Procurement, distribution and management of medicines in the health sub-districts under the decentralization system in Uganda; a case study of Iganga District.

Abstract

The general objective of the study was to examine the procurement, distribution and management of medicines in Health Sub Districts (HSDs) under the decentralized health care systems with the view of identifying the gaps in these processes and how they can be reduced or eliminated, in order to improve the general quality of health care in Uganda. The specific objectives were: (1) to examine the methodology of medicines selection, quantification, ordering and financing in the HCs, (2) to establish the medicines delivery and distribution practices in the HCs, (3) to establish the medicines physical storage conditions, Procedures and Health Management Information system (HMIS), (4) to examine the human resource capacity to manage medicines in the HCs and (5) to solicit the patient’s perceptions and their suggestions. The study was cross sectional and employed qualitative and quantitative research design. Twenty nine key informants were purposively selected from three categories i.e. (a) from national agencies such as MOH and NMS, (b) from District stakeholders and (c) from the Health centers (HCs) themselves. Data was solicited from them using semi structured questionnaires and in-depth interviews. Other informants were patients in the Public, Private not for Profit (PNFP) and Private for Profit (PFP) HCs. Focus group discussions (FGDs) were organized and data was obtained using interview guides. Additionally, a total of 16 HCs (both public and private) were randomly selected and visited to ascertain their storage facilities, procedures and HMIS. Observation checklists were used in this investigation. Content analysis was used to analyze qualitative data, while the descriptive statistical method (SPSS) was used to analyze quantitative data. The findings from Public, PNFP, and PFP HCs were presented and the two systems compared in respect to service delivery. The results were as follows: (a) there are numerous irregularities in medicines selection, quantification, ordering and financing especially in public health systems which lead to medicines stock outs, (b) The delivery and distribution of medicines from the source up to the end users in public HCs is ineffective which leads to damage, theft and delays causing regular stock outs, (c) The personnel who handle medicines in all the HCs lack adequate skills,(d) Patients showed more satisfaction with the level of availability and accessibility of medicines in PFP HCs and generally the quality of health care provided in these facilities, than in the public and PNFP HCs. There are three major conclusions of the study. (1) There is need for well laid out procedures in medicines management to increase efficiency in delivery of health care to the targeted beneficiaries. (2) Uganda has many problems in the management of medicines which should be addressed as urgently as possible by the stakeholders. Finally, the study has revealed that there are many documents relating to management of medicines in Uganda, which cannot be easily accessed by the stakeholders in this field hence the need to summarize them into a hand book for ease of reference.