Supply Chain Challenges Affecting Access to IFA, Calcium, Oxytocin and Misoprostol in Kakamega County, Kenya.

ABSTRACT

Objectives: The broad objective was to assess components of the supply chain aiming at identifying facilitating factors and barriers to uninterrupted availability of IFA, oxytocic drugs, misoprostol, magnesium sulphate and calcium with a view of formulating innovative solutions. Methods: A cross-sectional design was used to conduct supply chain assessment in Kakamega County, Kenya. It included a random selection of 7 dispensaries, 8 health centres, 3 district hospitals and 1 referral hospital. Data was collected through record reviews, observations, key informant interviews and client exit interviews. Results: The study found glaring gaps in commodity forecasting and quantification, sub-optimal inventory management, and there were frequent prolonged stock outs. Commodity specific gaps were identified including lack of inclusion in the essential drugs list, absence of service delivery guidelines and a large proportion of commodities available in the market that did not meet the recommended dose composition for the intended purposes. For example, only 12% of the combined IFA formulations found in the market met the recommended doses for antenatal supplementation. There was also inadequate local manufacturing capacity of these commodities. Conclusions: In conclusion, there are glaring weaknesses in the supply chain. Streamlining the supply chain entails addressing policy issues, advocacy for local manufacture, strengthening forecasting and quantification capacity as well as a carefully thought out procurement processes.