBJECTIVES
Increasing the
number of
skilled
professionals
working in the
public sector
Operations of NHFP








8
Warehousing
Distribution of
Pharmaceuticals & Medical
Sundries
Supply
Chain
Institutional - dispensing and
clinical services in public
hospital and health centres
Management of Commercial
pharmacies
Pharmacy
Services


SHARED SERVICES
Human Resource
Management
Finance Audit
Information
Technology
Quality Management Procurement
Legal Service Administration Customer Service
PARISH PLAN
Pharmacy Services
Institutional
Primary Care Health Centres
Secondary Care
(Hospitals)
Drug Serv
Commercial
Paying Customers


MONTH 1
PARISH SECONDARY CARE PRIMARY CARE
FULL SERVICE
PRIMARY CARE
SCHEDULED
SERVICE
Kingston and St.
Andrew
Kingston Public Hospital Maxfield Park
Duhaney Park, Stony
Hill
Harbour View
St. James Cornwall Regional
Hospital
Montego Bay H/D Granville ,Adelphi
Catherine Hall,
Cambridge
Maroon Town
St. Ann St. Anns Bay Hospital Ocho Rios,
Claremont, St.Anns
Bay
Moneague
Alexandria
Browns Town
Manchester Drug Serv Mandeville
Regional Hospital
St. Mary Port Maria Hospital
Annotto Bay Hospital
Highgate
Gayle
Bellefield, Islington
Retreat, Castleton
Oracabessa
Annotto Bay
Windsor Castle


MONTH 2
PARISH SECONDARY CARE PRIMARY CARE
FULL SERVICE
PRIMARY CARE
SCHEDULED
SERVICE
St. Catherine Spanish Town Hospital Old Harbour, St .Jago Kitson Town,
Ewarton, Guys Hill
Westmoreland Savanna- La-Mar Hospital Darliston Whitehouse
Grange Hill, Negril
Kingston and St.
Andrew
Bustamante Hospital for
Children
Gordon Town
Windward Road
Comprehensive
Hagley Park
Edna Manley/ Sunrise
Kingston and St.
Andrew
Bellevue Hospital Vouch
Majesty Gardens
Kingston and St.
Andrew
National Chest Hospital Denham Town
Seaview, Oakglade
St. Thomas Drug Serv Princess
Margaret Hospital
Morant Bay H/D
Isaac Barrant
Seaforth
Yallahs, Llandewey
Port Morant


MONTH 3
PARISH SECONDARY CARE PRIMARY CARE
FULL SERVICE
PRIMARY CARE SCHEDULED
SERVICE
Hanover Noel Holmes Hospital Lucea Green Island, Ramble, Hopewell
Cascade
Portland Port Antonio Hospital Manchioneal,
Port Antonio, Buff Bay
Fair Prospect, Hope Bay
Fruitful Vale, Mount Pleasant
Manchester Percy Junor Hospital Manchester H/D Christiana, Cross Keys, Pratville
Mile Gully, Porus
St. Catherine Linstead Hospital Riversdale
Clarendon Lionel Town Hospital
Drug Serv
May Pen Hospital
Chapleton
May Pen H/D
Frankfield, Kellits
St. Elizabeth Drug Serv
Black River Hospital
Junction Health Centre Balaclava, New Market, Black
River H/D, Malvern, Lacovia,
South field, Aberdeen,
Middle Quarters, Prospect,
Maggotty, Springfield, Fyffe
Trelawny Falmouth Hospital Falmouth Health Centre Albert Town, Ulster Spring
Duncans, Lowe River, Wakefield,
Wait- a- Bit, Troy, Warsop


STAFF BENEFITS
Improved Salary

Better working conditions

Greater opportunity to extend
Pharmacy Practice Clinical Pharmacy


BENEFITS TO POPULATION
Improved
quality of
service
Increased access
to
pharmaceuticals
and medical
sundries
Improved
efficiency and
effectiveness of
the pharmacy
service


EXPECTED OUTCOMES
Improved Standards of
Operations
Expert systems
for drug orders
Improved
electronic
communication
system
Improvements in
automated order
fulfillment systems
for both outpatient
and inpatients
ORDERLY TRANSFER
of Pharmacy
Services

