• Introduction

DTC is one of the most effective strategies to promote the rational use of medicines and medical devices.
The medicine use process in health facilities is a multifaceted process that requires the active
involvement of various departments including clinical, pharmacy, administrative. A single entity cannot
adequately address all issues regarding medicines. It requires a concerted effort to avail most needed,
safe, efficacious, and cost-effective medicines. It also requires even more collaboration and coordination
to ensure available medicines are appropriately used for the intended purpose.

Recognizing its benefits, the Ethiopian Ministry of Health has made efforts to include DTC
health transformation plans (HSTP)1 and reform guidelines (EHSTG2
and EHCRIG3
) which
necessitate health facilities to establish a functional DTC. Moreover, the Ethiopian Standard
Agency (ESA) has set establishment of DTC in its minimum regulatory standards health facility.
DTC is the committee composed of medical, pharmacy and administrative departments. DTC
evaluates the clinical use of medicines, develops policies for managing pharmaceutical use and
administration, and manages the formulary system. DTC is an essential component of a health
facility’s effort to improve availability and ensure rational use of medicines.
Particular areas of inefficiency and medicine use problems that necessitate the establishment of
DTC include:

1 Health Sector Transformation Plan (HSTP)

2Ethiopian Hospital Service Transformation Guidelines (EHSTG)

3 Ethiopian Health Center Reform Implementation Guidelines (EHCRIG

in its Drugs and Therapeutics Committee

Each hospital should establish a functional Drug and Therapeutics Committee

(DTC) having multidisciplinary representative members. The DTC brings together all the relevant
professionals to work jointly to improve healthcare delivery. The DTC has an advisory role and
discharges its responsibility of promoting the safe, rational and cost effective use of
pharmaceuticals by providing guidance to pharmacy, clinical departments, and management of
the hospital.

3.2.1. Membership of DTC

While deciding number of DTC members, the hospital shall consider that fewer DTC members
will enable to reach consensus more easily while more. DTC members provides greater expertise,
reduce workload for individuals and increase chances of DTC decision implementation.
Considering this,

DTCs shall have the following members, as a minimum:

• Chief Clinical Officer or equivalent (Chairperson)

• Pharmacy director/head (Secretary)

• Head of laboratory service

• Head of nursing service

• Head of clinical departments (internal medicine, surgery, pediatrics, gynobs, etc.)

• Head of finance department

• Representative from other services as deemed necessary

Other non-voting, non-executive participants can be invited to attend DTC meetings to discuss
specific issues that require their particular expertise. All DTC members, especially the chair and
secretary, should be given sufficient time for their DTC functions and this should be included in
their job [Link]-committees of the DTC may be formed to address specific issues as the
need arises (for example a policy on the use of antimicrobials, etc.)

3.2.2. Procedures of DTC meetings

The DTC should meet at a minimum every two months, or more often as the need arises.
Minutes should be kept for all DTC meetings. The agenda, supplementary materials and minutes
of the previous meeting should be prepared by the secretary and distributed to members for
review in sufficient time before the meeting. These documents should be kept as permanent
records of the hospital and recommendations should be circulated to hospital management and
concerned units/departments. Seventy-five percent of the members will constitute a quorum for
any meeting and 50% plus members’ support will approve decisions of any discussed issue.

3.2.3. Roles and responsibilities of the DTC

The DTC should develop terms of reference (TOR) detailing the objectives, scope, meeting
frequency, membership, and roles and responsibilities of the DTC and each member. The DTC is
expected to develop and implement annual action plan in line with its roles and responsibilities.
The DTC should have the following roles and responsibilities:

The DTC develops and maintains the hospital’s specific list of pharmaceuticals:

The DTC coordinates all relevant departments of the hospital to take part in the selection and
prioritization of pharmaceuticals needed by the hospital. Pharmacy, medical, laboratory, medical
equipment management and imaging departments should take part in the process.

Preparation of SOPs and guidelines needed to ensure provision of proper pharmacy

services:

SOPs should be developed for drug supply management, disposal, drug information services,
generic substitution and therapeutic interchange, use of specific medications such as narcotics
and psychotropic agents, high-alert medications, chemotherapeutic agents, highly expensive
medications, etc.
 The DTC promotes the adoption and utilization of standard treatment guidelines (STG):
The DTC should promote utilization of national STGs. Specialized hospitals may also develop their
own STGs based on availability of required expertise, facilities, e

The DTC establishes mechanisms to identify and address drug use problems:

The DTC should establish policy/procedures for identifying and managing drug use problems.
The DTC follows the implementation of these activities by itself or by setting up a subcommittee
composed of relevant departments. When problems are identified, the DTC should devise specific
interventions to improve practices. Interventions may be educational, managerial and/or
regulatory.

