A public-health approach to site-specific formulary management: addressing deficient drug supplies in Malawi† (original) (raw)
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The Queen Elizabeth Central Hospital drug supply costs constitutes a large portion of the hospital expenses, consuming over 50% of the total annual budget for the past 4 years. Despite huge budgetary allocations, drugs are often out of stock when they are needed. Robust drug inventory management would provide an opportunity to improve the availability of drugs at a reduced cost by balancing the inventory needs at each time period and the requirements. The purpose of the study was to explore strategies of eliminating drug inventory management problems in order to optimize inventory stock through the use of modern management tools such as ABC and VEN1 Analyses. Therefore, the study focused on evaluation of the accuracy of record keeping and drug stock monitoring practices at the hospital pharmacy. This was an Intervention study design with the aim of determining drug inventory management at the hospital warehouse pharmacy using secondary data, documentation reviews and stakeholders focus group discussion. To achieve this, the Researcher conducted a pre-test study to determine the system strengths and weaknesses and then feasible solutions or interventions were formulated to improve it. Using inventory management indicators, this study was able to determine the impact of the interventions employed. Results of the study using the ABC-VEN analyses indicated that none of the low priority drugs were amongst relatively high expenditure drug group to necessitate the removal of non-essential drugs from the list and opt for more cost effective alternative medicine. As for the assessment of the effectiveness of the record keeping, the study revealed that the system is not close to the ideal situation of achieving 100% accurate records as it was still pegged at 52% even after the implementation of key interventions. However, there is room for improvement in terms of drug stock levels, since the pharmacy warehouse has the capacity to maintain a range of products in stock. This was evidenced by registering a slight increase in the proportion of medical products availability from 88% to 92% despite persistent stock outs of a few drugs for an average of 15 days during Pre-intervention phase and 23 days for post –intervention phase within the assessment period. Recommendations of the study include classifying each medication item into A, B, or C categories, conducting physical inventory more frequently, setting up maximum and minimum stock levels, and determining an Average Monthly Consumption of each medication. The findings of this study can assist to illustrate that the elimination of drug inventory management practices can help health facilities to effectively manage the supply chain pipeline.
2015
BACKGROUND: Essential drugs are important for quality service delivery in the healthcare system. Proper inventory management of essential drugs in the health facilities is critical in ensuring availability of essential drugs (ED). Despite the importance of the required essential drugs at various user points, about one third of the world's population does not have access to ED. This is a serious problem considering that drugs take up a significant portion of the healthcare budget and availability of ED is critical in quality healthcare provision which is a priority of the Health Systems.
Availability of Essential Medicines in Malawi's Public Health Facilities: Enablers and Barriers
2020
Essential medicines can save lives and improve quality of life. However, shortage of essential medicines has emerged as a major health system challenge in Malawi and other developing countries. Essential medicines are not available to one-third of the world's population and half of people living in the poorest countries of Africa and Asia (WHO 2014). Shortage of essential medicines limits healthcare provider's ability to treat patients and manage disease conditions; this has huge implications for countries' health systems. Previous studies have demonstrated that shortage of some essential medicines is a chronic issue in Malawi, however, there are few studies on factors that contribute to the availability or shortage of essential medicines in Malawi's public health facilities. This research explores the issue of shortages in Malawi's public health facilities using an exploratory sequential mixed methods design. Using a quantitative approach, this study sought to d...
To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation. Quantitative survey, interviewer reported Key obstacles reported by CHWs to obtaining CCM supplies % CHWs reporting each type of obstacle (coded from open-ended and multiple responses) Quantitative survey, CHW interview * CHWs = community health workers; CCM = community case management; ORS = oral rehydration salts; AL = artemether/lumefantrine. The Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project collects other key indicators, such as training on reporting and storage that are not highlighted in this report.
His research interest is in the area of integrating developing countries into the global public procurement framework. Kambaza Stephen Faculty of education is a lecturer in Kyambogo University in the Fcaulity of Psychology(psychometry) His interests are Psychometric assessment: Values, beliefs, attitude measurement, Influence of values and beliefs on life perceptions and orientation, Development of materialism, consumer psychology. ABSTRACT. Recent empirical studies point to structural supply chain constraints in the supply of essential drugs in developing countries, hence calling for interventions and policy direction. Despite Uganda's commitment to improve drug access and availability, actual realization remains low and structural bottlenecks in the chain have not been identified and documented. A cross sectional survey was conducted on 240 respondents in four malaria prone districts. Structural bottlenecks at each stage of the supply chain have been systematically identified and documented as a starting point. Findings indicated hospitals were mainly affected by lack of credible and accessible drug consumption information, poor planning, forecasting and logistics. Health centre IVs mainly faced inadequate procurement skills and consumption information. Health centre IIIs encountered poor procurement practices and logistics. Health centre IIs faced poor procurement practices, collaborative linkages and logistics. These findings add to the literature of the increasingly complex drugs supply chains in developing countries. The paper concluded that access and availability of essential drugs remains sub-optimal. Recommendations are drawn towards policy interventions aimed at strengthening programmes at local governments, investing resources in collaborative services, training staff in procurement best practices, and logistical management.
