challenges facing inventory management of essential medicines in chunya - district

8/12/2019 challenges facing inventory management of essential medicines in Chunya - District

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CERTIFICATION The below undersigned certify that, he read and hereby recommend for examination of

project paper entitled Challenges facing inventory management of essential

medicines in Chunya District in partial fulfilment of the requirements for the award

Post Graduate Diploma in Procurement and Logistic management

_____________________________________

Mr. Swallo C.G(Supervisor)

Date: _________________________________


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CERTIFICATION

The below undersigned certify that, he read and hereby recommend for examination of

project paper entitled Challenges facing inventory management of essential

medicines in Chunya district in partial fulfilment of the requirements for the

Postgraduate Diploma of Procurement of Logistics management

_____________________________________

Mr. Swallo C.G.(Supervisor)

Date: _________________________________


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DECLARATIONAND

COPYRIGHT

I, Kabandika Twaha declare that this Project report is my original work and that it has

not been presented and will not be presented to any other university for a similar or anydegree award.

Signature: ..................................................... . Date: .............................................

This dissertation is a copyright material protected under the Berne Convention, the

Copyright Act 1999 and other international and national enactments, in that behalf, on

intellectual property. It may not be reproduced by any means, in full or in part, except

for short extracts in fair dealing, for research or private study, critical scholarly review

or discourse with an acknowledgement, without the written permission of the

Directorate of Postgraduate Studies, on behalf of both the authors and the Tanzania

Institute of Accountancy.


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ACKNOWLEDGEMENT

My special thanks and appreciation to Mr. Swallo C. G. as my supervisors for hisdedication and tireless guidance provided throughout the time to complete this project.

I wish to thanks, the course facilitators at Mbeya campus for their support and

organization throughout the course.

Also my thanks must go to the Executive Director of Chunya District for the

encouragement and permission to pursue my course.

I wish to thank the following for their valuable support and efforts provide to me,

District Medical Officer for granting permission to collect data from respective survey

setting.

I would like to acknowledge the Medical Officers In charges (MOI)/ Facility In charges

for providing relevant information/data from their respective working station (survey

setting).

I am grateful too for the support and input from all members/colleagues who made mycourse successful through their contribution and good cooperation throughout the

course.


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DEDICATION

To my lovely wife Nasra Twaha and my daughter Fatma Twaha.


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Table of Contents

CERTIFICATION .............................................................................................................. i

DECLARATION ............................................................................................................. iii

ACKNOWLEDGEMENT ................................................................................................ iv

DEDICATION ................................................................................................................... v

ABSTRACT ...................................................................................................................... vi

List of figures ..................................................................................................................... x

List of tables ....................................................................................................................... x

List of Abbreviations....................................................................................................... xii

CHAPTER ONE: INTRODUCTION ............................................................................ 1

1.2. Problem Statement .................................................................................................. 5

1.3. Research Questions ................................................................................................. 6

1.3.1 General Research Question ................................................................................... 6

1.3.2 Specific Research Question................................................................................... 6

1.4.0 Research Objectives ............................................................................................ 7

1.4.1 General Research Objective .................................................................................. 7

1.4.2 Specific Research Objectives ................................................................................ 7

1.5 Rationale of the Study .............................................................................................. 8

1.6 Limitations of the Study ........................................................................................... 9

CHAPTER TWO: LITERATURE REVIEW .................................................................. 10

CHAPTER THREE: METHODOLOGY ........................................................................ 13

3.0. Methods and materials .......................................................................................... 13

3.1. Overview of Study area ......................................................................................... 13

3.1.2. Selection criteria................................................................................................. 13


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3.1.3. Inclusion and Exclusion criteria ......................................................................... 14

3.2. Methodology ......................................................................................................... 14

3.2.1. Study Design .................................................................................................. 14

3.2.2. Survey setting ................................................................................................. 15

3.2.3. Survey period and duration ............................................................................ 15

3.2.4. Survey areas ................................................................................................... 15

3.2.5. Selecting the sample size ............................................................................... 15

3.3. Data collection .................................................................................................. 15

3.4. Study variables .................................................................................................. 15

3.5. Data management and analysis ............................................................................. 16

3.6. Study limitation ..................................................................................................... 16

3.7. Ethical consideration ............................................................................................. 17

CHAPTER FOUR: RESULTS ........................................................................................ 18

4.1. Age and sex distribution among Participants ........................................................ 18 4.2. Professional level among the study participants ................................................... 18

4.3. Knowledge on inventory management of essential medicines ............................. 20

4.4. Storage conditions of essential medicine .............................................................. 22

4.5. Problem encountered during ordering processing ................................................ 23

4.6. Reported stock out of essential medicines ............................................................ 24

4.7. Challenges on proper management of health commodities .................................. 25

4.8. Recommendation on essential medicine availability and control ......................... 25

CHAPTER FIVE: DISCUSSION .................................................................................... 27

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS ................................. 31

Conclusion ................................................................................................................... 31


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Recommendations ........................................................................................................ 32

CHAPTER SEVEN: REFERENCES .............................................................................. 33

APPENDICES ............................................................................................................. 36

APPENDIX I: Questionnaire: ...................................................................................... 36

APPENDIX II: Informed consent agreement .............................................................. 40


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List of figuresFigure 1: MAP OF CHUNYA ......................................................................................... 14

