MINISTRY OF HEALTH PHARMACY DEPARTMENT APRIL 2020 FACILITY TRACER MEDICINES STOCK STATUS REPORT A Publication of the Ministry of Health Uganda This monthly report on the facility stock status of the 41 tracer items (in different baskets) provides information about the stock situation of health facilities in the country in order to inform the Ministry of Health and all stakeholders to make appropriate logistics decisions that ensure an effective health commodities supply chain. The report shows the number and percentages of facilities that are appropriately stocked, over stocked or out of stock by level of care and ownership based on Months of Stock (MOS). The MOS highlights the number of months a product will last based on the present consumption rate. It also further indicates facilities that have over 8 months of stock (MOS) broken down by level of care and ownership. The report shows the availability of the different and overall baskets using two indicators i.e. 1) Average percentage availability of a basket of 41 commodities based on all reporting facilities in the previous cycle Definition : Availability is measured as the number of days for which a specific commodity was in stock at the facility store during the reporting period. 2) Percentage of facilities that had over 95% availability of a basket of commodities in the previous cycle Definition : This indicator measures the % of health facilities that reported having the basket of commodities available during the reporting period. The contents of the different baskets are listed below: ARV BASKET LOC EMHS BASKET LOC Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) 300mg/300mg/ 600mgHC2 Artemether/Lumefantrine 20/120 mg HC2 AZT/3TC/NVP 300mg/150mg/200mg HC2 Therapeutic milk F75 (75Kcal/100ml) Hospital Atazanavir/ritonavir(ATV/r)300/100mg table* HC3 Oral Liquid Morphine 5ml/ml* HC3 Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg* HC3 Ready to use Therapeutic feeds (RUTF) HC2 TDF/3TC/DTG 300mg/300mg/50mg(TLD)* HC3 Cotrimoxazole 960mg tablet HC2 TLE 300mg/300mg/400mg HC2 Chlorhexidine Digluconate Gel 7.1% HC2 Abacavir/Lamivudine (ABC/3TC) 120mg/60mg (Paediatric) HC3 Bendrofulazide (Aprinox) 5mg HC3 Lopinavir40mg/ritonavir 10mg pellets in capsules* HC3 Artesunate 60mg* HC3 Nifedipine tablets 20mg tablet HC3 LAB BASKET LOC Captopril 25mg tablet HC4 Determine HIV 1 & 2 screening test HC2 Metformin 500mg HC3 Stat -pack HIV Confirmatory rapid tests, tests HC2 Glibenclamide 5mg tablet HC4 SD Bioline test-Tie Breaker HC2 Insulin short-acting HC4 CD4 reagent HC4 Cardiac Aspirin 75/80 mg HC4 Malaria Rapid Diagnostic tests HC2 GeneXepert Catridges* HC3 Blood 450 ml HC4 RMNCAH BASKET LOC TB BASKET LOC Depot medroxy progesterone acetate (DMPA) HC2 (RHZE) blister strip 150/75/400/275 mg HC3 Amoxicillin 250 mg capsule* HC2 RHZ Blister 75mg/50mg/150mg HC3 Sulfadoxine/ Pyrimethamine tablet HC2 ORS Sachets with zinc tablet HC2 Measles-Rubella Vaccine HC2 Misoprostol 200mcg Tablet HC2 Amoxicillin dispersible 250mg tablet HC2 Ceftriaxone 1g Injection HC3 Oxytocin Injection HC3 Note: * New commodity Mama Kit HC2 With the revision of the HMIS tools and change in treatment guidelines a total of eight new commodities were introduced. KEY FINDINGS 1. The average facility reporting rate per district for the month of April 2020 on HMIS-105:6 (Stock status) was at 77% and nationally it was at 54% (4001/7478). •A total of fifteen districts had 100% reporting for all their facilities while 5 districts had less than 50% of their facilities reporting. Notably, the least being Rubirizi, Kayunga, Mukono, Wakiso, and Kampala •Out of the 14 Regional Referral Hospitals; four submitted complete reports and 5 submitted incomplete reports on the 41 tracer commodities. •Arua, Hoima, Mbale, Jinja and Mubende Regional Referral Hospitals did not submit report on the 41 tracer commodities. 2. Overall average availability for the basket of 41 tracer commodities was 81% (n=1583), indicating no change from the month of March 2020 which was 81% (n=1673). a) TB commodities had better availability of 86% (n=689) than other baskets while ARV basket had the least with 71% (n=1137) availability. b) An average of 55% (n=1583) of facilities reported over 95% availability of commodities, decreasing from the month of March 2020 which was 56% (n=1673). 3. Ready to use Therapeutic feeds, TLE 300mg/300mg/600mg, CD4 reagent, SD-Bioline test and Oral Liquid Morphine 5ml/ml were stocked-out in most health facilities. 4. ACTs and Malaria Rapid Diagnostic tests commodities were overstocked in 48% and 42% respectively in Government HCII, HCIII and HCIV facilities. 