Assessment of Factors Contributing to Medicine Expiry in Rwanda: Case of the Medical Procurement and Production Division

BackgroundRegardless of the significant efforts used and put in place to enhance supply chain performance in Rwanda, there is still poor inventory management and big loss due to expiry of medicines at Medical Procurement and Production Division (MPPD).ObjectiveTo assess the factors that contributes to expiry of medicines at MPPD and formulate recommendations for the improvement of the current situation.MethodsThis is a descriptive cross-sectional study used for 25 respondents. A questionnaire containing closed-ended questions was used focusing on factors contributing to expiries of medicines for each product category managed by MPPD from 2014-2018. Additionally, the researcher reviewed all inventory reports, including expiries for the same period under study. The study focused on targeting respondents working at MPPD as pharmacists both technical and administrative, also other non-pharmacist working in the warehouse were considered as respondents. The hard copy of questionnaire was handed over to 26 respondents and requested to provide filled questionnaire within seven days. Twenty-five respondents were able to return the filled questionnaire on time, giving 96% response rate.ResultsThe study found that in MPPD, medicines are still expiring. During five years (from 2014 up to 2018) the total expired products were valued at RWF 6,046,778,655 for all program categories: HIV commodities had the largest share 53.3%, Essential Medicines 22.5%, Malaria 13%, Maternal Child Health commodities 5.7%, Products used for Community health workers 4.5%, TB products 1% and 0.1% for Family Planning products. The study found that major contributing factors for expiry of health commodities at MPPD, are ranked as follows: Supply chain management 90%, other factors 73%, Poor storage management 68% and Excessive drug supply 67%. ConclusionConsidering the study results, it looks like no significant effect of excessive drug supply and inventory management on the expiration of medicines at MPPD. However, the Supply Chain Management components are the most vulnerable to contribute to the expiration of medicines at MPPD. There are many changes to be done inside the institution to remedy the issue of expiration like working according to the standard operating procedures, improving the Skills of personnel in supply chain management, empowering the procurement unit with skilled personnel and improving the communication with stakeholders to facilitate the smooth and quick replenishment and distribution of the stock. Rwanda J Med Health Sci 2021;4(2): 281-291

The use of Public-Private Partnerships in Health Supply Chain Management in Rwanda

BackgroundThe Government of Rwanda considers the private sector to play an important role in supporting provision of strategic national investments through Public-Private Partnerships (PPPs).ObjectiveThis study aims to describe the various aspects of PPPs in Health Supply Chain Management (HSCM) in Rwanda.MethodsA questionnaire was used to collect data from health professionals and individuals familiar with HSCM Public-Private Partnerships for this descriptive, cross-sectional and quantitative study.ResultsThe PPP interventional areas used in HSCM in Rwanda were namely supply of commodities (99%), delivered health Information Technology (IT) supplies and equipment (operate) (53%), finance (52%), and maintenance area (40%). The main challenges were limited conversation and absence of formal platforms for public and private engagement (83.7%) and complex procurement requirements for medical products and equipment by public institutions (73.3%). The strategies to improve the PPPs in HSCM were effective coordination of PPPs (93.3%) and improved dialogue and formal platforms (90.6%)ConclusionThese findings indicated that private sector through PPPs plays an important role in HSCM in Rwanda. The engagement of the private sector can increase the financial support in terms of financing HSCM activities like supply of health commodities and equipment. Rwanda J Med Health Sci 2021;4(2): 237-256

Effective Demand Forecasting in Health Supply Chains: Emerging Trend, Enablers, and Blockers

Health supply chains aim to improve access to healthcare, and this can be attained only when health commodities appropriate to the health needs of the global population are developed, manufactured, and made available when and where needed. The weak links in the health supply chains are hindering the access of essential healthcare resulting in inefficient use of scarce resources and loss of lives. A chain is only as strong as its weakest link, and demand forecasting is one of the weakest links of health supply chains. Also, many of the existing bottlenecks in supply chains and health systems impede the accurate forecasting of demand, and without the ability to forecast demand with certainty, the stakeholders cannot plan and make commitments for the future. Forecasts are an important feeder for budgeting and logistics planning. Under this backdrop, the study examines how improved forecasting can lead to better short-term and long-term access to health commodities and outlines market-related risks. It explores further how incentives are misaligned creating an uneven distribution of risks, leading to the inability to match demand and supply. For this purpose, a systematic literature review was performed, analyzing 71 articles from a descriptive and content approach. Findings indicate the emerging trends in global health and the consequences of inaccurate demand forecasting for health supply chains. The content analysis identifies key factors that can pose a varying degree of risks for the health supply chain stakeholders. The study highlights how the key factors emerge as enablers and blockers, depending on the impact on the overall health supply chains. The study also provides recommendations for actions for reducing these risks. Consequently, limitations of this work are presented, and opportunities are identified for future lines of research. Finally, the conclusion confirms that by adopting a combination of approaches, stakeholders can ensure better information sharing, identify avenues of diversifying risks, and understand the implications.

