Exploring the role of ICT in pharmaceutical supply chain practices and operational performance in Ethiopia: a structural equation modeling approach.

BACKGROUND: A well-coordinated supply chain ensures the sustainable availability of life-saving medicines that improve public health outcomes. Information Communication Technology (ICT) is one of the strategies for optimizing supply chain coordination. However, there is a paucity of data on how it affects supply chain practice and performance at the Ethiopian Pharmaceutical Supply Agency (EPSA). OBJECTIVE: This study aimed to explore the relationships between information and communication technology, supply chain practice, and pharmaceutical supply chain operational performance using a structural equation modeling approach. METHODS: We conducted an analytical cross-sectional study between April and June 2021. Three hundred twenty EPSA employees participated in the survey. We used a pretested, self-administered five-point Likert scale questionnaire to collect the intended data. A structural equation modeling confirmed the relationship between the constructs (information communication technology, supply chain practices, and performance). Thus, the measurement models were first validated using exploratory and confirmatory factor analysis in SPSS/AMOS software. A p-value of less than 5% indicated statistical significance. RESULTS: Of the 320 questionnaires distributed, 300 participants (202 males and 98 females) duly responded. In this survey, supply chain practices (mainly customer relationship management and information sharing) and ICT had significant positive direct effects on operational performance with standardized regression weights (ß) of 0.65 (p < .001) and 0.29 (p < .001), respectively. On the other hand, 73% of the variations in operational performance were explained by ICT and supply chain practices, wherein ICT played moderate mediation effects between supply chain practice and performance (VAF = 0.24, p < .001). Despite the significant positive influence of ICT, the agency still faced data visibility problems with customers and other supply chain partners. CONCLUSION: The findings revealed that supply chain practices and ICT implementation impacted the agency's supply chain performance positively and significantly. The ICT implementation practice in the agency posited a significant positive partial mediating role between supply chain practice and operational performance. Thus, if the agency focuses on the automation and integration of customer relationship management and the practice of information exchange, the essential supply chain practices, it can further improve operational performance.

Inventory management performance for laboratory commodities and their challenges in public health facilities of Gambella Regional State, Ethiopia: A mixed cross-sectional study.

Background: Sustaining an adequate inventory level of laboratory commodities is critical as 70% of medical decisions are made using laboratory-related information. However, millions of populations in developing countries still do not get elementary laboratory services due to the inaccessibility of laboratory commodities. Hence, this study aimed to assess inventory management performance and challenges for laboratory commodities in public health facilities of Gambella regional state, Ethiopia. Method: A health facility-based descriptive cross-sectional study was conducted using a mixed quantitative and qualitative method in seventeen public health facilities of the Gambella regional state between May and July 2021. Data were collected from documents, health professionals, and health care facilities' warehouses. Quantitative data were analyzed using Excel spreadsheets version 14 and SPSS version 23. In the qualitative part, 18 key informants were interviewed, and data were analyzed using thematic analysis techniques. Result: The average availability of laboratory commodities on the day of the visit was 60.39% in health facilities. Over the past year, 12.94% (37,488.76 US$) of laboratory commodities were wasted due to damage and expiration, while the average stock out date was 58 days. The average accuracy, completeness, and timeliness of the report and requisition form were 49%, 71%, and 64%, respectively. The health facilities had attained only, 68.2% of the storage conditions criteria. Lack of adequate and committed staff, budget constraints, insufficient storage space, frequent shortages of commodities from the suppliers, lack of frequent supervision, and feedback from higher officials were the main challenges for inventory management of laboratory commodities. Conclusion: The inventory management for laboratory commodities was inadequate, which was disclosed by inaccurate records and reports, stock-outs, high wastage rate, lack of adequate staff, budget constraints, and unacceptable storage conditions criteria. The study result suggests strict and close monitoring is needed to improve the inventory management performance for laboratory commodities at health facilities.

The mediating effect of information sharing on pharmaceutical supply chain integration and operational performance in Ethiopia: an analytical cross-sectional study.

