Health supply chain system in Uganda: assessment of status and of performance of health facilities

Abstract

Background Health supply chain systems are essential for effective and efficient healthcare system by ensuring availability of quality essential medicines and health supplies. While several interventions have been made to ensure the availability of quality essential medicines and health supplies, health facilities continue to report stockouts in Uganda. Objectives This study aimed to assess the status and performance of the supply chain system across all levels of care in health facilities in Uganda. Methods This was a cross-sectional study conducted in 128 public and private-not-for-profit health facilities across 48 districts in Uganda. These facilities included all levels of care from Health Centres II, III, IV, general and referral hospitals, and national referral hospitals. Data were collected using desk reviews, health facility surveys, and key informant interviews with key personnel. Stock registers were reviewed to assess the availability of a basket of essential medicines based on the essential medicines list of the Ministry of Health. Results Less than half (42%) of health facilities had computer hardware. Most (84%) of health facilities were using a form of Logistics Management Information System with only (6%) were using the Electronic Logistics Management Information System. Just under a third (33%) of health information officers and (51%) of public health officers’ positions were filled in the health facilities. Nearly (66%) of health facilities used supply chain data to support decision-making. Most (84%) of health facilities reported stockouts of Essential Medicines and Health Supplies in the past 6 months. The main reasons for stockouts were (59%) a sudden increase in demand (40%) delivery gaps/delayed deliveries and (35%) discrepancies in orders and deliveries. Health facilities responded to stockouts through various means including (75%) redistribution (43%) purchased from a distributor, and (30%) placing emergency orders. Conclusions The findings from this study show that the performance of health facilities in different supply chain processes and functions was defective. To improve the supply chain performance of health facilities, it is important to invest in infrastructure development, provide computer hardware and internet connection and strengthen the capacity key personnel. This is key for ensuring full functionality of the supply chain and availability of quality medicines and health supplies to the end-user.

Compliance of public health facilities with essential medicines and health supplies redistribution guidelines in Mbale district, Eastern Uganda: a mixed-methods study

“…Ordering of medicines follows a pull system at Hospitals and HCs level IV and a push or kit system at HCs level III and II [ 4 ]. The pull system requires each health facility to determine what and how much to order.…”

“…Higher level health facilities, HCs level IV and Hospitals order EMHS from the central medical store, NMS, every 2 months based on their allocated budgets. Lower level health facilities, HCs, level II and level III are allocated uniform kits per district [ 4 ]. Pharmaceutical kits contain selected EMHS in predetermined quantities for supply to lower level health facilities [ 5 , 6 ].…”

“…These EMHS are an integral part of health service delivery and should always be available if the Ministry of Health’s (MOH) targets for service delivery are to be met. However, many public health facilities in Uganda continue to report stockouts, expiries, and only about 40.6% achievement of set targets in managing endemic diseases, such as malaria [ 4 , 11 , 14 , 15 ]. The recent annual health sector performance report showed that only 43% of the health facilities had 95% availability of a basket of commodities over a 3-month period which is below the target of 75% of the facilities [ 11 ].…”

Compliance of Public Health Facilities with Essential Medicines and Health Supplies Redistribution Guidelines in Mbale District, Eastern Uganda: A mixed-methods study

“…Higher-level health facilities, HCs level IV and Hospitals order EMHS from the central medical store, NMS, every two months based on their allocated budgets. Lower-level health facilities, HCs, level II and level III are allocated uniform kits per district (4). Pharmaceutical kits contain selected EMHS in predetermined quantities for supply to lower-level health facilities (5,6).…”

“…These EMHS are an integral part of health service delivery and should always be available if the Ministry of Health's (MOH) targets for service delivery are to be met. However, many public health facilities in Uganda continue to report stockouts, expiries, and only about 40.6% achievement of set targets in managing endemic diseases such as malaria (4,11,14,15). The recent annual health sector performance report showed that only 43% of the health facilities had 95% availability of a basket of commodities over a three-month period which is below the target of 75% of the facilities (11).…”