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Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia

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Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Integrated Pharmaceutical Logistics System Implementation in Chagni Primary Hospital and Injibara General Hospital, Awi Zone, Ethiopia Bereket Bahiru Tefera 1 Background: Integrated Pharmaceutical Logistics System is the primary mechanism Wubetu Yihunie 1 through which all public health facilities in Ethiopia get essential pharmaceutical products Azmeraw Bekele 2 from their main supplier. Pharmaceuticals should be managed appropriately because they are part of the link between the patient and health services and account for up to half of the 1Department of Pharmacy, College of Health Science, Debre Markos University, healthcare budget. This study aimed to assess the status of Integrated Pharmaceutical Debre Markos, Amhara, Ethiopia; Logistics System implementation at both Chagni Primary Hospital and Injibara General 2 Institute of Health Science, Jimma Hospital. University, Jimma, Oromia, Ethiopia Methods: Facility-based descriptive study design supported with a qualitative study design was used. Face-to-face interviews, observation of practices, and document review were conducted to gather quantitative data. Besides, the qualitative data were collected through in- depth face-to-face interviews. Frequency and percentage were computed, and the results were briefly described in text and displayed in tables and graphs. The qualitative data were transcribed manually, and thematic analysis was done. Results: All IPLS materials were available in both hospitals, but the stock recording card was not available at Injibara General Hospital. About 90% and 100% of the dispensing units in Chagni Primary Hospital and Injibara general hospital were utilizing bin-cards, respec­ tively. Besides, 50% and 80% of the bin-cards in Chagrin Primary Hospital and Injibara General Hospital were regularly updated, respectively. About 80% and 75% of the IFRRs in Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Besides, 66.67% and 50% of the RRFs reviewed at Chagni Primary Hospital and Injibara General Hospital reported valid data, respectively. Medicine stockouts, poor staff commit­ ment, and workload were the major bottlenecks for IPLS execution. Conclusion: The status of most of the IPLS implementation indicators in both hospitals was good. Especially, the availabilities of IPLS materials and the calculation accuracy of both RRFs and IFRRs were encouraging in both hospitals. However, the validity of the data reported in IFRRs and RRFs, and the status of the storage conditions in both hospitals need some improvement during the implementations of IPLS. Keywords: IPLS implementation, report and requisition form, bin-card, hospital Introduction The World Health Organization (WHO) estimates that around one-third of the Correspondence: Bereket Bahiru Tefera world’s population lack access to essential medicines and even this amount Department of Pharmacy, College of 1 Health Science, Debre Markos University, increases in the poorest parts of Africa and Asia. The causes of poor access and Debre Markos, Amhara, Ethiopia availability of medicines were multifaceted and some of the contributing factors for Tel +251909881252 Email [email protected] these complications are irrational use of medicines, unsustainable financing Journal of Multidisciplinary Healthcare 2021:14 1673–1682 1673 © 2021 Tefera et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Tefera et al Dovepress mechanisms, and ineffective health care supply chain sys­ of pharmaceuticals at all levels of the public health supply tems to deliver medicines to the final consumers.1,2 chain system throughout the country.10 Besides, each com­ Besides, in the pharmaceutical industry, there is ponent has its own set of indicators for measuring a growing concern with supply chain sustainability during improvements and performances of the system.10,11 the COVID-19 pandemic.3 Different reports from various parts of the country The delivery of health care services needs the avail­ show that the implementation of IPLS has improved the ability of safe, effective, and affordable pharmaceuticals recording and reporting of LMIS, storage practices, as well and related medical supplies of the required quality, with as the availability of essential pharmaceuticals at service adequate quantity at all times.1 These pharmaceuticals delivery points.10 However, there is no available study should be managed appropriately because usually, they conducted to assess the IPLS implementation in both account for up to half of the health care budget, and Chagni Primary Hospital and Injibara General Hospital medicines are part of the link between the patient and and even in the region where those hospitals were found. health services.4 Because even minor disruptions in the Therefore, this study aimed to assess the status of IPLS pharmaceutical supply chain can result in severe disasters, implementation in these hospitals, which are the main pharmaceutical product distribution must combine cost hospitals providing healthcare services for the majority minimization with strict adherence to service standards of the population in that region. while accounting for risks due to uncertainty.5 When hos­ pitals faced drug shortages, they had to postpone treat­ Methodology ments and rely on less effective and more expensive substitutes.6 Study Setting and Period The Federal Minister of Health (FMoH) of Ethiopia The study was conducted to assess the status of IPLS has been working to ensure that all Ethiopians have implementation in Chagni Primary Hospital and Injibara a successful and high-performing supply chain of health­ General Hospital, which are found in Awi zone, Amhara care that guarantees equal access to quality drugs and regional state, Ethiopia. Injibara General Hospital is related supplies. Although substantial progress has been located in northwest Ethiopia, which is 144 and 450 kilo­ made, several problems remain, including an insufficient metres far from Bahir Dar (which is the capital city of supply of quality and affordable essential pharmaceuticals, Amhara Regional State), and Addis Ababa, respectively. poor storage conditions, and inadequate inventory Besides, it was serving an estimated 1.2 million population 12 management.7 To encourage the public sector healthcare in Awi zonal administration. Chagni Primary Hospital is supply chain, the FMoH introduced a comprehensive sup­ located in the Awi Zone of the Amhara Regional state, and ply chain strategic planning process that emphasizes the it is 165 kilometres from Bahir Dar and 502 kilometres far integration of all health commodities into one supply from Addis Ababa. chain, which was the Integrated Pharmaceutical Logistics System (IPLS). IPLS began in 2009 and the mandate for Study Design implementing it was given to Pharmaceutical Fund and A facility-based descriptive study design supported with 8 Supply Agency (PFSA). a qualitative study was employed for assessing the status IPLS is a system used as a pharmaceutical reporting of IPLS implementation. and distribution system that integrates the management of HIV/AIDS, malaria, TB and leprosy, EPI, MCH, and other Source Population purchased essential drugs. It aims to ensure that the six The source populations of this survey were Chagni Primer rights of pharmaceutical supply chain management are Hospital and Injibara General Hospital, the IPLS-related fulfilled by ensuring the right products in the right quan­ documents, and the healthcare professionals of these tity, of the right quality, at the right place, at the right time, hospitals. and for the right cost.1,9 The IPLS is the primary mechan­ ism through which all public health facilities obtain essen­ tial medicines.9 The IPLS has three main components Study Populations including policies and guidelines for logistics management The study units of this study were dispensing units, IPLS- information system (LMIS), inventory control, and storage related documents in selected dispensing units (bin-cars, 1674 https://doi.org/10.2147/JMDH.S316595 Journal of Multidisciplinary Healthcare 2021:14 DovePress Dovepress Tefera et al IFRR, and RRF), store manager, and pharmacy head of Indicators Assessment Tool (LIAT).13 The structured ques­ each hospital. tionnaire had two sections. The first section had questions to assess the socio-demographic characteristics of the Sample Size Determination and Sampling selected hospitals and hospital pharmacy staff (who are primarily responsible for the majority of the IPLS imple­ Procedure mentation). The second section included questions impor­ The data regarding the status of bin-card management tant to capture the data required to compute the selected were collected through reviewing the last 2 months (before IPLS implementation indicators, which were used to mea­ data collection) bin-cars
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