The Organization of an Integrated Medicine and Supply Management System in the Dominican Republic: Progress and Challenges

The study identified fragmentation in the supply process as a major cause of inefficiencies and stock-outs. A proposal for an integrated system, known as the Integrated System for Medicine and Supply Management (SUGEMI), was presented to health authorities and technical cooperation agencies. SUGEMI was established as the institutional mechanism for managing the pharmaceutical supply system in the public network of health facilities. The system was designed to improve the availability of medicines and supplies, reduce costs, and strengthen the national pharmaceutical system. SUGEMI's functions were distributed among several entities, including the National Pharmaceutical Management Unit (UNGM), the Program of Essential Medicines and Center for Logistical Support (PROMESE/CAL), and the Regional Health Directorates (DPSs). The implementation of SUGEMI involved two phases. Phase 1 (2010-2012) focused on developing manuals and procedures for the supply chain, securing political-administrative support, and organizing operators. Phase 2 (2012-2014) involved incorporating additional public sector institutions and components into the integrated system, including the Maternal-Child Health and Protected Diseases programs, laboratory materials and reagents for general use, and laboratory materials and reagents for the TB program. SUGEMI's implementation was supported by technical and financial cooperation agencies, including the US Agency for International Development (USAID). The system's incorporation of a national inventory and physically transferring handled by the DPSs to the SRSs, as dictated by the health reform process, was a key aspect of its implementation. Standardizing delivery procedures and transportation routines made them consistent with other products distributed in the public health network. The training of human resources was a critical component of SUGEMI's implementation. Beginning in 2014, two diploma courses were organized, resulting in the training of 37 professionals in supply management. The combined on- and off-site methodology allowed students to use theoretical knowledge acquired in practice and implement SUGEMI's operating procedures. The availability of medicines and supplies in DCPs that have been integrated into SUGEMI has increased, and the previously observed chronic shortages have been reduced. The system's incorporation of a national inventory and physically transferring handled by the DPSs to the SRSs has improved the supply of medicines and supplies. SUGEMI's implementation has also strengthened the national pharmaceutical system, making it more sustainable and efficient.