BACKGROUND: Information is crucial in enhancing partnership, reducing uncertainties and inventory costs, improving order fulfillment, and increasing customer satisfaction. However, there is a scantiness of studies on how information sharing affects pharmaceutical supply chain practices and performance. Hence, this study aimed to examine the mediating effect of information sharing between supply chain integration and operational performance. METHOD: We conducted an analytical cross-sectional study complemented with a qualitative assessment between May and July 2021. The study populations (n = 343) were selected employees working at the Ethiopian pharmaceutical supply agency's head office and selected hubs. The quantitative data were collected by self-administered five-point Likert-scale questions and analyzed using SPSS®-version 23. The mediation effect was determined using sequential linear regression based on the Baron and Kenny stepwise approach. A 95% confidence interval and a p-value less than 5% were used to determine statistical significance. We gathered the qualitative data through in-depth face-to-face interviews with nine key informants and analyzed them using a thematic analysis technique. RESULTS: Among 320 completed questionnaires returned (with a response rate of 93%), we used 288 in the analysis. Of the respondents, 97 (33.7%) disagreed that information sharing with the agency is simplified. One hundred seventeen (40.6%) disagreed that customers share information via an online system. Most respondents (76.4%) agreed that internal integration in the agency reduced total order time. Information sharing (ß = 0.270, p < 0.001), customer integration (ß = 0.265, p < 0.001), and internal integration (ß = 0.151, p < 0.001) were predictor variables that had a direct positive effect on operational performance. Information sharing posited a partially mediating role between customer integration and operational performance with ß = 0.136 at p < 0.001. Data quality problems, human-resource-related issues, and natural and human-made calamities were the major challenges affecting information sharing and the overall supply chain practices. CONCLUSION: Customer integration, internal integration, and information sharing influenced operational performance positively. Although coordination among the units in the agency is reasonable, there was a lack of communication and quick response from partners, as well as data quality problems and the absence of an automation system in most health facilities. The key informants suggested end-to-end supply systems connections with partners through Enterprise Resource Planning and other means.

Health Professionals' COVID-19 Vaccine Acceptance and Associated Factors in Tertiary Hospitals of South-West Ethiopia: A Multi-Center Cross- Sectional Study.

BACKGROUND: Acceptance of the COVID-19 vaccine by health professionals highly influences the communities' decision to receive the vaccine, because health professionals are perceived to be a reliable source of health information. Hence, this study aimed at assessing COVID-19 vaccine acceptance and associated factors among health professionals in two tertiary hospitals in southwest Ethiopia. METHODS: A cross-sectional study was conducted among 319 health professionals working in Jimma University Medical Center and Mizan-Tepi university teaching hospital, southwest Ethiopia, from June 30, 2021 to July 30, 2021. Data were collected by a structured self-administered questionnaire and analyzed by SPSS version 23. A multivariate logistic regression model was used to identify independent factors associated with health professionals' covid-19 vaccine acceptance. Variables with P-value < .25 on univariate analysis were candidates for multivariate logistic regression. Then, variables with P-value < .05 at 95% CI in multivariate logistics regression were considered statistically significant. RESULTS: Of the total participants, 232 (72.73%) received COVID-19 vaccines. Among non-vaccinated health care professionals, 82 (94.3%) of them stated, worries about the safety and side effects of the vaccines, as the reason for non-acceptance. Factors such as, friends or families diagnosed with COVID-19 (AOR = .086; CI: 95%, .041-.18; P = .001), and attitudes and beliefs about COVID-19 and its vaccine (AOR = .129; CI: 95%, .037-.449; P = .001), were significantly associated with the acceptance of COVID-19 vaccine. CONCLUSION: More than one-fourth of health professionals who did not accept COVID-19 vaccines require immediate intervention through awareness creation on the safety and adverse effects of the vaccine by the government and other stakeholders. Otherwise, the community may in large reject the vaccine as they trust health professionals.

Procurement Practice of Program Drugs and Its Challenges at the Ethiopian Pharmaceuticals Supply Agency: A Mixed Methods Study.