Figure 2: Knowledge level on inventory management of essential medicines. ............... 21

Figure 3: Storage Condition level among the Surveyed health facilities ......................... 23

List of tablesTable 4.1 Age and sex distribution among participants ................................................ 18


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Table 4.2 Professional level among the study participants ............................................. 19

Table 4.3.1 Respondent on inventory control .................................................................. 20

Table 4.3.2 Awareness on variables used during ordering .............................................. 21

Table 4.4 Storage conditions standards at the facilities surveyed ................................... 22

Table 4.5 Reported problems encountered during preparation and sending an order of

the essential medicines ..................................................................................................... 24

Table 4.6 Reported reasons for out of stock for essential medicines ............................... 25

Table 4.7 Reported challenges on proper management of health commodities .............. 25


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List of AbbreviationsAMO : Assistant Medical Offices

CO : Clinical Officer

DMO : District Medical Officer

EDP : Essential Drug Program

EML : Essential Medicine List

FEFO : First Expire First Out

FIFO : First in First Out

HC : Health Center

LMIS : Logistic Management Information System

MOHSW : Ministry of Health and Social Welfare

MOI : Medical Officer In charge

MSD : Medical Store Department

MSH : Management Science for Health

NHIF : National Health Insurance Fund

PV : Prime Vendor

RA : Researcher AssistancesR & R forms : Report and Request Forms

SOP : Standard Operating Procedure

STG : Standard Treatment Guideline

VMI : Vendor Managed Inventory


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CHAPTER ONE: INTRODUCTION

Inventory management is the heart of the drug supply system; it involves

ordering, receiving, storing, issuing and then reordering a limited list of items.

In reality, the task is difficult, and in many countries like Tanzania, poor

inventory management in the public drug supply system lead to waste of

financial resources, shortage of essential and vital medicines ( MSH, 2000).

These eventually reduce the quality of patients care services. Inventory

management involves more than just purchasing supplies; it also involves

handling, storing, moving, and restocking those supplies. Thus, inventory

management is an important area for health facilities to consider during

provision of services.

Essential medicines are those that satisfy the health care needs of the population

and are intended to be available within the context of a functioning health

system at all times in adequate amount, in the appropriate dosage form, and at

the price the community can afford (WHO 1997).

Its not uncommon to find that public health facilities from dispensaries to

Consultant hospitals lack vital medicines and the situation is very serious in

district and lower level heath facilities such as dispensaries and health centers,

this condition leads to loss of confidence to the public health facilities by the

public, (Battersbery et al, 2003).

In early 1970s, Tanzania had scarcity of health professions especiallypharmaceutical personnel, in order ensure that pharmaceutical services are

provided uninterruptedly, medicines were handled by non-pharmaceutical

personnels , (Pharmacy board,1978). Due to poor knowledge, improper

documentation, it was not possible to exactly quantify the medicines


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consumption of the health facilities; the forecasting of medicines was not

possible. Due to this, the country opted to adopt the EDP kit system (Bhattari,

2004), in this system, the quantification of medicines consumption for all

facilities in the country was done centrally through MSD and the medicines

were distributed to the facilities quarterly. However, a number of facilities

received medicines which were not demanded by the catchment population

because the order was not initiated by the facilities, medicines ended up with

expiring and prolonged out of stocks of essential medicines. Therefore, these

were the unnecessary costs that government was incurring simply because ofpoor medicine inventory management

The EDP Kit system was used by health facilities and dispensaries until early

2000s; currently the Integrated Logistic system (Indent system) is used whereby

each facility initiates its own according to the actual consumption with regard to

the diseases prevailing in the catchment areas.

Unlike lower health facilities, hospitals had to adopt a separate system of

medicines supply as population and the number of pharmaceutical personnel

increased. At the end of each financial year, prior to budgeting all government

hospitals including district hospitals are required to budget for their annual

medicines consumption and expenditure. This quantification is usually done by

adopting one or combination of the following methods: consumption method,

morbidity method, adjusted consumption method and service level projection ofbudget requirements; this can be manually or computerized (MSH, 2007). These

involves estimating the quantities of essential medicines for procurement, it also

estimates financial requirements to purchase the medicines, the complete order


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is finally handled to MOHSW for further financial processes and deliveries

through MSD, funding and deliveries is normally done on quarterly basis.

Accurate and stock records are source of information used to calculate needs

and inaccurate records produce inaccurate need estimation and this causes stock

out and expiry. Each inventory system should monitor performance with

indicators and produce regular reports on inventory and order status, operating

costs and consumption patterns.

Poor medicines stock management can lead to irrational medicine use, when no

overview exists of the available medicines in stock. The good inventory control

makes ordering and medicines management easier, essential medicines

programs place a high priority on improving inventory control to ensure a

reliable supply of essential medicines, vaccines, and other items at health

facilities (MSH, 1997). To achieve this aim, staff need to be trained in inventory

control, storage and ordering procedure. The choice of appropriate inventorycontrol method varies according to the types of facility, scale of operations as

well as staff capabilities

The stock record and reports form the foundation of effective inventory

management. Stock records are core records in inventory management system,

they are the primary source of information used in the various reordering

formulas and they are also the source of data used to compile the reports. Thestock records can be either manual or computerized, commonly used manual

records include ledger system, and bin card.