Integrated Pharmacy Research and Practice
Maternal, newborn, and child health is a global priority, while most countries in sub-Saharan Africa have a poor implementation of maternal, newborn, and child health programs. Objective: To assess inventory management practice and associated challenges of maternal, newborn, and child health life-saving drugs in public hospitals of Jimma zone and Jimma city. Methods: Hospital-based mixed-method cross-sectional study was conducted from October 1 to 30, 2020. The quantitative data was collected using physical inventory and document reviews. Thus, seventy-eight bin cards and annual report and resupply forms were reviewed, and the collected data was analyzed using SPSS |Version 24| software. Statistical significance was determined at p < 0.05. Twelve semi-structured in-depth interviews were conducted to collect qualitative data and analysed manually using a thematic analysis technique. Results: About half of the evaluated drugs experienced 22 stock-outs per year with a stock-out rate and mean stock-out duration of 83.3% and 1.69 months, respectively. All hospitals placed at least one emergency order. The wastage rate of products was 13.1%. The data quality of report and resupply forms such as the average data accuracy of 396 (84.61%) had a significant association with the increasing level of education, X 2 (16, N = 13) = 297.7, p = 0.019. Thirty-five (97.22%) reports and resupply forms were complete, while 24 (66.67%) of them were submitted to suppliers as per the predetermined timeline with an annual reporting rate of 94.44%. Conclusion: Data quality of bin card records was more promising than report and resupply form reports. All hospitals encountered at least one stock-out and one emergency order per year. The wastage rate was twice more than the national normal. Storage management, human asset, and capacity building challenges were identified as inventory management challenges.
Research in Social and Administrative Pharmacy, 2019
Shortages of medicines is a global problem that can have significant impact on health outcomes of patients and reduce the effectiveness of public health programmes. There are a multitude of reasons for medicines shortages occurring, however, and it is important for specific country settings to better understand the issues affecting medicines supply in order to effectively intervene. Namibia relies heavily on imports of medicines as it does not have an adequate pharmaceutical industry sector developed enough to produce sufficient medicines for the burden of disease arising. In addition, because there is no unifying system of medicines monitoring it is difficult to plan interventions to resolve common medicines shortages. This study reports the findings from a pilot survey that was undertaken to improve the information monitoring of medicines shortages in Namibia. The survey sought information from medicines suppliers from various pharmacy sectors who may provide a vital insight into how medicines shortages should be monitored and the causes of shortages observed in Namibia. A more robust survey as part of a broader system can be informed by this survey to address the shortage of medicines in Namibia and surrounding region.
BMC Health Services Research
Background: Retail drug shops play a significant role in managing pediatric fevers in rural areas in Uganda. Targeted interventions to improve drug seller practices require understanding of the retail drug shop market and motivations that influence practices. This study aimed at describing the operational environment in relation to the Uganda National Drug Authority guidelines for setup of drug shops; characteristics, and dispensing practices of private retail drug shops in managing febrile conditions among under-five children in rural western Uganda. Methods: Cross sectional survey of 74 registered drug shops, observation checklist, and 428 exit interviews using a semi-structured questionnaire with care-seekers of children under five years of age, who sought care at drug shops during the survey period. The survey was conducted in Mbarara and Bushenyi districts, South Western Uganda, in May 2013. Results: Up to 90 and 79% of surveyed drug shops in Mbarara and Bushenyi, largely operate in premises that meet National Drug Authority requirements for operational suitability and ensuring medicines safety and quality. Drug shop attendants had some health or medical related training with 60% in Mbarara and 59% in Bushenyi being nurses or midwives. The rest were clinical officers, pharmacists. The most commonly stocked medicines at drug shops were Paracetamol, Quinine, Cough syrup, ORS/Zinc, Amoxicillin syrup, Septrin® syrup, Artemisinin-based combination therapies, and multivitamins, among others. Decisions on what medicines to stock were influenced by among others: recommended medicines from Ministry of Health, consumer demand, most profitable medicines, and seasonal disease patterns. Dispensing decisions were influenced by: prescriptions presented by client, patients' finances, and patient preferences, among others. Most drug shops surveyed had clinical guidelines, iCCM guidelines, malaria and diarrhea treatment algorithms and charts as recommended by the Ministry of Health. Some drug shops offered additional services such as immunization and sold non-medical goods, as a mechanism for diversification. Conclusion: Most drug shops premises adhered to the recommended guidelines. Market factors, including client demand and preferences, pricing and profitability, and seasonality largely influenced dispensing and stocking practices. Improving retail drug shop practices and quality of services, requires designing and implementing both supply-side and demand side strategies.
Missing Medicines in Malawi: Campaigning against stock-outs of essential drugs
2012
Malawi is one of the poorest countries in the world. The government has introduced some measures to improve the health of its people, but a number of major problems remain. One of these is the lack of essential medicines in government health clinics – known as ‘stock-outs’. These medicines should be free to poor people, but most find that they have to pay. This case study – one of a series of Programme Insights on Local Governance and Community Action – looks at an innovative campaign which aimed to tackle this problem by enhancing the capacity of local communities and civil society organizations to demand the right to access these medicines. The campaign lobbied for a commitment to increased availability and accessibility in rural areas and carried out budget and resource tracking. The case study looks at the difficulties the campaign faced and outlines the factors that contributed to its success.