BACKGROUND: Effective drug procurement guarantees the sustainable supply of products for health and eliminates excessive costs. However, there is limited information on the area of pharmaceutical procurement practice in Ethiopia. Thus, this study aimed at assessing the procurement practices of program drugs and its challenges at the Ethiopian Pharmaceuticals Supply Agency. METHODS: A cross-sectional study accompanied by qualitative assessment was conducted between February 21 and April 20/2020 to examine the procurement practice of the Ethiopian pharmaceutical supply agency. The quantitative data were gathered by reviewing documents and electronic records. Mean forecast error, price paid to international price reference, number of emergency orders placed, and lead time variability were the measurements used to assess the procurement practice. A statistical package for the social sciences version 23 was used to analyze the data. The results were then summarized using tables and texts. The qualitative data were collated through face-to-face in-depth interviews to explore the challenges behind the procurement practice. And the data were analyzed manually using the thematic analysis technique. RESULTS: The agency had its own procurement list which defines the items to be procured. The overall mean forecast error in the 2018/19 budget year was 27.8%. Of the 70 program commodities included in the study, 52 (74.3%) items had a mean price less than the international price reference. Three of the 14 orders (21.4%) placed in the aforementioned year were emergency purchases made through direct procurement. The mean lead time for the suppliers of the agency was 137.3 days. Poor data quality from service delivery points, staff capacity constraints, communication problems, and policy issues became the major challenges to implement an effective procurement system in the agency. CONCLUSION: The procurement practice at the agency has strong side. However, it was not without weaknesses. Using a procurement list is a worthwhile practice. Despite this, much remains to improve lead times and forecasting accuracy.

Matrix analyses of pharmaceutical products for the years 2017 to 2019 among public health facilities in Hadiya zone, Ethiopia: a cross-sectional descriptive study.

BACKGROUND: To date, global healthcare spending becomes a primary concern, and pharmaceutical costs are the main drivers. The issue is more pressing in developing countries like Ethiopia. However, there is a scantiness of comprehensive data on inventory control practices in health facilities. This study, therefore, aimed to assess the criticality, financial value, and consumption patterns of pharmaceuticals using inventory matrix analyses and explore the related challenges. METHODS: A cross-sectional study supplemented with qualitative assessments was carried out from December 2020 to January 2021 in public health facilities. Three hospitals and 14 health centers were proportionally selected using a simple random sampling technique. Self-administered questionnaires and review of logistics documents and databases like Dagu-Facility were used to obtain the quantitative data. The data were analyzed using excel spreadsheets and SPSS version 23. We gathered the qualitative data through face-to-face in-depth interviews. RESULTS: The facilities spent 66,312,277.0 Ethiopian birrs to procure 518 pharmaceuticals between 2017 and 2019. Of the total products, 68 (13.1%) belonged to class A and 353 (68.1%) belonged to class C. Among 427 items identified by VEN analysis, 202 (47.3%) were vitals, and 201 (47.1%) were essential products making the highest proportions. Cross-tabulations of ABC and VEN showed that 230 (53.9%) items formed category I, representing 84.3% of total expenditures. Sterile surgical gloves #7.5, amoxicillin capsules, examination gloves, and 40% dextrose injection were among the top-ten high-value closing inventories, accounting for 21% of class X items. The fast-moving items were the most prevalent in all years, accounting for more than 45%, and shared the maximum expenditure, up to 90%. Scarcity of infrastructure and skilled human resources, shortage of pharmaceuticals and problems with suppliers, and management issues were the major challenges in the health facilities. CONCLUSION: Most of the items identified by ABC-VEN and FSN-XYZ were Category one, i.e., mainly vital costly products and a few fast-moving items with high closing inventory values, respectively, suggesting close supervision. However, several issues became impediments. Hence, facilities should alleviate the bottlenecks and monitor the stock status to prevent theft and stock out.

Medication counselling practices amid COVID -19 pandemic and associated factors in drug retail outlets of Jimma town, Southwest Ethiopia: cross-sectional study.

