The role of procurement processes on the availability of modern contraceptives in lower level public and private health facilities in Kampala, Uganda.
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Introduction: Access to quality contraceptives in health facilities is important in improving maternal and child health in Uganda. In 2010, the Uganda government committed to improving contraception by increasing budgetary allocation for contraceptives to more than 100%. The aim of this study was to investigate how procurement operations affect availability of modern contraceptives in public and private health facilities in Kampala city, Uganda. Methods: A cross-sectional mixed methods study was conducted in 5 public and 5 private facilities. Facility functionality of the procurement processes was assessed using capacity indicators and compliance to the standard Health Management Information Systems 2010 manual. Facility stock status was assessed by comparing monthly stock-out frequency of five efficacious modern contraceptives for the period between 2011-2014. Causes of contraceptive stock outs were investigated through key informant interviews. Qualitative data was analyzed using thematic content analysis. Stata 12 was used for descriptive analysis of quantitative data Results: Public health facilities had better capacity for their procurement processes to function compared to Private health facilities. 80% of public facilities were compliant to standard procurement processes while only 20% of private facilities were compliant. Public facilities suffered the highest proportion of stock-out balances in oral pills (50%) and condoms (29%) while in private facilities most stock-outs where in Injecta Plan (30%) and copper IUD (19%). The major causes of stock-outs in both public and private facilities included lack of co-ordination in procurement levels, errors of omission on the order forms and failure to place orders. The key remedies identified included exclusive adherence to all process standards and co-ordination at all contraceptive procurement levels. Conclusion: Standard procurement processes at the facility have a limited role in the availability of modern contraceptives. There is need to strengthen coordination between suppliers and facility personnel while monitoring the contraceptive procurement processes in order to realize maximum availability.