DOI: 10.5061/dryad.gqnk98smd
title: Drug and Therapeutics Committee (DTC) evolvement and expanded scope in Ethiopia

description: 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 &lt;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.
description: 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.
description: Detail information the dataset is presented in the
 ReadMe_DTC_Study_Dataset attached with uploaded dataset file.