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Additionally, recently MSD introduce direct delivery system to the health

facilities (dispensaries) to reduce some of problems incurred before such as

reducing lead time. However currently there are still stock outs in the health

facilities as well as huge stocks of expired medicines. However, there is no much

studies which has been recently done to explain what are real challenges facing

the inventory control despite of long outstanding stock outs of medicines and

poor quality of pharmaceutical services provided by lower level public health

facilities such as Dispensaries and Health centers

The information obtained from this study will be used to devise appropriate

strategies for improvement of inventory management of essential medicines and

quality of services at the lower level of public health facilities.


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1.3. Research Questions

1.3.1 General Research QuestionWhat are the challenges facing inventory management of essential medicines at

the Public health facilities in Chunya distict council?

1.3.2 Specific Research Question

1. Do the health facilities have staff of required knowledge to handle

medicines inventory?

2. What do HCP knows and practice regarding inventory management of

essential medicines?

3. What are factors contribute to poor inventory management essential

medicines?


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1.4.0 Research Objectives

1.4.1 General Research ObjectiveTo assess challenges facing inventory management of essential medicines in

Chunya district Mbeya region.

1.4.2 Specific Research Objectives

1. To explore the level of staff who are responsible to handle medicine inventory in

the lower level public health facilities.

2. To assess knowledge, practical competence and reported practice regarding

inventory management of essential medicines among health care provider (HCP)

in Chunya district

3. To assess factors contribute to the poor inventory management of essential

medicines


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1.5 Rationale of the Study

Effective inventory management is very important in the supply system of

essential medicines because it is the source of information used to calculate and

forecasting the medicines needs and safe storage , It provides the basis of

trading off between the level of inventory to be kept and the required service

level at optimal operating cost.

It is expected that these findings can be utilized in many ways in providing

better solutions of inventory management for essential medicines, hence,

improving availability of essential medicine at the lower level public health

facilities in Chunya District. Also policy-makers and health managers that are

involved in planning training activities will help to address these challenges of

inventory management, and thus ensuring constant availability of these

important and life-saving medicines and properly manage.


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1.6 Limitations of the Study

Private health facilities were excluded from the survey due to financial and time

constraints. Additionally, it was not easy to access some of the information,

since other participants perceived the study as inspection and therefore did not

provide full participations


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CHAPTER TWO: LITERATURE REVIEWPharmaceutical inventory management is the set of practices aimed at ensuring the

timely availability and appropriate use of safe, effective, quality medicines and related

products and services in any health care setting. It has four components that for a cycle,

namely selection, procurement, distribution and its to use to the patients (MSH/WHO,

1997).

Medicines inventory management depend largely on LMIS tools such as Ledger books,

bin cards, EMLs and STGs, however their availability and utilization in health facilities

was found to be 38%, and 52% respectively, various reasons were given for this poor

adherence to the LMIS tools ( MOHSW, 2008). Additionally, it was reported that 33%

of the facilities had registered personnel to handle the essential medicines. (MOHSW

2008).

Some of the studies show some variations in the pattern of availability of individual

medicines, low quality of services, and poor inventory management of essential

medicines. In a study conducted by John Snow Inc. (JSI) showed that there were stockouts of antiretroviral drugs especially in those health facilities that depended on Medical

Stores Department (MSD) zonal centers for their supply (JSI/Delivery, 2003).

Medicines efficacy can be impaired when poorly stored; normally there are specific

conditions which are recommended by manufactures in which each drug should be

stored as to maintain its efficacy. Poorly stored medicines cannot give the desired

results, however it common to find medicines stored contrally to manufacturerscondition. In study conducted in Dar es salaam city it showed that , 36% of the health

facilities were found to stock medicines not stick on to manufactures recommendations

(Silumbe, 2011).


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Inventory control is the process of managing inventory in order to meet customer

demand at the lowest possible cost and with a minimum investment (Blackburn J, 2010).

Several objectives in inventory control such as minimize inventory investment;

determine the appropriate of customer service level; balance supply and demand;

minimize ordering cost and holding cost; also preservation of inventory control system.

Some of various inventory control model are Economic Order Quantity (EOQ) safety

stock and Replenishment. In order to reduce cost and improve service level, hospital is

considered to implement various innovative supply chain strategies. Based on the

literature, the standard or conventional supply chain was replaced by a number ofinitiatives that have been undertaken such as just-in time (JIT) (Garry J, 2006) stockless

inventory (Rivard-Royal H. et al, 2002) and vendor managed inventory (VMI) (Cheng

S. H. and G. J. Whittemore, 2008).

The problem of expire of essential medicines was found to be common in health

facilities in Uganda, the main reasons given to this were: short lives of donated drugs,

patients preference of brand medicines rather than generic medicines and poor

estimation of medicines to be procured. In Uganda, most of expired medicines were

donated with short expire period and were for special program, (Nakanyazi et al, 2010).

To reduce unnecessary stock outs in the facilities, Lead time is among key factors to be

considered during placing orders. This has been observed to cause drug shortages in

many of health facilities in Malawi, in which only 42% of the personnel who were

handling medicines could competently apply Lead times in drug ordering procedures

(Lufesi and Andrew, 2007).

Additionally large inventories also make it difficult to track expiration dates and to make

sure that items are being billed for correctly. Research shows that annual inventory


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carrying cost averages between 15% and 40 % of the dollar value of the inventory,

which is a huge burden to carry for healthcare providers (Chris, 2003). In most of a

health facility excess inventory may lead to expiry of some medicines (Muyingo S. et al,

2000, Nakyanzi J. K. et al 2010).