Drug supply shortage in Nigeria during COVID-19: efforts and challenges

The COVID-19 pandemic has resulted in massive disruptions in global supply chains. Nigeria is particularly vulnerable with respect to pharmaceuticals since there is reduced local production and about 70% of the drug supply is imported creating a huge supply–demand disparity particularly in times like COVID-19. Nigeria is in need of huge quantities of quality-assured health commodities to effectively respond to the pandemic. Significant shortages of other essential medicines and medical products across the country could be imminent. Drug scarcity in Nigeria during the COVID-19 pandemic period is because of several accumulated factors, majorly as a result of global lockdown, decreased manufacturing, unaddressed regulatory affairs, poor access to resources by the population, lack of buffer stocks, security instability, and poor funding of the healthcare system. This situation if left unattended, could cause serious drawbacks to the health of the populace as well as the quality of life of Nigerians amid the COVID-19 Pandemic. Appropriate measures should be directed to ensure ethical processes on drug production, importation, pricing, and distribution to avoid such events during unavoidable scenarios, like the COVID-19 pandemic and other public health emergencies.

Drug supply situation in Rwanda during COVID-19: issues, efforts and challenges

COVID-19 is a threat to health systems around the world and Rwanda is not an exception. The impact of the pandemic is far-reaching and access to health commodities is not spared. Proper drug supply is critical for a robust healthcare system. It determines the extent at which the population are likely to have access to essential medicines and treatments. In Rwanda, the pharmaceutical sector heavily relies on imports. With the emergence of COVID-19 pandemic, the drug supply system was interrupted leaving many stores from small local pharmacies to the big medical stores running out of stock. The reasons were limited importation of goods from abroad, and the panic buying practice among the customers and some institutions when responding to the pandemic. Drug and medicines accessibility, availability and affordability should be the core of any drug management policy. It is with no doubt that, Rwanda has made a tremendous work to mitigate the effect of COVID-19 on the country’s drug supply; however, efforts are still needed to invest in local pharmaceutical production as a way to minimize import expenses in the country. Good policy on drug importation, production and distribution should be enforced to avoid any drug shortage that may be encountered in the Rwandan drug market.

Access to oxytocin and misoprostol for management of postpartum haemorrhage in Kenya, Uganda and Zambia: a cross-sectional assessment of availability, prices and affordability

ObjectiveTo assess access (availability and affordability) to oxytocin and misoprostol at health facilities in Kenya, Uganda and Zambia to improve prevention and management of postpartum haemorrhage (PPH).DesignThe assessment was undertaken using data from Health Action International (HAI) research on sexual and reproductive health commodities based on a cross-sectional design adapted from the standardised WHO/HAI methodology.SettingData were collected from 376 health facilities in in Kenya, Uganda and Zambia in July and August 2017.Outcome measuresAvailability was calculated as mean percentage of sampled medicine outlets where medicine was found on the day of data collection. Medicine prices were compared with international reference prices (IRP) and expressed as median price ratios. Affordability was calculated using number of days required to pay for a standard treatment based on the daily income of the lowest paid government worker.ResultsAvailability of either oxytocin or misoprostol at health facilities was high; 81% in Kenya, 82% in Uganda and 76% in Zambia. Oxytocin was more available than misoprostol, and it was most available in the public sector in the three countries. Availability of misoprostol was highest in the public sector in Uganda (88%). Oxytocin and misoprostol were purchased by patients at prices above IRP, but both medicines cost less than a day’s wages and were therefore affordable. Availability of misoprostol was poor in rural settings where it would be more preferred due to lack of trained personnel and cold storage facilities required for oxytocin.ConclusionAvailability and affordability of either oxytocin or misoprostol at health facilities met the WHO benchmark of 80%. However, countries with limited resources should explore mechanisms to optimise management of PPH by improving access to misoprostol especially in rural areas.

Transformation of the Tanzania medical store department through global fund support: an impact assessment study

BackgroundThe Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria to reform its Medical Stores Department, with the aim of improving performance. The study sought to assess the impact of the reforms and document the lessons learnt.MethodsQuantitative and qualitative research methods were applied to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. Interrupted time series analysis was used to determine the change in average availability of essential health commodities at health zones. Qualitative data were collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques and responses were analysed through thematic content analysis.ResultsAvailability of essential health commodities increased significantly by 12.6% (95% CI 9.6% to 15.6%) after the reforms and continued to increase on a monthly basis by 0.2% (95%CI 0.0% to 0.3%) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/2015 and 2017/2018. Surplus income increased by 56.4% between 2014/2015 and 2017/2018 with reductions in rent and fuel expenditure. There was consensus among study participants that the reforms were instrumental in improving performance of the Medical Stores Department.ConclusionPositive results were realised through the reforms. However, despite the progress, there were risks such as the increasing government receivable that could jeopardise the sustainability of the gains. Therefore, multistakeholder efforts are necessary to make progress and expand public health.

Towards effective inventory management of health commodities at service delivery points: A case of health personnel in Shamva District, Zimbabwe.

Despite much effort at improving availability of health commodities, stock-outs and expiries are still commonplace at service delivery centres. The success of any inventory management programme relies on the people undertaking it and there seems to be a missing link in the supply chain that could be related to the people tasked with inventory management at service delivery points. The study thus sought to assess whether the personnel’s knowledge, attitude, perceptions and practices are the missing link resulting in stock-outs and expires. The study employed a mixed method approach wherein quantitative and qualitative data collection methods were employed. The data collected sought to explore various aspects of the personnel including the training facility regarding inventory management, personal attitudes and, perceptions and practices towards certain inventory management aspects. Clearly it was found that personnel knowledge levels were very low, attitudes and perceptions veer in the negative whilst practices are not up to standard. This correlated to the availability of drugs and commodities at service delivery points.