5. Determine HIV test and RHZ Blister were expired in 19% and 8% of the health facilities respectively. Most being in HCII and HCIII facilities. 6. Measles Vaccine and Determine HIV test had higher cost value for expiry amounting to 664,024,691 shillings and 455,554,842 shillings respectively. ACTION POINTS 1. Pharmacy Department working with regional IPs to ensure that all facilities get adequate stock of legacy regimens from central warehouses. 2. Pharmacy Department will continue monitoring the blood stock levels to inform blood bank decisions for improved blood availability. 3. Pharmacy Department to target their supervisions to the poor performing Regional Referral Hospitals and health facilities 4. Work with the IPs to prioritize and strengthen health facility reporting and quality of data especially for quantity expired. Quality Assurance of the data submitted should be prioritized. 5. Pharmacy Department to support health facilities to report using the new HMIS tools. There is a plan to conduct Regional and Facility Based HMIS Training. This should impove the reporting rate and quality of reports submitted. April 2020 Facility Stock Status Report 1 of 10 AVAILABILITY INDICATORS Percentage Average Availability of Basket of commodities Dec'18 -Apr'20 Percentage of facilities with over 95% availability of commodities 90 90 Dec'18-Apr'20 80 80 70 70 60 60 50 50 40 40 30 30 20 20 Dec'18- Feb- Apr- Aug- Oct- Dec'18- Feb- Apr- Aug- Oct- Jun-Jul'19 Jan-20 Feb-20 Mar-20 Apr-20 Jun-Jul'19 Jan-20 Feb-20 Mar-20 Apr-20 Jan'19 Mar'19 May'19 Sep'19 Nov'19 Jan'19 Mar'19 May'19 Sep'19 Nov'19 EMHS (14 items) 77 84 81 77 75 76 81 84 83 81 EMHS (14 items) 43 48 44 39 38 39 56 59 58 57 ARV (8 items) 74 76 76 75 72 72 74 74 73 71 ARV (8 items) 42 41 42 42 37 35 43 42 43 39 LAB (7 items) 82 87 86 84 84 84 82 83 83 84 LAB (7 items) 53 59 57 54 53 54 57 57 59 63 TB (2 items) 66 87 88 87 86 85 84 85 87 86 TB (2 items) 51 71 72 70 66 67 74 75 77 75 RMNCAH (10 items) 82 85 85 82 83 85 78 82 81 81 RMNCAH (10 items) 39 45 44 40 42 45 36 41 41 42 Percentage availability for each item (EMHS basket) Percentage availability for each item (ARV basket) Item n % availty % expiryItem n % availty % expiry 7 Artemether/Lumefantrine 20/120 mg 1893 94% 4.4% Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) 300mg/300mg/1042 76% 600mg 1.6% 8 Therapeutic milk F75 (75Kcal/100ml) 39 56% AZT/3TC/NVP 300mg/150mg/200mg 944 73% 2.0% 11 Oral Liquid Morphine 5ml/ml 301 11% 0.2% Atazanavir/ritonavir(ATV/r)300/100mg table 668 80% 2.2% 12 Ready to use Therapeutic feeds (RUTF)647 36% 0.7% Tenofovir/Lamivudine (TDF/3TC) 300mg/300mg 677 91% 4.8% 14 Cotrimoxazole 960mg tablet 1054 75% 1.0% TDF/3TC/DTG 300mg/300mg/50mg(TLD) 709 95% 1.6% 15 Chlorhexidine Digluconate Gel 7.1% 967 71% 2.0% TLE 300mg/300mg/600mg 557 15% 0.6% 16 Bendrofulazide (Aprinox) 5mg 673 86% 2.1% Abacavir/Lamivudine (ABC/3TC) 120mg/60mg (Paediatric)660 89% 3.1% 19 Artesunate 60mg 744 88% 1.7% Lopinavir/ritonavir 40mg/10mg pellets in capsules 605 72% 4.3% 20 Nifedipine tablets 20mg tablet 716 80% 1.4% 23 Captopril 25mg tablet 145 70% 2.0% 27 Metformin 500mg 642 76% 1.5% Percentage availability for each item (TB basket) 30 Glibenclamide 5mg tablet 150 82% 3.3% Item n % availty % expiry 32 Insulin short-acting 126 63% 3.5% 4 (RHZE) blister strip 150/75/400/275 mg 660 91% 1.8% 37 Cardiac Aspirin 75/80 mg 142 67% 2.7% 31 RHZ Blister 75mg/50mg/150mg 586 80% 7.6% 38 38 38 38 38 38 38 38 38 38 Percentage availability for each item (RMNCAH basket) Percentage availability for each item (LAB basket) Item n % availty %Item expiry n % availty % expiry Depot medroxy progesterone acetate1400 (DMPA) 67% 2.4% 2 Determine HIV 1 & 2 screening test 1463 85% 18.8% Amoxicillin 250 mg capsule 1834 83% 1.8% 9 Stat -pack HIV Confirmatory rapid tests, tests 1204 77% 2.7% Sulfadoxine/ Pyrimethamine tablet 1662 86% 2.8% 10 SD Bioline test-Tie Breaker 1005 63% 4.4% ORS Sachets with zinc tablet 1767 89% 1.7% 17 CD4 reagent 90 47% 6.1% Measles-Rubella Vaccine 1307 88% 2.0% 33 Malaria Rapid Diagnostic tests 1771 94% 4.1% Misoprostol 200mcg Tablet 1235 86% 5.8% 39 GeneXepert Catridges 88 70% 0.0% Amoxicillin dispersible 250mg tablet 1405 78% 1.4% 40 Blood 450 ml 87 57% 6.3% Ceftriaxone 1g Injection 736 84% 1.3% Oxytocin Injection 657 74% 1.6% Mama Kit 957 63% 1.0% Note: % expiry - percentage of facilities the reported on expiry DISTRICT LEAGUE TABLE Note: The district league table ranks districts based on the percentage of facilities with over 95% availability within the district.