In a study conducted by Talafha to assess pharmacy and inventory control in ministry of

health hospitals in Jordan showed that medication quantification requirements are not

estimated according to actual hospital needs and standard procedures. In addition there

were improper stock recording practices in some hospitals (Talafha H, 2006)

Stock management is rarely taught in medicine, nursing or pharmacy courses, this mayresults in a negative impact on access to medicines. Factors contributing to stock outs on

one hand and over stocking on the other in a lower health facilities Tanzania are not very

clear. Lack of funds and proper logistics and inventory management skills have been

speculated as contributing factors.


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CHAPTER THREE: METHODOLOGY

3.0. Methods and materials

3.1. Overview of Study area

3.1.1. Geographical locations

Chunya district is located in the North -Western part of Mbeya Region. The district is

among the eight (8) districts of Mbeya region and it lies between 7 0 and 9 0 Latitudes

South of the Equator, and between 320

and 340

Longitudes East of Greenwich. Thedistrict is bordered by Singida and Tabora regions to the North; Iringa region and

Mbarali districts to the East; Mbozi and Mbeya districts to the South; Rukwa region and

lake Rukwa to the West.

3.1.2. Selection criteria

Chunya districts is among the hardly to reach area in Tanzania. Also from the baseline

survey of the availability and management of medicines and medical supplies, it was

shown order fulfillment rate was 67.6 % from MSD. (MOHSW, 2003). AdditionallyChunya is one of districts where essential medicines direct delivery supply system had

recently introduces.


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Figure 1: MAP OF CHUNYA

3.1.3. Inclusion and Exclusion criteria

Inclusion

Lower level Public Health facilities

Willingness to participate in the study

Exclusion

District hospitals and private health facilities

3.2. Methodology

3.2.1. Study Design

A cross sectional descriptive survey on assessing challenges facing inventory

management of essential medicines at the lower level public health facilities inChunya District.


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3.2.2. Survey setting

This study examined the challenges facing inventory management of essential

medicines. Data was collected from lower level public health facilities situated in

Chunya district.

3.2.3. Survey period and duration

The survey was conducted in May 2014. Prior to data collection, the principal

investigator contacted the health facility In charge of the survey area in order to

ensure good cooperation.

3.2.4. Survey areas The study was conducted at the lower level of public health facilities in Chunya

District.

3.2.5. Selecting the sample size

Selecting of public health facilities:

All 35 lower level public health facilities were selected in Chunya district.

3.3. Data collection

Data collection tools for challenges facing inventory management of essential

medicines included: questionnaire. (Appendix I)

3.4. Study variables

The variables of the study were as follows:

Knowledge (what they know) and practice (how they behave and demonstrate their

knowledge and their action at the working place). The study involves assessment of

knowledge and practice of Health Care Providers.

3.4.1 Knowledge and practice analysis

In the section of assessing knowledge one mark will be award for each correct

answer and zero for each wrong or unsure or disagree.


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3.4.2. Health care provider knowledge

Arbitrary scoring systems were used to assess the level of knowledge base on the

maximum of 11 correct score. The total knowledge score will be categorize into

three levels indicated by

0 - 3 Poor knowledge

4 7 Moderate knowledge

8 11 Good knowledge

3.4.3 Practices:

For the practice questions on high risk behavior or practice will be assessed, where

reports of at least one behavior associated with poor inventory management will be

considered as high risk behavior marked a score of zero and opposite behavior

marked score of one.

3.5. Data management and analysis

All collected data and completed forms were checked on daily basis by the

investigator. If any of important information was missing, a follow-up by revisiting

or telephone call was made to obtain any of remaining information.

Data was first cleaned and entered into Ms Excel 2007 and SPSS v.16 for analysis

3.6. Study limitation

Cross sectional study collect data at one point in time, presents of competent staffs at

the health facilities was assessed in one day survey. Consequently, some facilities

may usually had a competent staff but it happened on the day of survey were not

available. Private hospitals and district hospital were excluded from the survey due

to financial and time constraints.


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3.7. Ethical consideration

Permission to do this research was obtained from the DMO and Facility in

charges/MOIs at their respective levels of administration. Principal investigator used

prepared informed consent from participant and explaining the objectives and

confidentiality concerns, as a support if participants asked questions (Appendix II).

Contact information was also supplied for any concern or questions. In order to

ensure confidentiality, no names of the participants were recorded in the

questionnaires. Data were entered into the computer Microsoft excels 2007 using

only study code number. Ethical clearance was obtained from TIA Research and

Publication Committee


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CHAPTER FOUR: RESULTS

4.1. Age and sex distribution among Participants

Sixty six percent (66%) of respondents were females. The ratio of female to male

was 1.5:1. Similarly, 11 (31.5%) were aged above 45 years, 10 (28.6%) were aged

36 to 45, 9 (25.7%) were aged 26 to 35 and only 5 (14.2%) were aged 15 to 25

(Table 4.1). These two variables were found to have no effect in the status of

inventory management.