Increased staffing.
Improved
access to
Pharmaceutical
Care


SUMMARY
SUMMARY
Paradigm Shifts
COUNTRY
Leading edge and
integrated technology
PATIENT
Improved access to
Pharmacy Services
Improvement to physical
infrastructure
Improved Service Delivery
STAFF
Improved waiting times
FACILITY
Improved Salary package
Improved Health Outcomes
Enhanced Customer Satisfaction
and Retention Revenue Growth
WIN WIN


SUMMARY
Better working Conditions
THANK YOU
Corporate Plan
NATIONAL HEALTH FUND
Pharmaceuticals







February 26
h
,2013



19
20
Auditor
Generals Report
(December
2011)

Human Resource
Audit
Trevor Hamilton
& Associates
(September 2012)


Establishing NHFP will
allow:
opportunity to normalize
the salary anamoly
without inviting industrial
relations risks.
the MOH has directed
the NHF to assume
responsibility for the
pharmacy service in an
effort to make sustainable
improvements.
Justification for NHFP
VISION 2030 - Health Sector Plan
Four (4) main goals
2.0 High quality
facilities for
health services
delivery
3.0 A cadre of
world class
human resources
for the
health services
4.0 World class and
accessible health
service delivery
5.0 Sustainable,
equitable, efficient
and effective public
health financing
accessible by all
STRATEGIC PRIORITIES








22


OUTCOMES - Increased access to pharmaceuticals
- Improved Efficiency of the Pharmacy Service
- Improved quality of service
- Revenue enhancement

Contribute to the
improvement in
the health
outcomes of the
population
BY
Expanding the
number of access
points at the level
of primary health
care
Close the gap in
the unmet needs
of patients
BY
Increasing the
number of
skilled
professionals
working in the
public sector
pharmacy
service;
Provide an
opportunity for
revenue
enhancement
BY
Increasing
revenue flow.
Transform the
pharmacy service
in the public
sector
BY
Modernise all
aspects of the
pharmacy service
including the
infrastructure
and systems;
STRUCTURE OF NHFP








23
Pharmacists

Pharmacy
Technicians
Staffing
Total
Staff
500
Staffing Staff Costs
Supply Chain
64 $125,945,649.81
Pharmacy Services
436 $1,096,478,266.62
TOTAL
500 $1,222.423,916.42
110
165
Operations of NHFP








25
Purchasing
Warehousing
Distribution of
Pharmaceuticals & Medical
Sundries
Supply
Chain
Institutional - dispensing and
clinical services in public
hospital and health centres
Management of Commercial
pharmacies
Pharmacy
Services
PARISH PLAN
Pharmacy Services
Institutional
Primary Care Health Centres
Secondary Care
(Hospitals)
Drug Serv
Commercial
Paying Customers
27
PARISH PLAN
Parish Plan No. of facilities to offer services
Weekly
services to be
offered
Scheduled Services
based on demand
Primary Care
Combination
of full time &
scheduled
services
Secondary Care
20
Hospitals will serve as the base for Pharmacy staff
Services will be offered in Primary care depending on
need.
Some facilities will offer full time services, other will offer
scheduled services
Strategies to achieve outcomes
Stewardship
Accountability
Procurement practices
Human Resources
Stakeholder Management
Change Management
Environmental protection strategies
Proper waste disposal for
Pharmaceuticals
Information systems and technologies
Patient-focused
service
29









R I S K M A N A G E M E N T

Key results mapping
30








Inputs
Human
Resources
Management Information and
team trained
Disseminated
Buildings/

Performance Monitored
Targeted
Quality of
Pharmacy
Service
Outputs
Assured
Equipment
Resources Secured and
Allocated
Financial & Technical Support
Delivered
IT/IS
Quality standards met
Jamaicans are
empowered to
achieve their
fullest potential




Finance
Corporate Plan, MOU,
Guidelines Formulated,
Appraised and Disseminated
Pharmacies Achieve
Council Standard
Service Points Transformed
Boards and CEO advised
Standards
Competent Staff in Post
Management
Information
Income Earned
Strategies
(Activities)
Organisational
Outcomes
(Immediate)
National Outcomes
(Intermediate)
Key Outputs Final/National Outcome
(Impact)
SHARED SERVICES








