Ratsimbazafimahefa H R, Sadeghipour F, Trouiller P, Pannatier A, Allenet B
School of Pharmacy, University of Antananarivo, Antananarivo Madagascar; Campus Ambohitsaina, BP 375, Antananarivo 101, Madagascar.
Pharmacy Department of University Hospitals of Lausanne, 1211 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, 1211 Geneva, Switzerland.
Ann Pharm Fr. 2018 May;76(3):218-227. doi: 10.1016/j.pharma.2017.12.003. Epub 2018 Jan 17.
Madagascar's health care system has operated without formal hospital pharmacies for more than two decades. The gradual integration of pharmacists in public hospitals since 2012 will allow the structuring of this field. This study was conducted to characterize the current situation regarding all aspects relating to the general functioning of hospital pharmacies and the services provided.
This qualitative research used semi-structured interviews. Interviewees' perceptions about the general organization and functioning of hospital pharmacies and details on services provided were collected. The 16 interviewees were Ministry of Health staff members involved in hospital pharmacy, hospital directors, medical staff members and hospital pharmacy managers. Interviews were recorded, translated into French if conducted in Malagasy, and fully transcribed. Verbatim transcripts were coded according to the themes of hospital pharmacy and topical content analysis was performed.
The principal issue perceived by interviewees was the heterogeneity of the system in terms of technical and financing management, with a main impact on the restocking of pharmaceutical products. The drug supply chain is not under control: no internal procedure has been established for the selection of pharmaceutical products, the quantification of needs is complex, stock management is difficult to supervise, a standard prescription protocol is lacking, dispensing is performed by unqualified staff, no pharmaceutical preparation is manufactured in the hospitals and administration occurs without pharmaceutical support.
Progressive structuring of efficient hospital pharmacy services using the Basel statements for the future of hospital pharmacy is urgently needed to improve health care in Madagascar.
马达加斯加的医疗保健系统在没有正规医院药房的情况下运行了二十多年。自2012年以来，药剂师逐渐融入公立医院，这将使该领域得以构建。本研究旨在描述医院药房整体运作及所提供服务各方面的现状。
本定性研究采用半结构化访谈。收集了受访者对医院药房总体组织和运作的看法以及所提供服务的详细信息。16名受访者为参与医院药房工作的卫生部工作人员、医院院长、医务人员和医院药房经理。访谈进行了录音，若用马达加斯加语进行访谈则翻译成法语，并进行了完整转录。逐字记录根据医院药房主题进行编码，并进行了主题内容分析。
受访者认为的主要问题是该系统在技术和财务管理方面的异质性，这对药品补货产生了主要影响。药品供应链不受控制：没有建立内部药品选择程序，需求量化复杂，库存管理难以监督，缺乏标准处方规程，由不合格人员进行配药，医院不生产药品制剂，药品管理缺乏药学支持。
迫切需要利用医院药房未来的巴塞尔声明逐步构建高效的医院药房服务，以改善马达加斯加的医疗保健状况。
