Historical background of SSPP
Since the signing of the Comprehensive Peace Agreement in January 2005, the Government of Southern Sudan has instituted the Interim National Constitution, which has decentralized Government into four levels, i.e. Central, State and County. The Constitution recognizes the provision of health care services in the country, through promotion of public health and guarantees equal access to Primary Health Care Services.
The Ministry of Health has developed an Interim Health Policy for Southern Sudan in 2005, which took into consideration the first South Sudan Health Policy of 1994 and the second one of 1998. This document states that the Ministry of Health, Government of Southern Sudan is committed to ensuring the availability, accessibility, safety, efficiency, effectiveness and affordability of drugs and pharmaceuticals in both the public and private sectors. It also refers to the development of guidelines to ensure rational medicines use and effective regulatory mechanisms and procurement and distribution systems for medicines, including guidelines for donation.
This Southern Sudan Pharmacy Policy is therefore a means to expound on this commitment and guide health service providers and users, both in the public and private sectors on effective implementation of the pharmaceutical aspects of the overall health policy. The process of developing this policy started before the signing of the CPA, and draws experiences and expertise of a wide range of experts at various times, involving national and international pharmacy- and other health professionals. The World Health Organization guidelines for the development of National Medicines Policies were also extensively referred to in the process of the development.
In this document considerations have been made to the current situation of the pharmaceuticals sector, the opportunities, challenges and constraints, as well as, possible future scenarios. At times therefore, reference is made to institutions that are yet to be established. To ensure effective implementation of this Policy, a comprehensive Pharmaceutical Master Plan will be developed shortly after its adoption. Moreover, applicable laws, regulations and guidelines, such as the Southern Sudan Pharmacy and Drugs Act and respective regulations, Essential Medicines List for Southern Sudan and a proposal for the establishment of autonomous Central Medical Stores are already in the final stages of development. These documents will augment and elucidate this policy further.
2. The key takeaways from the SSPP
A medicines survey that was conducted in 2004 by MOH and stakeholders indicates that there was irrational use of medicines at all levels of primary health care in the country
To ensure the constant availability of quality, safe and efficacious medicines according to South Sudan standards to all segments of the population
To monitor and evaluate equitable distribution, storage affordability of medicines to all areas of the country whether by the government, private or non-governmental organizations
To facilitate and actively promote rational use of medicines through sound prescribing, good storage/dispensing practices and appropriate training of health professionals and suitable public education
To encourage self-sufficiency, self-reliance and capacity building through technical, economic and commercial facilitation of local manufacture of pharmaceuticals which meet GMP standards for domestic use and export
To encourage and promote evidence-based use of traditional and herbal medicines, with due consideration to quality and safety
To ensure that the provision and access of medicines for veterinary services are consistent with this policy
To ensure that sound and effective pharmaceutical regulatory mechanisms and a quality assurance system are maintained at all levels.
3. Your analysis of its implementation’s status
Pharmacy practice in South Sudan is still regulated by the laws of the Republic of the Sudan until the establishment of the Government of Southern Sudan, in January 2005.
There is currently no local manufacturing in Southern Sudan. There have been expressions of interest in setting up manufacturing firms. However, no progress has been made in that respect pending the formulation and adoption of the relevant policy framework.
I. Shortage of qualified pharmacy professionals and inadequate regulatory mechanisms that has left the handling of pharmaceuticals to untrained persons and unlicensed premises.
II. The poor infrastructure and porous borders with the neighboring countries are also contributing to the availability of substandard medicines in the country.
III. Implementing treatment guidelines and national health policy is a lack of credibility and acceptance
Republic of South Sudan to establishment and effective functioning of Therapeutic Committees in all hospitals to ensure correct, efficient and cost-effective handling and use of medicines in hospitals.
2. Standard Treatment Guidelines
1. Historical background on the country STG
The Standard Treatment Guidelines of South Sudan (SS STGs 2019 edition) is the second edition for the Republic of South Sudan. The first edition (2006) was developed in 2006 before South Sudan attained her independence in 2011. The SS STGs incorporate the essential current medical knowledge, practices and new developments in the treatment of disease conditions based on national, WHO and other global standards and recommendations.
These STGs outline principles for prescribing and list the best treatments that are currently available at affordable prices. The application and correct use of these guidelines in South Sudan brings huge benefits to improve the health status and well-being of the population, limits potential harm that incorrect prescribing can cause. Developed as pocket guides for different levels of care in line with the Basic Package of Health and Nutrition Services (BPHNS), these STGs greatly simplify the task of health professionals in prescribing and ensures that those using the health system know that they are getting the best treatments with the least chance of side effects at low cost. With STG, the use of medicines becomes rational.
These STGs will be used by policy makers in South Sudan to set standards and regulate practices. Supply chain managers will consult them to ensure affordable generic medicines are available in line with the STGs and South Sudan Essential Medicines List. Prescribers (health professionals) will consult and use them to ensure all their prescribing is appropriate, evidence-based, and affordable. Dispensers (pharmacists and those authorised to dispense) check that health professionals are prescribing correctly and not duplicating medicines unnecessarily or using inappropriate or expensive medicines. Patients will benefit from the application and correct use of the STGs in knowing that they are receiving the best evidence- based, effective and affordable medicines, greatly improving the quality of treatment they receive and limiting any out of pocket expenses.
2.Approach (health facility tier systems, programs)
South Sudan has a health system with three tiers, primary care units (PHCU), primary care centers (PHCC) and Hospitals which exists as either state, county and Boma level
South Sudan structure in health services delivery is in order of community, primary secondary and tertiary level.
3. Printing, Distribution and Management of STGs
i. strengthen the capacities at CMS, SMoH, and CHD for efficient procurement, storage and distribution of essential medicines in line with the respective mandates.
ii. Strengthen the stock management systems in CMS, and health facilities to minimize expiries, damages, pilferage, and wastage.
iii. Integrate parallel supply chain systems for efficiency and economies of scale.
4. Utilization and monitoring of STG
The great indicators for the utilization and monitoring of STG in South Sudan considers as follows:
I. Establishment of therapeutic committee at all health facilities base on the guidelines in South Sudan.
II. Health professional at each level has been trained to use the treatment described. Each set of guidelines outlines which professionals are authorised to prescribe which treatments.