31


(9) areas for
services to be
shared
between NHF
and NHFP
Human
Resource
Management
Finance
Information
Technology
Audit
Legal
Services
Quality
Management
Procurement
Administration
Customer
Service
COST SAVINGS
$ Consolidated
Fund
NHF
Pharmaceutical
&
Drug Serv
Hospital/health
centres
&
Public Patients
The bills are sent to
the MOH from
respective hospitals
or RHAs as required
Year to date,
December 31,
2012, amount
billed to the MOH -
$2,553.96
payments to the
NHF - $1,727.02, a
shortfall of $0.9B
YTD - indicates a demand
of $3.4B, compared to
payments from the MOH of
$2.3B, indicating a shortfall
in funding of $1.1B, and an
increase in NHFs
receivables of $1.1B.
Additional source of Funds
Or
Mechanism for providing funds needs
to be improved
Financing the business : Current Financing
Model
Financing the business : Proposed
Model








33
MOF&P provide NHF with the
drug budget directly.
The estimated cost to NHF for
supplying pharmaceuticals to
the Public Sector is
$4,955.46M;
DRUG BUDGET

NO PATIENT WILL
BE TURNED AWAY
Prescription fees
charged to
patients
In Secondary
Care
Subvention of
$4,740.91M
Revenue
from fees -
$214.54M

IMPLEMENTATION PLANS -
RECOMMENDATIONS
Human Resource
Staff to be taken over
Emolument package
Future staff needs
Recruitment
Systems required
Systems and protocols
needed to move to a higher
level of efficiency
Overlaying MODEL To
highlight equipment needs

Customer Service
Training
CSME Customer
Service Monitoring and
Evaluation
IMPLEMENTATION PLAN
(1) Analysis of current staff cadre vs. staff cadre needed for optimal service
delivery
RISK
Income for location may not be able to sustain costs for additional staff
Persons may not have requisite skills for efficiency
MITIGATING RISK
Rationalize recruitments and utilize technology where possible to reduce
human efforts
Training
(2) Analysis of present systems of operations and the protocols
Establish protocol to guide :
Relationship between Drug Serv & hospital
Control/Access
RISK
Resistance to change
MITIGATING RISK
Training



IMPLEMENTATION PLAN Medium - Long Term
Civil works Physical infrastructural needs for improved service delivery
RISK
Structural integrity may not be conducive for expansion
MITIGATING RISK
Possible relocation at other parts of facility?
TIMELINE
Commence six (6) months after roll out date




Thank
you
37
INTRODUCTION

Hospital Pharmacy may be defined as
department of hospital which deals with
procurement, storage, compounding,
dispensing, manufacturing, testing,
packaging and distribution of drugs

A Hospital Pharmacy is controlled by a
professionally competent and a qualified
pharmacist
All organization can be represented as
Organization
Input Output
Within the organization, the work can be sub-
divided into the direct production and service
activities
Input Output

Production
Services
Production


DEPARTMENTS AND THEIR
ORGANIZATION

The organi zed hospi tal pharmacy
department has an i ntegrated setup
consi sti ng of di spensi ng secti on,
manufacturi ng secti on, qual i ty
control secti on and cl i ni cal pharmacy
HOSPITAL ORGANIZATION
FLOWCHART






ADMINISTRATOR
HEAD OF PHARMACY SERVICES
(M.Pharm)
Dispensing
chemist
Manufacturing
chemist
Clinical
pharmacist
Quality
Control
pharmacist
Medical stores
pharmacist
In
patient
Out
patient
Manufacturing of
I.V fluid
Other
manufacturing
services
STAFFS
4) Junior & Senior Pharmacists
To work in main store, sub-store, dispensing section etc.
They are under graduate pharmacist and reports to
graduate pharmacist
5) Helpers
To support functions and functionaries in pharmacy

Organization Chart of hospital having
bed strength less than


100-400 beds (Small District Hospital)
2 Head Pharmacists (having degree in Pharmacy)
In-patient
Out-patient
5 Assistant Pharmacists(having diploma in Pharmacy)
2 under Head Pharmacist(In-patient)
3 under Head Pharmacist (Out-patient)









