DRUGS (MEDICINES) AND

THERAPEUTICS COMMITTEE (DTC)

2017

BOTSWANA

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 Background
• Medicines are key to the success of any Health Care Strategy.
For this reason, the Botswana National Drug (Medicine) Policy
(BNDP) was established with the aim “to make medicines of
acceptable safety, efficacy and quality available and affordable to
all those who need them and to promote their rational use by
prescribers, dispensers and consumers”.

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 Background… contd.
• The Ministry of Health and Wellness, through the BNDP,
encourages the key health personnel, both in public and private
sector, to participate in collaborative management of medicines
in their facilities so as to promote rational, efficient and cost-
effective use of medicines.

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 Key Definition
• A collaborative management committee, generally referred to
as Drugs (Medicines) and Therapeutics Committee
(DTC).
• The DTC is a multi-disciplinary committee that advises the
medical staff, administration, pharmacy and other
departments in the health facility on matters relating to the
therapeutic use of medicines. 12/30/2017 4
 ..Definition contd..
• DTC is a forum to bring together all stakeholders involved in decisions
about medicine use. It may exist at any level within the health-care
system, i.e. at district level (overseeing primary health-care facilities, be
it in hospital or clinic) or at national level.
• This is a committee within a health facility which is responsible for the
evaluation of medicines, as well as ensuring proper management, use
and administration of all pharmaceuticals in that facility.
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 ..Definition contd..

• The DTC provides a formal communication link between the

health facility and Botswana Essential Drugs (Medicines)
Action Programme (BEDAP) and / or National Standing
Committee on Drugs (NASCOD) in the Ministry of Health
and Wellness.
• It provides a forum to bring together all the relevant carders
to work jointly to improve health-care delivery. 12/30/2017 6
The need for a DTC in a Health facility
• As a result of studies which showed that inappropriate, ineffective and economically inefficient
procurement and use of pharmaceuticals was a common practice in both developed and
developing countries, the World Health Organisation (WHO) came up with the concept of
rational drug use.
• Data from developed countries shows that DTCs are very effective in safe-guarding and
promoting efficient and rational use of medicines. Many health facilities face serious problems
such as:-
• increasing adverse drug reactions (ADRs)
• overuse of antibiotics
• increasing antimicrobial resistance
• significantly higher costs linked to pharmaceutical use.
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 The need for a DTC in a Health facility
• DTC can offer the leadership and structure in identifying problems
related to medicine use, promote rational use of medicines, as well as
reduction of pharmaceutical costs.
• DTC exists to come up with educational programmes that provide
advanced knowledge on matters related to medicines and their use, so as
to meet the needs of every health professional staff in the facility.

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 GOALS AND OBJECTIVES
Goals
• The aim of a DTC is to ensure that patients are provided with the best
possible cost-effective and quality care.
• In addition, the DTC has to oversee the safe, effective and economic use
of medicines within the facility.

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 GOALS AND OBJECTIVES … contd.
Objectives
In order to achieve the above goals, the DTC has the following specific objectives:
• To ensure that only efficacious, safe, cost effective and good quality
medicines are used
• To ensure the best possible medicine safety through monitoring, evaluating and
thereby preventing adverse drug reactions (ADRs) and medication errors.
• To develop and implement interventions to improve medicine use by
prescribers, dispensers and patients.
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 COMPOSITION / MEMBERSHIP OF A DTC
Referral hospitals
• Hospital Superintendent departments:  Infection Control
• Pharmacist in charge  Medicine  Administration
• Nursing Officer in charge  IDCC
• Pathologist  Surgery
• Laboratory Officer in charge  Paediatrics
• Radiologist or Radiographer  Obstetrics and
Gynaecology
• Nursing Superintendent
 Oncology
• Specialist / Medical Officer in
charge of the following  Dentistry
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 COMPOSITION / MEMBERSHIP OF A DTC
District Health Management Teams