Table 4.1 Age and sex distribution among participants (n=35)

S/n Sex Number of participants (%)

1 Male 14 (40)

2 Female 21 (60)

Total 35 (100)

Age

1 15-25 5 (14.2)

2 26-35 9 (25.7)

3 36-45 10 (28.6)

4 Above 45 11(31.5)

Total 35 (100)

4.2. Professional level among the study participants

Respondents were the core and supporting staff of all health facilities. Regarding

professional level of the participants, it was found that 5 were medical attendant, 13

were nurses, 14 were clinical officer and 3 were AMO. This shows that, all staffs

manage essential medicines in lower level health facilities were are not legally


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Table 4.2 Professional level among the study participants (n=35)

S/n Professional No. of professional (%)

1 Medical attendants 4 (14.3)

2 Nurses 13 (37.1)

3 Clinical officer 15 (42.8)

4 Advance medical officer 3 (8.7)

Total 35 (100%)


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4.3. Knowledge on inventory management of essential medicines

4.3.1. Inventory control of essential medicines

The knowledge on safety stock formula was low, nearly 13 (37.1%) of participant

got the correct answer for it. Additionally knowledge on the types of method used for

quantification was low, as it was shown that about12 (34.3%) of the participant

scored the correct answer. However most of the participant had knowledge on the

essential medicines management tools and reasons for holding stock at the facility

(Table 4.3).

Table 4.3.1 Respondent on inventory control

Scenario Respondent

Correct

answer (%)

1 Ledger and bin card are among document used to control

medicines

34 (97.1%)

2 Formula of Safety stock is the is the lead time (LT) multiplied by the average month consumption

13 (37.1%)

3 Morbidity is one of the methods used during quantification 12 (34.3%)

4 One of the reasons to held stock in hand is to maintain

confidence of the health system

26 (74.3%)

4.3.2. Awareness on variables used during ordering

Most of the respondent said they were aware on variable used in ordering. However,

participants had low awareness on the lead time and re-order level during ordering.

Only 9 (25.7%) and 13 (37.1%) had got the correct answers for reorder level and

lead time respectively (Table 4.3.2).


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Table 4.3.2 Awareness on variables used during ordering

Scenario Participants correct answer (%)

5 Average consumption 24 (68.6%)

6 Lead time 13 (37.1%)

7 Safety stock 28 (80%)

8 Reorder level 9 (25.7%)

9 Maximum stock level 26 (74.3%)

10 Stock position 25 (71.4%)

11 Procurement period 25 (71.5%)

4.3.3. Level of knowledge on inventory management of essential medicines

Majority of participants (74%) had moderate knowledge on inventory management

of essential medicines. Only 2 (5.7%) had poor knowledge on inventory management

(Figure 2 below).

Figure 2: Knowledge level on inventory management of essential medicines.

01020304050607080

2

2675.7

74.3

20.0

H e a

l t h f a c i l i t i e s

Level of knowledge on inventory management

No. of respondent

Perentage (%)


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4.4. Storage conditions of essential medicine

Proper Storage condition such as good labeling and posses of enough storage space

were shown only in a few facilities. However, most of facilities 34 (97.1%) stored

medicines far away from insecticide and chemicals (Table 4.4).

Table 4.4 Storage conditions standards at the facilities surveyed (n=35)

Storage standards as per MSH, 2000. No. of facilities adhering tothe standard (%).

1. Medicines are arranged so that identificationlabels and expiry dates and manufacturing datesare visible.

17 (48.6)

2. Medicines are stored and organized in a manneraccessible for first-expiry, first out counting andgeneral management.

18 (51.4)

3. The facility makes it a practice to separatedamaged and expired medicines from inventory.

30 (85.7)

4. Medicines are stored at the appropriatetemperature according to temperaturespecification.

20 (57.1)

5. Roof is maintained in good condition to avoid

sunlight and water penetration at all times.

22 (62.3)

6. Storeroom is maintained in good condition (e.g.Clean, shelves are sturdy, boxes are organized).

23 (65.7)

7. Current space and organization is sufficient forexisting medicines

12 (34.3)

8. Product are stacked at least 10cm off the floor. 28 (80%)9. Medicines are stacked at least 30cm away fromthe walls.

15 (42.9)

10. Medicines are stored separately frominsecticides and chemicals.

34 (97.1%)

The storage conditions in various health facilities was categorized as poor (0 - 2),

average (3 - 5), good (6 - 8), and very good (9 - 10). Majority 23 (65.7%) of the

respondent had good storage condition of essential medicines. However, 1 (2.9%)

facility had poor storage condition of essential medicines (Figure 3).


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Figure 3: Storage Condition level among the Surveyed health facilities

4.5. Problem encountered during ordering processing

51.4 percent (18) of respondents agreed to the fact that they faced problems during

writing an order. While 3 % (1) only said they did not faced any problems.

Poor knowledge on logistics tools and few numbers of staffs were the main problems

encountered during ordering process. Plenty of medicines on the scheduled ordered

form and lack of stationery were the least problems encountered during the ordering

process (Table 4.5 below).

2.9

25.7

65.7

5.7

Poor

Average

Good

Very good


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Table 4.6 Reported reasons for out of stock for essential medicines

Statement Number (%)1 Delay delivery from MSD 11 (32)2 Presence of many customer (high service

level)8 (23.5)

3 Presence of missed items or receive less thanwhat they ordered

17 (50)

4 Limited number of medicines in the scheduledlist

5 (14.2)

5 Lack of funds for self procurement of essentialmedicines

5 (14.2)

4.7. Challenges on proper management of health commodities

97 percent of respondents agreed to the fact that there were a lot of challenges

impairing the proper management of health commodities, whilst 3 percent said they

did not face any challenges.