Establishing Antimicrobial Stewardship Program (ASP):

The DTC should establish Antimicrobial Stewardship Program (ASP) to promote rational
antimicrobial use and contain antimicrobial resistance (AMR). The program should be
implemented through a multidisciplinary approach containing physicians, pharmacists, nurses,
laboratory professionals, infection prevention committee and others as needed.

Support and oversee establishment and functioning of Drug Information Services (DIS):

As part of improving access to unbiased and current information on medicines, the DTC should
support establishment of a functional Drug Information Service (DIS) that serves both health
professionals, patients and the public at large. For further details, please refer the DTC manual

3.3. Hospital Specific Pharmaceuticals List

All hospitals shall develop hospital specific pharmaceuticals list comprised of medicines, medical
supplies, medical equipment and laboratory reagents which are prioritized as vital (V), essential
(E) and non-essential (N). This list is developed based on the national formulary. The hospital
should use the list for procurement purposes and for monitoring prescribing and use. In addition,
specialized hospitals may have formulary manual for specific medicines used for their specialty
services. These hospitals may include pharmaceuticals not included in the national list. Hospital
specific pharmaceuticals list should be prepared by multi-disciplinary team of health
professionals drawn from medical, pharmacy, laboratory, and imaging departments. The
selection of pharmaceuticals should be based on:

• The local pattern of disease

• National standard treatment guidelines (STGs)

• The recent national drug list (List of drugs for Ethiopia)

• Type of health services given by the hospital

• Availability of expertise in the hospital (specializations)

 • Diagnostic capacity of the hospital

The description of pharmaceuticals in the list should contain generic names, dosage form, and
strength. The list is recommended to include a limited number of drugs so as to improve drug
availability, adherence to treatment, focused prescribing, and to simplify supply management.
The pharmaceuticals list should be reviewed and updated at least annually. The list should be
available in clinical departments, the pharmaceuticals store, dispensaries, laboratory, finance,
etc. to be used as references.

DTC and antimicrobials:

To be effective, the DTC needs to obtain institutional management and leadership support.
Documentation of clinical and economic benefits of the DTC will provide evidence to senior
hospital administrators of the vital role the DTC plays in helping to preserve the effectiveness of
existing antimicrobials. This effect can be accomplished by multifaceted methods led by the DTC
including the following—

• Updating and managing an antimicrobial formulary

• Developing policies on antimicrobial procurement and quality

• Developing and updating antibiotic guidelines and protocols

• Developing policies (e.g., reserve antimicrobials, levels of prescribing, automatic stop orders, and AOFs)
to improve compliance with guidelines and protocols

• Evaluating antimicrobial use based on pre-established criteria of appropriateness and applying

remedial measures (DUE)

• Providing preservice and in-service education on rational use and AMR

• Liaising with the Infection Control Committee with regard to assessment and use of data obtained from
monitoring antimicrobial resistance

• Providing education to patients on the use and abuse of antimicrobials and encouraging adherence

• Supporting pharmacovigilance activities for antimicrobials

Drugs used to treat

S/N Drug Name Dose form Strength/Size Clinical use LO
U
1. ANAESTHETICS, PRE- & INTRA-OPERATIVE MEDICINES and MEDICAL
GASES
1.1. General Anaesthetics and Oxygen
1.1.1. Inhalational medicines
[Link]  Halothan  Inhalation  250m 
e al l
[Link]   Inhalation  
al
[Link]   Inhalation  
al
1 .1.1.4   Inhalation  
al
[Link]  Inhalation
al
[Link] Sevoflurane  Liquid 250ml  Use in
critically ill
geriatric and
paediatric
patients and
those with
cardiovascula
r disease
1.1.2. Injectable medicines
[Link]
[Link].
[Link].
[Link].
[Link].
[Link].
1.2. Local Anaesthetics
For spinal, epidural, caudal or IV regional anaesthesia, use preservative-free
injections
1.
1.
2. 2

3.
4.

1.3. Pre- and intra-operative merdication and sedation for short-term procedures