• Hospital Superintendent (district departments:

hospitals) /Chief medical officer  Medicine OR in other DHMTs
(primary hospitals)  IDCC • Medical Officers in charge of
• Head of DHMT  Surgery  Outpatient department
• DHMT Pharmacist/Pharmaceutical 
officer in charge
Paediatrics  IDCC
 Obstetrics and Gynaecology  Wards
• Nursing Officer in charge
 Oncology  Officer in charge of clusters or
• Laboratory officer in charge
 Dentistry clinics
• Radiologist or Radiographer
 Infection Control  Administration
• Hospital Manager
 Administration
• Specialist / Medical Officer in
charge of the following
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PRIMARY FUNCTIONS OF A DTC
There are many possible functions of a DTC. Depending on local capacity and structure, the
committee must decide which functions to undertake as a priority. Furthermore, certain
functions might require liaison with other committees or teams, e.g. Infection Control
Committee, Procurement Team.
Primarily, the most important functions of a DTC are summarized as follows:

• DTC serves as an advisory committee to medical staff, administration and

pharmacy.
It is a valuable resource that can provide advice to medical staff, nurses, administration,
pharmacy and other departments within the hospital. The DTC can advise on issues, policies
and guidelines concerning the selection, distribution and use of medicines.
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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• DTC promotes and monitors safe, cost effective and rational use of
medicines.
Standard Treatment guidelines/protocols are a proven way to
promote the rational use of medicines. The DTC is responsible for
monitoring and ensuring adherence to national treatment
guidelines/protocols and policies as a way to achieve the above
objective.
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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• DTC functions as a formal link to the Botswana Essential Drug

Action Programme (BEDAP) and/or National Standing Committee
on Drugs (NASCOD).
-The DTC is expected to advise NASCOD on Medicine selection (addition,
deletion), categorization and use of medicines contained within the Botswana
Essential Medicines List (BEML).

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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• DTC assesses medicine use in the health facility to identify

problems.
The DTC should identify the priority problems in medicine use and make appropriate
recommendations. Some methods that can be used to identify medicine use problems include:
 Medicine utilization reviews
 monitoring of adverse drug (medicine) reactions
 medication errors and adherence to standard treatment guidelines
 Antimicrobial resistance surveillance (currently the biggest problem worldwide).
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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• DTC conducts effective interventions to improve medicine use

 The DTC is the main body within a facility that is responsible for ensuring that medicine
information is provided to health staff, as well as conducting interventions to further promote
rational medicine use. Examples of important interventions include:-
 monitoring and supervision of educational programs
 in-service training
 use of standard treatment guidelines
 provision of unbiased medicine information.

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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• Managing Adverse Drug Reactions (ADRs)

Adverse drug reactions (ADRs) are a serious cause of patient harm (morbidity
and mortality) and avoidable economic cost. While the estimated incidence of
this problem varies widely amongst studies, the availability data suggests that
ADRs are a large and serious problem. Since DTCs are responsible for
ensuring that patients are treated as safely as possible, monitoring and
reporting of ADRs is an essential part of ensuring patient safety.

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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• Managing Medication Errors

Medication errors occur in all health-care settings. These can occur at different stages of prescribing, dispensing or
administration of a medicine. Causes of such errors include:
 lack of knowledge
 fatigue of staff
 poor procedures
 lack of policies
 unfamiliar dosage forms
 Human error.
DTCs can reduce such errors by monitoring, analysing, reporting errors and subsequently implementing corrective
action.

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 PRIMARY FUNCTIONS OF A DTC… CONTD.

• To play a supervisory, monitoring and educational role at

the facility and within catchment area.
As a committee composed of different health professionals, the DTC is well
placed to supervise, advise, lead and monitor all matters relating to health care
delivery and medicine use in particular.

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 BENEFITS OF AN ACTIVE AND
FUNCTIONING DTC

Through a fully functional and active DTC in the health facility:

• Safe, effective, high quality and cost effective pharmaceuticals can be
selected for the formulary.
• The facility is able to identify problems related to medicine use and
raise concerns to relevant authoritative bodies in time and be addressed
within a reasonable time frame.
• The negative impact of irrational use of medicines on the health care
system can eventually be eradicated or minimised.