Lack of enough space and shortage of trained personnel were the main challenges

facing management of commodities. However inadequate of health commodities

tools are the least challenges on proper management of health commodities (Table4.7).

Table 4.7 Reported challenges on proper management of health commodities

Statement No. of respondent(%)

1 Lack of enough storage spaces 24 (70.6)2 Transportation and communication problems 11 (32.4)3 In adequate of health commodities tools 3 (8.8)

4 Lack of funds 10 (29.4)5 Shortage of trained personnel 17 (50)6 Quarterly ordering interval (long interval) 6 (17.7)

4.8. Recommendation on essential medicine availability and control

Majority of participant said that increase storage size and number of trained staff

were the strategies for medicines control and availability. Howe ever 5 (14.2%)

recommend self procurement as good strategy for medicine control and availability,

while 3 (8.5%) had no any recommendation (Table 4.8).


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Table 4.8 Reported recommendation for medicine control and availability:

Statements No. of respondent(%)

To increase storage size of essentialmedicines 28 (80)To increase number of trained staff 18 (51)Self procure of essential medicines whichwere missed from MSD

5 (14.2)

Need training of essential medicine oninventory management

14 (40)

To add some essential medicines to thescheduled list

4 (11.4)

No recommendation 3 (8.5)


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CHAPTER FIVE: DISCUSSION

In Tanzania essential medicines are expensive and constitute a large proportion of MOHSW

expenditure as well as donor funds, hence they require very efficient management in order to

realize its impact to the health service provision. Lack of skills on inventory management of

medicines in Tanzania contributes to the interruption of the supply chain of essential medicines

(MSH/WHO, 1997).This may result into patient not being able to receive medicines promptly,

frequent stock-outs, late deliveries and unnecessary expire of medicines at the facility. These

causes not only lose confidence in the facilities by patients but also waste of financial resources

and decrease in quality of patient care.

It is expected that these findings can be utilized in many ways in providing better solutions of

inventory management for essential medicines, hence, improving availability of essential

medicine in the public health facilities at Chunya District. Also policy-makers and health

managers that are involved in planning training activities will help to address these challenges

facing inventory management, and thus ensuring constant availability of these essential

medicines and properly manage

Across all surveyed lower level of public health facilities (Health centers and Dispensaries) in

Chunya district had no pharmaceutical personnel. This indicates that there is still a shortage of

pharmaceutical personnel in Chunya district especially pharmaceutical technicians and

pharmaceutical assistants. These are responsible in doing operation duties on essential medicines

management and properly delivering the services to the community. Medical attendant, Nurses,

Clinical officers and Assistant Medical Officer were found as the key personnel on stock

management, basically they lack important knowledge and skills in managing medicines. Thiswas almost the same with the study conducted in public hospitals in Dar es Salaam (Kagashe et

al, 2012 ), Mbeya (Mwakalewesya et al, (2012 ) and private sector Dar es Salaam (Minzi et al,

2008) which shows that nurses and clinical officers involved in essential medicines management.


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Inventory control is the process of managing inventory in order to meet customer demand at the

lowest possible cost and with a minimum investment (Blackburn J, et al (2010)). Several

objectives in inventory control such as minimize inventory investment; determine the appropriate

of customer service level; balance supply and demand; minimize ordering cost and holding cost;

also preservation of inventory control system.

One of the models in controlling inventory is safety stock. Safety stock must be considered

where there is an uncertainty in demand; also safety stock is needed during the replenishment

lead time when there is a mismatch between actual demand and expected demand (Blackburn J,

2010). This study shows that, the knowledge on safety stock formula was low, nearly only 13

(37.1%) of participant got the correct answer for it. This finding was almost the same compared

to the results of a recent study that was conducted in Dar es Salaam; in which sixty six percent of

respondents said there was no predetermined time for placing orders for different medicines

stored ( Kagashe et al, 2012).

Additionally, about 74.3% and 62.3 % of the participant didnt know if reorder level and lead

time respectively as variables used during ordering process. This number is higher compared

with the findings of study that was conducted in Mbeya (Mwakalewesa E, et al (2012), and

Malawi (Lufesi A et al, 2007). These studies shows that, personnel in Mbeya and Malawi who

handle medicines were not able apply the concept of lead-time in managing availability of

medicines in the public hospitals were 39.3% and 52% respectively. These differences were due

to the fact that lower level health facilities lack high number of competent personnel on

inventory management. Also finding was almost the same with the study conduct in Dar es

salaam, Tanzania (Kagashe et al 2012) which shows that no single item (medicine) whose time

for placing order was predetermined. This shows that participants had low awareness on the

variables used during ordering process.

Quantification process of medicines required two methods, the consumption method and the

morbidity method (MSH/WHO 1997). The consumption method look on the average amounts of

medicines consumed monthly as the basis for calculations. The morbidity method involve

knowledge of disease pattern of the area which the health facility is serving and from that the

incidence of common diseases, the expected attendances and standard treatment patterns are


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considered to estimate the needs (MSH/WHO 1997). The study shows that, knowledge on the

types of method used for quantification was low, as it was reported that about 12 (34.3%) of the

participant scored the correct answer. The same results was obtained from the study conducted

in Dar es Saalam (Kagashe et al 2012) whereby sixty five percent (65%) were incapable to

mention the quantification methods used. This implies that most of the staff involved in

medicines stock control does not know quantification methods.

