Empirical Framework for Point-of-Care Diagnostics Supply Chain Management for Accessibility and Sustainability of Diagnostic Services in Ghana's Primary Health Care Clinics

Drain

et al. 2019

BMC Health Serv Res

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Background World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs). Methods We conducted a systematic scoping review using Arksey and O’Malley’s framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach. Results Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers’ responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%. Conclusions The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential. PROSPERO registration number CRD42016043711. Electronic supplementary material The online version of this article (10.1186/s12913-019-4351-3) contains supplementary material, which is available to authorized users.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review

Drain

et al. 2019

BMC Health Serv Res

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“…Despite the above-mentioned strengths of the study, the following limitations should be noted. Access to a referral health facility from a PHC clinic for ANC diagnostic services may also be determined by a complex interplay of a diverse set of factors such as the health system (supply chain management, availability, quality, and cost) and population (education, wealth, and culturally mediated perceptions) [28], [29], [30], [31]. Although, we assembled a comprehensive set of data describing the landscape, it is possible that we may not have captured all the local details such as the population of women at reproductive age, which in some cases may be relevant.…”

Section: Discussionmentioning

confidence: 99%

Geographical Accessibility to District Hospitals/Medical Laboratories for Comprehensive Antenatal Point-of-Care Diagnostic Services in the Upper East Region, Ghana

Adu²,

et al. 2019

EClinicalMedicine

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BackgroundAccess to referral healthcare facilities from primary healthcare (PHC) clinics for diagnostic services is critical for improving maternal health outcomes. We described the geographical distribution and accessibility to district hospitals/medical laboratories for comprehensive antenatal point-of-care (POC) diagnostic services in the Upper East region (UER), Ghana.MethodsWe assembled detailed spatial data on 100 participated PHC clinics in our previous survey, their nearest referral district hospitals/medical laboratories, and landscape features influencing journeys in the UER. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest referral health facility for antenatal POC diagnostic services. Spatial distribution of the facilities was determined using spatial auto-correlation tool run in ArcMap 10.4.1. We employed Stata V14 for all other analysis.FindingsOf the 100 PHC clinics included in the analysis, only 15% were located less than 10 km to their nearest referral health facilities. The mean distance ± standard deviation from a PHC clinic to the nearest referral district hospital/medical laboratory for comprehensive antenatal POC diagnostic services was 7.0 km ± 4.9. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest referral health facility for comprehensive antenatal POC diagnostic was 14.0 min ± 8.8. The spatial auto-correlation results for the PHC clinics suggested that the PHC clinics were spatially distributed at random rather than clustered (MI = 0.01, z-score = 0.33, p = 0.74). Whereas the spatial distribution of the referral health facilities suggested that the hospitals or medical laboratories were spatially dispersed (MI = − 0.69 z-score = − 2.05, p = 0.04).InterpretationAlthough there is moderate geographical accessibility to district hospitals/medical laboratories for comprehensive antenatal diagnostic services in the UER, targeted improvement of POC diagnostic services in PHC clinics is recommended for improved maternal healthcare.FundingUniversity of KwaZulu-Natal, College of Health Sciences Research Scholarship.

“…Furgerson et al study demonstrated having POC diagnostic tests closer to people streamlines critical care paths [ 29 ]. We further recommend the strengthening of supply chain management of these diagnostic devices to prevent stock-out and ensure the sustainability of HDP POC testing services in rural PHC clinics [ 16 , 32 ]. Subsequently, this could potentially lead to improved maternal and perinatal health outcomes, and reduce maternal mortality to less than 70 per 100,000 live births as stipulated by sustainable development goal 3.1 [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Geographical access to point-of-care testing for hypertensive disorders of pregnancy as an integral part of maternal healthcare in Ghana

Adu

BMC Pregnancy Childbirth

et al. 2020

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Background Hypertensive disorders of pregnancy (HDP) are associated with high maternal mortality in Ghana and globally. Evidence shows that there is poor availability of pregnancy-related point-of-care (POC) tests in Ghana’s primary healthcare (PHC) clinics (health centre or community-based health planning services facilities). Therefore, we employed geographic information systems to estimate the geographical distribution of and physical accessibility to HDP POC testing services in the Upper East Region (UER), Ghana. Methods We collected data on 100 out of 365 PHC clinics, public hospitals providing HDP testing, PHC clinic type, ownership, and availability of urine dipsticks and blood pressure (BP) devices. We also obtained the geo-located data of the PHC clinics and hospitals using the global positioning system. We employed ArcGIS 10.4 to measure the distance and travel time from the location of each PHC clinic without HDP POC testing services as well as from all locations of each district to the nearest hospital/clinic where the service is available. The travel time was estimated using an assumed motorised tricycle speed of 20 km/hour. We further calculated the spatial distribution of the hospitals/clinics providing HDP POC testing services using the spatial autocorrelation tool in ArcMap, and Stata version 14 for descriptive statistical analysis. Results Of the 100 participating PHC clinics, POC testing for HDP was available in 19% (14% health centres and 5% community-based health planning services compounds) in addition to the 10 hospitals use as referral points for the service. The findings indicated that the spatial pattern of the distribution of the health facilities providing HDP POC testing was random (z-score = -0.61; p = 0.54). About 17% of the PHC clinics without HDP POC testing service were located > 10 km to the nearest facility offering the service. The mean distance and travel time from PHC clinics without HDP POC testing to a health facility providing the service were 11.4 ± 9.9 km and 31.1 ± 29.2 min respectively. The results suggest that if every 19% of the 365 PHC clinics are offering HDP POC testing in addition to these 10 hospitals identified, then the estimated coverage (health facility-to-women in fertility age ratio) in the UER is 1: 3,869. Conclusions There is poor physical accessibility to HDP POC testing services from PHC clinics without HDP POC testing in the UER. Mothers who obtain maternal healthcare in about 17% of the PHC clinics travel long distances (> 10 km) to access the service when needed. Hence, there is a need to improve the availability of HDP POC diagnostic tests in Ghana’s rural clinics.