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 BENEFITS OF AN ACTIVE AND FUNCTIONING DTC
contd…

• There can be improved medicine procurement, as well as management of the stock.

• Pharmaceutical expenditures can be well managed and controlled , through better
management.
• There can be reduced ADRs, as well as medication errors with improved management.
• Working together with BEDAP and appreciating each other’s challenges can help improve
quality of patient health care system and subsequently improve the quality of lives of
the patients being served.

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 CHALLENGES TO HAVING FULLY
FUNCTIONAL FACILITY DTCs

Scarcity of Professionals
• Transfer of officers-Other facilities go down because some officers who have been active get transferred, resulting in the
slowdown of the committee.
• Active officers going on end of contract leaves and not coming back.
• Resignation of officers who have been active or ensuring the running of the committee.
• Officers not able to honour scheduled meetings due to other commitments or clashes.
-DTC members are generally Heads of Departments in most cases, who sit in other important committees, hence have
to postpone some of the scheduled meetings at times due to business or conflicting responsibilities.
• Shortage of staff- Some facilities do not have Pharmacists to mobilise the existence and functioning of the committee.

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 CHALLENGES NOT TO HAVING FULLY FUNCTIONAL
FACILITY DTC…………… contd.

• Lack of Proper Knowledge

-Failure to appreciate purpose and importance of committee

• Lack of Monitoring
-Due to shortage of staff in the monitoring unit at the Ministry (BEDAP), facilities have not been
closely monitored effectively in the past.
 Role of pharmacy therefore very crucial in the functioning of a facility DTC.

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 STRATEGIES PUT IN PLACE TO APPROACH,
ENCOURAGE AND MONITOR FACILITIES

Increase Monitoring
• Ensuring facilities submit schedule of meetings at the beginning of financial year.
• Submission of minutes for meetings held.
• Facility visits once a year. Priority given to those facilities with no DTCs.
Improved Communication
• Monthly email communication, followed by telephone, reminding facilities to submit minutes of
the meetings held.
• Feedback from minutes given to facilities.
Benchmarking
• For facilities not doing well, suggestions made to that facility to liaise with another that is active. 25

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 CURRENT STATUS OF DTCs IN HEALTH FACILITIES
COUNTRYWIDE
BASELINE INFORMATION -AS AT END OF 1st Quarter 2016/2017
Number of Percentage (%)
facilities out of Out of 31
the total 31 facilities
Number of facilities with existing DTC 20 64.5%
Number of facilities with non-existing DTC 11 35.5 %
Number of facilities with existing, functional DTC 11 35.5%
Number of facilities with existing, non-functional 9 29 %
DTC
Number of facilities with up-to-date DTC 6 30% (subjective)
minutes(out of those with DTCs)
Number of facilities without DTC minutes (out of 14 70% (subjective)
those with DTCs)
Number of facilities with no response 0 0%
Total number of facilities 31 100% 26

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 PROGRESS–AS AT END OF 4th QUARTER 2016/2017
COUNTRYWIDE Number of Percentage (%)
facilities out of out of 35
the total 35 facilities

Number of facilities with existing DTC 24 68.6%

Number of facilities with non-existing DTC 11 31.4%
Number of facilities with existing, functional DTC 6 17.1%
Number of facilities with existing, almost functional DTC 8 22.9%
Number of facilities with existing, non-functional DTC 11 31.4%
Number of facilities with up-to-date DTC minutes (out of those with 12 50% (subjective)
DTCs)
Number of facilities without DTC minutes(out of those with DTCs) 12 50% (subjective)
Number of facilities with Newly formed/revived DTC(formed in the 3 8.6 %
last quarter)
Number of facilities with no response 2 5.7 %
27
Total number of facilities 35 100%
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 THANK YOU

QUESTIONS/COMMENTS

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