Storage conditions, dimensions of store buildings in some of the health facilities were not

sufficient enough to store medicines according to recommended guidelines as described by

(MSH,2000). Proper arrangement of medicines was found to be impossible in some of health

facilities due to poor storage space, recommended FIFO system and pharmacological

arrangement were impossible to implement. In some stores, roofs and floor were not as smooth

and intact as recommended and sometimes medicines were found placed on floor without pellets,

the situation which threaten the efficacy of the medicines.

The finding was almost slightly the same with the one conducted in Dar es Salaam whereby

shelved were not enough, no good arrangement and presence of dust in Temeke, Amana and

Mwananyamala hospitals (Kagashe et al 2012). Additionally, same finding from the study

conducted in Mbeya shows poor storage space (Mwakalewesya et al 2012).

On the other hand , this may result into risks for people working in these stores as some dust

from medicines can cause allergy and drug interactions. Also if medicines not well arranged may

lead to mixing up of items especially when the packages of the items are similar. Poor storage

condition, may be due to absence of fund allocation for maintenance and building of new store

buildings

A number of factors were sighted as causes of out of stock. The study reported that delayed

delivery and presence of missed items were the major factors contributing to stock out at the

facility. This was almost quite difference from the study conducted in Public Hospital, Dar es

Salaam (Kagashe et al, 2012) where lack of funds was a major cause. This difference was due to

the fact that lower level health facilities located far away from the MSD offices and made their


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order on quarterly basis as oppose to hospitals which ordered regularly and bought medicines in

the private pharmacies. Additionally, the difference may due to the fact that these lower level

facilities do not have direct possessed of money/funds to procure medicines for themselves.

However there were great challenges facing these health facilities in managing health

commodities. The study revealed that, lack of enough space and shortages of trained personnel

were the main challenges facing management of commodities. These finding was slightly the

same with the study conducted in Ghana on assessment of Health Commodities Management

Practices in Health Care Delivery ( Annan J et al, (2012).


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CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

Conclusion

The study reveals that all staff manages essential medicines in lower level health facilities do not posses enough skill on inventory management . Storage conditions at the health facilities were not

good. Stock outs of medicines in the health facilities is not solely due to poor inventory

management but also lack fund and late delivery from the MSD which is the solely source of

essential medicines. Shortage of skilled staffs and lack of enough storage spaces were the main

challenges facing management of health related commodities at the lower level of public health

facilities.


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Recommendations

1. Training staff on procurement and inventory management will make these commodities

readily available and improve the service level. The curriculum in the universities and

colleges that provide pharmaceutical education should be reviewed to accommodate the

Inventory management aspects, this should also include other health related colleges

because they play important role in providing pharmaceutical services.

2. Improving the human resources crisis on pharmaceutical management at the lower level of publichealth facilities is needed. There is need for the government to work with professional

organizations, regulatory bodies, training institutions to develop long term workforce plans. For

example expanding the ability of existing training institution to train more Pharmaceutical

assistant and Pharmaceutical technician in order to improve pharmaceutical services in the lower

level health facilities where there are few or no registered pharmaceutical personnel

3. On job training on Inventory management should be given priority in all staff dealing in

managing medicines inventories, this is important to equip them with changes that

happening in both pharmaceutical and Inventory management fields. This can be done

through the routinely supervision done by higher level health facilities

4. Sensitization of staff about the benefits of adopting effective commodities management

best practices to boost the performance of our health facilities in terms of the service

delivery.


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CHAPTER SEVEN: REFERENCES

Annan J et al (2012): An Assessment of Health Commodities Management Practices in Health

Care Delivery in Ghana: The Case of Selected Hospitals in Ashanti Region-Ghana

Battersby, A., Goodman , C, Abondo, C., and Mandike, R. (2003). Improving the supply,

distribution and use of antimalarial drugs by the private sector in Tanzania. Malaria

Consortium .

Bhattari, HR. (2004). Assessment of pharmaceutical management information and monitoring

and evaluation of the republic of Namibia. Lundu: WarnerBook.

Cheng S. H, Graham J. Whittemore, (2008). An Engineering Approach to Improving Hospital

Supply Chains, M.Eng Thesis, Massachusetts Institute of Technology, USA,

Hugo Rivard- Royer, Sylvain Landry, Martin Beaulieu, (2002). Hybrid Stockless: A Case Study:

Lessons for Healthcare Supply Chain Integration, International Journal of Operations

and Production Management. 22: 412-424.

Jeff Blackburn,(2010). Fundamental of Purchasing and Inventory Control for Certified

Pharmacy Technicians: A Knowledge Based Co urse, The Texas Tech University.

John Snow, Inc./DELIVER( 2003). Baseline Survey for Integrated Logistics System. Arlington,

Va: for the U.S. Agency for International Development.

John Snow, Inc./DELIVER, ( 2003). Tanzania: Commodity Availability for Selected HealthProducts

Kagashe et al, (2012). Medicines stock out and inventory management problems in public

hospitals in Tanzania: A case of Dar es Salaam Region Hospitals. Int J Pharm 2: 252-259.


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Lufesi, N., Andrew, M., and Auresness, I. (2007). Deficient supplies of drugs for Life

threatening diseases in an African Community . BMC-Health Services Research

Journal.2007.

