Resource Optimisation in Delivering Health Care: A Study on Minimising Risks in the Supply Chain of Health Commodities (original) (raw)

Background: Kenya’s Medical Supply Chain (MSC) has been described as suffering from a “multiplicity of parallel procurement systems, a complexity full of inefficiency and lack of clarity and synergy” [1]. The general objective of this study was to review the performance of the public MSC’s planning, budgeting, procurement and distribution of drugs and supplies (D&S) with a view to establishing strengths, weaknesses and opportunities in the system. Design: The study adopted a qualitative formative case study design. The study sought to explore all unknown variables that affect effective and efficient delivery of health commodities against need based on epidemiological and other relevant data in Kajiado. The investigation involved collection of primary data through interviews as well as review of secondary data. Data collection sources were then triangulated to form findings on common themes. Results: A total of 80 respondents, 69 (86%) from 14 health facilities in Kajiado and 11 (14%) national level Ministry and Kenya Medical Supplies Agency (KEMSA) staff and Development Partners were interviewed for the study. The study illustrated that at the County level, the available MSC-related resources are not sufficient and/or consistently supplied and neither is resource allocation guided by demographic and epidemiological profiling. Moreover, the existing personnel are not sufficient or adequately trained in the areas of governance and management, key to maximising D&S resources. Lack of stewardship of the MSC in Kenya is the key deterrent to an efficient and effective system. Inefficient parallel MSC systems have also created what one respondent described as a circus of a system. Government officials reported that not enough was being done by the relevant authorities to streamline the systems. Recommendations: To enhance delivery of D&S, the Government should lead, and engage stakeholders, in implementing governance reforms that address the (1) the health policy framework through integration and regulation of the parallel supply chain systems at national and County levels; at County level, there is an urgent need to train health officials if they are expected to maximise the resources allocated to them, (2) with the MSC human resource (HR), a paradigm shift in work allocation should be considered to have more administrators, qualified and continuously trained in supply chain issues, (3) MSC processes and operations could be improved through cross-linkages of the Health Management Information System (HMIS) and a Logistics Management Information System (LMIS) that would allow automated access, analysis and monitoring of demographic, epidemiological and economic data to enhance information used for decision making in costing resource allocation; the health Ministries and KEMSA should also institute accountability mechanisms that facilitate customer responsiveness and (4) rational drug use could be improved through sensitisation targeting both medical practitioners and patients to maximise on the resources provided.