La organización de un sistema único de gestión del suministro de medicamentos e insumos en República Dominicana: avances y desafíos

The initiative aimed to address the inefficiencies and shortages caused by the fragmentation of the supply chain in multiple vertical chains organized around disease control programs (PCEs) such as tuberculosis (TB) and HIV/AIDS. Prior to the implementation of SUGEMI, a rapid assessment in 2008 identified the main causes of inefficiencies and shortages as the fragmentation of the supply chain, with different programs having their own mechanisms for procurement, storage, and information systems. The study proposed the organization of a single, integrated system for the management of pharmaceutical supplies and inputs. The Ministry of Public Health requested assistance from the United States Agency for International Development (USAID) to implement SUGEMI, which was supported by a Disposition Ministerial in 2010. The system was designed to be integrated into the existing legal and regulatory framework of the Dominican Republic's healthcare system. SUGEMI established a structure with five main components: the National Unit for the Management of Medicines (UNGM), the Program for Essential Medicines and Central Logistics (PROMESE/CAL), the Regional Units for the Management of Medicines (URGM), the Disease Control Programs (PCEs), and the healthcare establishments. Each component has specific functions and responsibilities, including the coordination of procurement, storage, and distribution of pharmaceutical supplies and inputs. The implementation of SUGEMI was divided into two phases: the first phase (2010-2012) focused on the development of procedures, management of political and administrative support, and the organization of operators. The second phase (2012-2014) involved the incorporation of two major disease control programs (TB and HIV/AIDS) into the integrated system, as well as the incorporation of other components and institutions of the public sector. The implementation of SUGEMI has contributed to the increase in the availability of pharmaceutical supplies and inputs in the PCEs that have incorporated the system. Chronic shortages of antiretroviral (ARV) medications have virtually disappeared, and the information generated by SUGEMI has allowed for the identification of persistent shortages as a result of insufficient budget allocation rather than inefficiencies in the supply chain. This information has facilitated lobbying efforts with the Ministries of Health and Finance to secure additional budget resources. The implementation of SUGEMI has also involved the organization of a system for the training of human resources for the sustainability of the system. Two diploma courses have been organized, graduating 37 professionals who work mainly in the public healthcare sector. The semi-presential methodology used has allowed for the use of work space to put theoretical knowledge into practice and consolidate the implementation of SUGEMI. The SUGEMI system has been designed to be flexible and adaptable to the needs of the healthcare system, with a focus on improving the availability and accessibility of pharmaceutical supplies and inputs. The system has the potential to contribute to the improvement of healthcare outcomes and the reduction of health inequities in the Dominican Republic.