Background: Drug and Therapeutics Committee (DTC) is a platform where a group of multi-disciplinary professionals organized in a given health facility (HF), mainly hospitals and health centers, work together to improve the health care delivery. The Ministry of Health (MOH) Ethiopia, in collaboration with Regional Health Bureau (RHB) structures, its agencies and implementing partners (IPs), invested a lot in the establishment and strengthening of DTCs in Ethiopia. The Clinton Health Access Initiative (CHAI) Ethiopia is one of the key partners of the MOH. CHAI has been implementing the Child Survival Program (CSP) since October 2015 in collaboration with the MOH and Ethiopian Pharmaceutical Supply Agency (EPSA) in four big agrarian regions of Ethiopia, namely Amhara, Oromia, SNNPR and Tigray regions. Strengthening DTCs is part of the CHAI/CSP program to improve the overall supply chain management (SCM) of child health commodities. Hence, CHAI/CSP was interested in conducting DTC-specific studies. The objectives of this study are to review the evolution of DTCs in Ethiopia from their early years to current practice and identify the major hindering factors for their functionality and impacts on the SCM system and pharmacy services.

Methods: A descriptive study design was employed with mainly qualitative data collection methods and analysis. The assessment made use of both qualitative and quantitative data, generated from primary sources through key informant interviews and from secondary sources through desk review methods. As key informants, more than 20 experts on DTCs from government organizations (MOH, central EPSA, RHBs, EPSA hubs and Ethiopian Food and Drug Administration) and IPs (WHO,

United Nations Population Fund, United States Agency for International Development (USAID)/Chemonics/ Procurement and Supply Management, USAID Transform Health in Developing Regions, USAID/AIDS/Free and United States Pharmacopeia) were interviewed. For the desk review, the assessment team reviewed available relevant national and other documents from the MOH, RHBs, Central EPSA, CHAI, WHO and partners as supporting evidence of the assessment.

Results: DTCs were introduced in Ethiopia in the early 1980’s. The mandate of DTCs has been given to four different government organizations since this time in Ethiopia. As a result, its implementation was lagging. Recently, DTCs have been given attention both by the government and its partners. More than 5847 professionals underwent DTC training from 2016 onwards. DTC establishment in HFs improved from 85% to 98% between 2015 and 2019 during baseline and endline assessments carried out by CHAI/CSP. Similarly, DTC functionality in HFs improved from 20% to 63% in the same period. The CHAI/CSP regular bi-annual supportive supervision data analysis revealed that DTC establishment improved from 83% to 100% of HFs, while its functionality improved from 5% to 72% between 2016 and 2019, respectively. Moreover, a chi-square test of independence, performed to examine the relationship between training of facility heads and pharmacy heads on DTCs and the availability of a functional DTC in the same facility, revealed a significant association between the two variables at p-value <0.0001.

Recommendation: providing consistent capacity building and availing strong monitoring and evaluation system improves functionality of DTCs. Moreover, national coordinating body for DTC and similar structure at regional health bureaus and woreda health offices should be established.

1. Description of methods used for collection/generation of data:

The study employed both qualitative and quantitative data collection methods.

The qualitative study involved the collaborative efforts of a multidisciplinary research team coming from clinical background (medical doctors, internist, senior pharmacy professionals and senior public health professionals with extensive experience in project evaluations and operational researches. Furthermore, the KII participants were selected purposively from their current and/or previous position in relation with DTCs. Appropriate experience of the research team contributed a lot in identifying suitable KII participants as well as smooth relationship in conducting the study and virtue of the study. Meanwhile the quantitative component of the assessment was conducted to triangulate and strengthen the qualitative findings. The documents were identified from purposively selected most relevant organization that have been working on DTCs and SCM activities as a desk review. On top of that specific documents on DTC implementation were selected from those organizations. In this review, DTC training databases from MOH and CHAI were reviewed. Data and reports from baseline and endline assessments conducted by CHAI in Ethiopia were reviewed. Joint the Ethiopian Pharmaceutical Supply Agency, regional health bureaus and CHAI Ethiopia supportive supervision reports and databases were also reviewed.

2. Methods for processing the data:

Primarily, the training data was collected during each DTC training sessions using programmed Excel spreadsheet. Then cleaned, compiled and stored at national level. Similarly, the supportive supervision and surveys data were collected electronically using SurveyCTO data collection software and upload online. Then the real time collected data were downloaded from the SurveyCTO server in the form of Microsoft Excel comma separated values (CSV) file, cleaned, compiled and stored centrally.

For qualitative data semi-structured interview guides were used for the KIIs with open-ended questions to shape the discussion. The semi-structured interview guides were pretested in similar individuals in terms of educational and work experience background, but they were not selected for the actual interview and the feedbacks were incorporated into the interview guide.

3. Instrument- or software-specific information needed to interpret the data:

The audio recorded interviews and discussions were transcribed/translated from the languages of the interviewees into English for analysis. Then, a summary of each KII was developed and organized. The qualitative data analysis involved thematic coding of transcribed and translated in-depth interviews. Data were analyzed and compiled using a thematic approach (based on the different components of the KII) by conducting content analysis. Finally, narrative analysis was applied to merge most related segments of the findings that were summarized thematically. For quantitative data analysis from the secondary data, SPSS version 24 was applied for descriptive data analysis and some statistical tests like the Chi-Square test of independence to determines if there is an association between categorical variables.

Detail information the dataset is presented in the ReadMe_DTC_Study_Dataset attached with uploaded dataset file.