Determinants of Drug Stock-outs in Ugandan Public Health Facilities

Abstract

The objective of the study was to identify factors associated with drug stock outs in Ugandan public health facilities. The study adopted and used secondary data sourced from the National Service Delivery Survey (2015). The study utilized information collected on facility and staffing factors where drug stock-outs was the dependent variable assessed using a summative score index of 14 drugs at the health facilities. Furthermore, analysis was done using frequency distributions, summary statistics, the kruskal -wallis test and the negative binomial model. The functional forms of the continuous variables were determined using the multivariable factorial polynomials. In the results, the median drug stock outs at the health facilities was 4 drugs (0-14). The highest proportion (70.9%) of the facilities in the study had no functional transport means which may have yielded to the majority (64.8%) of the health facilities not receiving all the drugs that were ordered/expected. In the multivariate analysis, drug stock-outs were more likely among health centre IIIs (IRR=1.2) as compared to health centre IIs. Drug stock-outs showed an increasing trend for the health facilities receiving an average number of OPD patients to a point of 20,000 OPD patients in a month (IRR=1.5). Furthermore, the health facilities that never received all the requested/ordered drugs were more likely (1.2) to have drug stock-outs. The facilities located in the eastern region were more likely (IRR=1.2) to have drug stock-outs as compared to the health facilities located in the central region. Lastly, the facilities in need of more than one pharmacist/dispenser were more likely (1.1) to have drug stock-outs. On the other hand, drug stock outs were less likely among hospitals (IRR=0.7) as compared to health centre IIs. In conclusion, health facility levels, number of OPD patients received at the facility, reception of all requested drugs, presence of a pharmacist/dispenser at the health facility and location of a health facility by region have an impact on drug stock-outs at public health facilities. The government of Uganda should recruit more pharmacists/dispensers and also the staff responsible for the drug services at the facilities should adopt principles of the supply chain management to attain acceptable stock levels of essential drugs. For effective delivery of the drug service, the government should also ensure the availability of items and resources that are necessary for delivering the services such as equipment and drugs at health facilities. However, additional research is needed to ascertain the causal mechanisms that drive drug/medicine procurement and subsequent stock outs at different facility levels.