Minzi, OMS et al (2008). Pharmacies in Tanzania: The need for involving the private sector in

policy preparation and implementation. East African Journal of Public Health: 5:117-121.

MOHSW (Ministry of health and social welfare), (2003). In depth assessment of the medicine

supply system .Government Printer

MSH. (1997). Managing drug supply. United state of America by Kumarian pess.

MSH. (Management of science for health), (2000). Pharmaceutical management for malaria

assessment and training manual 12 th edition.

MSH. (Management Science for Health), 1997. Management Science for health. Managing drug

supply; the selection, procurement, distribution and use of Pharmaceuticals. Kumarian

Press. Second edition, revised and expanded.

MSH. (Management science for Health). (1991). Pharmacy inventory control operations

manual, Belize Ministry of health, Boston.

Muyingo S et al. (2000). Baseline assessment of drug Logistics systems in twelve DISH-

supported District and service delivery points (SDPs); DISH II project report.

Mwakalewesya et al, (2012): Inventory management of essential medicines of topten diseases in

Districct Hospitals of Mbeya Region.

Nakanyazi, JK, Kitutu, KY., Oria, H., and Kamba, PF. (2010). Expire Medicines in supply

outlets inn Uganda . Bull Word Health Organ.


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Nakyanzi JK et al , (2010). Expiry of medicines in supply outlets in Uganda. Bulletin of World

Health Organization: 88:2.

P. Garry Jarrett, (2006). The Benefits and Implications of Implementing Just -In-Time System

in the Healthcare Industry, Leadershi p in Health Service. 19:1-9.

Silumbe, R. (2011). Pharmaceutical Management and Prescribing pattern of Antimalarial drugs

in the Public Health facilities in Dar es salaam , July 2011.

Talafha H, (2006). Assessment of Pharmacy and Inventory Control in Ministry of HealthHospitals in Jordan. Bethesda, MD: The Partners for Health Reform plus Project, Abt

Associates Inc.


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APPENDICES

APPENDIX I: Questionnaire: Investigation of challenges facing inventory management

of essential medicines.

Self-completed questionnaire:

SECTION A: DEMOGRAPHIC CHARACTERISTICS

1. Sex

2. Age .

3. Name of Health Facility

4. Professional

SECTION B: KNOWLEDGE

A. Please select correct answer by putting a tick ( ) against each correct statement

in the table below.

No. Scenario (classification)Agree Disagree `Unsure

1 Ledger and bin card are among documentused to control medicines2 Formula of Safety stock is the is the lead time

(LT) multiplied by the average monthconsumption

3 Morbidity is one of the methods used duringquantification

4 One of the reasons to held stock in hand is tomaintain confidence of the health system


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5. Did you face any challenge during management of health commodities? Yes/No

If yes, what are those challenges?

.

..

SECTION D: OTHERS

1. In your own opinion what should be done in order to improve medicines availability

and control at your health facility?

....

Thank you very much for your time. The information you have provided is very

valuable. We will be happy to discuss our findings with you and are open to any

suggestions you may have. Thanks again for your assistance


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APPENDIX II: Informed consent agreement

Assessment of the challenges facing inventory management of essential medicines in lower level

of public health facilities.

Introduction

This Consent Form contains information about the research named above. In order to be sure that

you are informed about being in this research, we are asking you to read (or have read to you)

this Consent Form. You will also be asked to sign it (or make your mark in front of a witness).

We will give you a copy of this form. This consent form might contain some words that are

unfamiliar to you. Please ask us to explain anything you may not understand

Reasons for research

You are being invited to take part in a research project, which aims to assess the inventorymanagement of essential medicines to lower level health facilities.

Your decision to take part in the study is voluntary and you may refuse to take part or to stop

taking part at any time and you may refuse to answer any question asked.

This study has been given approval from the Directorate of research and publication committee

of Tanzania Institute of Accountancy and permission to do research has been obtained from the

Chunya District Excutive Director.

Procedure

If you agree to participate, you will be required to fill questionnaire. The questionnaire will ask

you about your demographic characteristics, knowledge and practices on inventory management

and challenges facing inventory management. The questionnaire will take about 15 30 min.

Benefit

The information you provide will help us to design a better guideline for inventory control of

medicine and address the challenges associated with inventory management of medicine. Your

information will be useful to researchers, policy makers, health professionals, and communities.

Risk/Discomfort

Some of the questions may be sensitive, so you might feel uncomfortable at the same time we are

going to take your time.


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Alternative

The only alternative is not to take part in this study.

Study withdrawal

You can stop being a study participant at any time. During the interview, you can stop the

interview by asking the interviewer to stop. The interviewer may stop you from being in the

study if he or she believes youre unable to answer questions because of tiredness.

Cost/Compensation

This exercise is voluntary, therefore there will be no payment given to the patients.

Confidentiality

All the information you provide will be confidential. Code number will identify the information

you provide in research record. We will not use your identity in any report or publication aboutthis research.

Questions

In case you have any question(s) you can ask the principle investigator in this study Twaha

Kabandika whose phone number is 0767918184 ans Mr. Swallo C. G.

(Research Supervisor) (0712468836).

They will be glad to answer any question at any time.

Acceptance

If you have understood and ready to participate please sign below;

Signature of the respondent/or witness. Date

challenges facing inventory management of essential medicines in chunya - district

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