The link between St. Francis Hospital, Zambia and NHS Borders Trust, UK was born after St. Francis sought assistance with its pharmacy record keeping system. Realising its current system was out-dated and unable to cope with a recent sharp increase in disbursements, the link was established with the aim of bringing in an electronic record keeping system that would be efficient, easy to learn and sustainable.

The stagnation of a pharmacy record keeping system

Built in 1948 and jointly managed by the Catholic and Anglican Church, St. Francis hospital is the oldest but largest hospital in the Eastern Province of Zambia. It is located in the rural part of Zambia in a small town called Katete which has a population of about 250,000 people.

Over the past couple of years there has been a sharp increase in the disbursements of medication as the hospital gets even bigger and patient numbers grow. Jeremiah Nyirenda, Pharmacy Officer in-charge, explains how the pharmacy record keeping system had been stagnant for a very long time:

‘Immediately [after] I finished my diploma programme in 1996, I was posted to St. Francis. We were using bin cards to manage stocks, just a piece of paper to write down drugs available. We had a Dutch pharmacist who introduced a stock management programme called MEDIS. It was computerised but run parallel with the bin cards for some time. By that time I was the only Pharmacy technologist working with 2 assistants (job trained) seeing about 100 patients a day.’

After some time, MEDIS crashed and the hospital reverted back to using bin-cards for about four years. This resulted in major inconsistencies with drug stocks as bin cards were not updated or went missing. This basic system also meant that valuable additional information, such as consumption levels and inventory records, could not be recorded. The system was clearly failing to address the growing demand on the pharmacy department.

NHS Borders visited St. Francis in 2010 to carry out a feasibility assessment. After establishing that there was a real need, they came back to install the ‘ascribe’ system. According to Jeremiah:

‘We have grown as a department to match the capacity of patients that are coming through but we are still very understaffed. ascribe has been currently running for about 8 months, but we have still kept the bin cards, running 2 parallel systems with the plans of slowly phasing out the bin cards.’

Bringing the pharmaceutical disbursement into the 21st Century

Though the ‘ascribe’ system has only been running for eight months, some achievements have already been achieved. Ordering of medicines has become much easier, and the use of these latest technologies in such a rural hospital is motivating the staff to input data more accurately. The overall management of stocks and statistics has also become more efficient. Most crucially, however, it has helped the hospital to better predict which drugs they need to buy, and this will be matched with available funds which in effect assist in the overall planning and budgeting process.

Making a difference

Mr. Abaraham Phiri, Data Entry Clerk at the pharmacy, also received training and narrates how ascribe has made his life much easier:

‘I have worked with St. Francis for three years ... before when using the bin cards, we used to face problems as the process was very long from bin cards. It was time consuming and in times of emergency they would first issue the drugs then later fill in the bin cards meaning entries were not done in real time and sometimes forgotten all together. The experience now is that it’s much easier and efficient to work and come up with reports, and this is more so with the growing numbers of patients, especially in the wards.’

The future of the system

As with all technical programmes, a few challenges remain with ascribe – the programme does not capture expiry dates, meaning that this still has to be done manually, and the introduction of new drugs will not be able to be included in the master database.

However, despite these challenges, Jeremiah is positive that they will be able to expand the current usage of the system as other features are locked and extend the services to dispensary level to ensure a more efficient service.

IHLFS Team, British Council Zambia