Organization Chart of hospital having
bed strength less than

500 beds (District/Small teaching Hospital)
Chief Pharmacist (having degree in Pharmacy)
2 Head Pharmacists
In-patient
Out-patient
6 Assistant Pharmacist
3 under Head Pharmacist(In-patient)
3 under Head Pharmacist (Out- patient)

Organization Chart of hospital having
bed strength less than

1000 beds (Teaching Hospital)
One Superintendent of Pharmacy (having Post
Graduate degree in Pharmacy)
3 Chief Pharmacists
Medical and surgical stores
Out-patient services
Quality assurance





Organization Chart of hospital having
bed strength less than

35 Assistant Pharmacists
6 under Chief Pharmacist 1 for medicine
supplies
4 under Chief Pharmacist 1 for medical
devices and surgical items
21 under Chief Pharmacist 2
4 under Chief Pharmacist 3
LOCATION
The pharmacy should be located in the hospital
premises so that patients and staffs can easily
approach it
In multi-storied building of a hospital, the
pharmacy should be preferably located on the
ground floor especially the dispensing unit
The departments are so laid out that there is
continuous flow of men and materials
Out-patient pharmacy should give a pleasant
appearance


Typical layout of Hospital Pharmacy




ASEPTIC SECTION


MANUFACTURING
SECTION

RAW MATERIALS
STORES
FINISHED PRODUCTS
PASSAGE
ADMINISTRATIVE
SECTION
Dispensing
Open space
LOCATION

Should have educative posters on health
Space must be provided for routine manufacturing
The manufacturing room and medical stores should be
adjacent to pharmacy
Medical stores & manufacturing units issue against
requisition from various departments
Pharmacy issues materials to in-patients and out-
patients
The in-patients are served by nursing stations

INFRASTRUCTURE
There are great variations in the size of floor
space devoted to pharmacy in hospitals of the
same size and type

Floor Space Requirements
The pharmacy requires a minimum of 250 sq.
feet for any sized hospital



INFRASTRUCTURE
From that point onwards, basic requirements
from 10 sq. feet per bed in 100 bedded
hospital, 6 sq. feet per bed in 200 bedded
hospital and an average of at least 5 sq. feet
per bed in larger hospitals
The floors of pharmacy should be smooth,
easily washable and acid-resistant

INFRASTRUCTURE
In manufacturing sections, drains should be
provided, walls should be smooth, painted in light
colors
The wooden cabinets are enameled or laminated
Fluorescent lamps are placed immediately above the
prescription counter
Gas outlets are required on the work table or
counter for the Bunsen burners

EQUIPMENTS
The usual equipment's are
Prescription case
Drug stock cabinets with proper shelves and
drawers
Sectional drawer cabinets with cupboard
bases
Work tables and counters for routine
dispensing
Sink with drain board
EQUIPMENTS
Cabinet to store mortar and pestles
Cabinet for glass utensils, funnels, flasks and
beakers
Refrigerator of suitable capacity
Narcotics safe with individually locked drawers
Office desk with telephone connection and file
cabinet
Shelf space for pharmacy library
WORKLOAD
Many factors t hat af fect t he l evel of wor k
i n t he i ndi vi dual phar macy, by far t he
most i mpor tant bei ng t he prescr i bi ng
act i vi t y of t he medi cal staf f

O t h e r s i n c l u d e t h e e x t e n t t o w h i c h
ma n u f a c t u r i n g i s c a r r i e d o u t , t h e
me t h o d s u s e w i t h i n t h e d e p a r t me n t ,
t h e s e r v i c e s o f f e r e d t o t h e o t h e r
p r o f e s s i o n s i n t h e h o s p i t a l a n d t h e
e x t e n t t o w h i c h t h e s e s e r v i c e s a r e
u s e d
WORKLOAD
In addition, there may be a considerable
amount of work involved in the provision of
supplies for the community services
A technique is needed which will enable the
activity and workload of a department to be
measured
At present, the only indicators available are
the total expenditure on drugs and number of
beds served

WORKLOAD
The total number of items issued can be
recorded and this will indicate the workload in
the dispensing and ward supply sections
The totals so collected will give some crude
indication of the work carried out and will
show any trends in the demands made upon
the departments

REFERENCES

M C Allwood & J T Fell ., Textbook of Hospital
Pharmacy, 1
st
ed. Australia: Blackwell Publications;
1980. p. 18-46
William E Hassan., Textbook of Hospital Pharmacy,
5
th
ed. U.S.A: Lea & Febiger; 1986. p. 35-90
Mc.Gibbony JR. Principles of Hospital
Administration, 2nd edition, GP Putnam and Sons,
New York 1969.
K.G. Revikumar, Text book of Pharmacy Practice,
1
st
ed. 2009. p.52



C. Staff pharmacists. The employees have daily
responsibility for the pharmacys distributive
and clinical duties.
1. Distributive duties include:
a. Physician order review and filling
b. Unit-dose chart checking
c. Extemporaneous compounding of
parenteral admixture, oral solution,
and topical preparations.
d. Specific assigned tasks, such as
purchasing, inventory control, and narcotic
distribution and control.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
61
2. Clinical duties of staff pharmacists are
varied.
a. Therapeutic assessment. In addition
to evaluating the appropriateness of
prescribed drugs and dosages, staff
pharmacist monitor for drug-drug
interactions and adverse drug effects.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
62
2. Clinical duties of staff pharmacists
are varied.
b. Staff pharmacist also advise
physicians, participate in physician
rounds, and may serve on the
nutritional support team.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
63
2. Clinical duties of staff pharmacists
are varied.
c. Other clinical duties of staff
pharmacist include
pharmacokinetic monitoring,
patient discharge counseling and in
service education.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
64
D. Clinical pharmacists. Because of their
specialized education and training, these
pharmacist are responsible for providing
clinical activities for the hospital
pharmacy.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
65
D. Clinical pharmacists.
1. Most clinical pharmacists have an
advanced degree, such as master of
science (MS) in clinical pharmacy or a
Doctor of Pharmacy degree (PharmD).
some also may have completed a
residency of fellowship in clinical
specialty.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
66
2. the clinical pharmacist play a major
role in monitoring and evaluating drug
therapy and intervening when
appropriate.
3. Depending of departmental
organization and hospital size, the clinical
pharmacist also may have drug
distribution duties.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
67
4. Some clinical pharmacists hold
appointments at colleges or schools
of pharmacy, serving as preceptors
to graduate and undergraduate
students.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
68
E. Hospital pharmacy residents. As
graduates of pharmacy programs, these
staff members have a special interest in
hospital practice.
1. Generally, pharmacy residencies are 1-
year or 2-year programs offered by
hospitals alone or in conjunction with a
college or school of pharmacy.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
69
2. Hospital pharmacy residents gain
intensive experience in the distributive,
clinical and administrative aspects of
institutional practice.

3. Many pharmacy residents go on to
graduate school, clinical fellowships, or
entry-level hospital pharmacy
management positions.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
70
4. The ASHP matches potential
pharmacy residents with ASHP
residency programs to facilitate the
selection process for both residency
candidates and hospitals.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
71
F. Technicians and other support
personnel play an important part in
hospital pharmacy operation.
1. Technicians may be pharmacy
students fulfilling their internship
requirements, or they may be high
school graduates.

June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
72
F. Technicians and other support personnel
2. Technicians work under the direct supervision
of a pharmacist. In fulfilling their primary
duty (i.e., helping to carry out the
pharmacists responsibilities) technicians
perform the following tasks:
a. Fill unit-dose cart
b. Fill floor stock pharmacy supplies
c. Extemporaneously compound and
prepare intravenous admixtures for
approval by a pharmacist.
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
73
Bed Strength
# of pharmacist
required
Up to 50 beds 3
Up to 100 beds 5
Up to 200 beds 8
Up to 300 beds 10
Up to 500 beds 15
June 14 Aleth Therese L. Dacanay, RPh, MSc Phar 74
PHARMACIST REQUIREMENT
June 14
Aleth Therese L. Dacanay, RPh, MSc
Phar
75