Background: Patients' good understanding and awareness of drug information received at the drug retail outlet is paramount to gaining expected outcomes. In the COVID-19 pandemic, the routine counselling practice faced multifactorial challenges. Objectives: The study aimed to assess medication counseling practice and associated factors in drug retail outlets of Jimma town, southwest Ethiopia. Methods: A facility-based cross-sectional study was conducted using an interviewer administered questionnaire. The data were analysed by using SPSS version 23. A multivariable logistic regression model was used to identify factors associated with medication counselling practice. Results: A total of 180 pharmacy professionals were enrolled in the study, about half (51.1%) of the participants reported good medication counselling provision for their patients. In A multivariable logistic regression analysis, reduced pharmacist's level of communication (AOR=0.008; CI: 0.001-0.292; p= 0.009) and shortage of personal protective equipment (AOR=0.021; CI: 0.002-0.226; p=0.002) due Covid-19 were factors associated with poor medication counselling practice. Conclusion: Reduced level of communication and shortage of personal protective equipment due to Covid-19 were factors associated with poor medication counselling practice. In general, Jimma town health offices and Oromia Region Health bureau should struggle in association with other stakeholders to improve the identified bottleneck of pharmacist's counselling practice.

COVID-19's Negative Impacts on Clinical Learning and Proposed Compensation Mechanisms Among Undergraduate Midwifery and Nursing Students of Jimma University.

BACKGROUND: Even though lockdown measures contributed to reducing the rate of COVID-19 transmission, it resulted in great distraction in clinical learning. Thus, the aim of this study was to assess COVID-19's negative impacts on clinical learning, and proposed compensation mechanisms among midwifery and nursing undergraduate students of Jimma University, southwest Ethiopia. METHODS: This study was conducted among 147 midwifery and nursing students of Jimma University in March 2021 using cross-sectional study design. The respondents were selected by simple random sampling method. Data were collected by using a self-administered questionnaire and analyzed descriptively by SPSS v.23. The results were presented in tables, and narrated. RESULTS: Three fifths (88 (59.9%)) of the study participants perceived high negative impacts of COVID-19 on their recent clinical learning. The proposed compensation mechanisms to be implemented before and during the next clinical practice include: using teacher-facilitated skill demonstration laboratory, case scenarios, clinical teaching videos, and clinical conferences. Students' effort to understand the objectives of their clinical learning and using multi-media to achieve it was another proposed compensation mechanism. Also, providing pre-placement training and in-service training with priority for students graduating during COVID-19 pandemic were proposed compensation mechanisms. CONCLUSION: COVID-19's negative impacts on clinical learning were great among the participants of this study. The proposed compensation mechanisms should be applied by all concerned bodies with great emphasis to end the long-term negative impact of the pandemic, thereby ensuring the production of competent midwives and nurses.

Assessment of Inventory Management Practices at the Ethiopian Pharmaceuticals Supply Agency, Addis Ababa, Ethiopia.

BACKGROUND: Maintaining an adequate level of inventory is critical since an enormous amount of capital tied up with it. Having excess inventory leads to wastage. On the contrary, insufficient commodity leads to stock out. Hence, this study aimed to assess inventory management practices of program commodities at Ethiopian Pharmaceutical Supply Agency. METHODS: A descriptive cross-sectional study complemented with a qualitative method was conducted from February 21 to April 20/2019. Order fill rate, wastage rate, frequency of emergency order, acceptable storage condition met, and stock out were the metrics we used to measure the inventory management practices of the agency. Quantitative data were collected through physical observation of the warehouses and review of logistics management tools. Seventeen in-depth interviews were conducted to explore the challenges of inventory management. RESULTS: From the total 70 program commodities managed by the agency, 2.1% wasted due to expiration and damage. These resulted in a loss of over US $2 million. The highest wastage was recorded for antimalarials which accounted for 13.1% of the malaria commodities' total inventory value. Only 14.8% of the orders were fulfilled above 80%. Thirty-seven items were stock out on average for 8.5 average days. Longer duration of stock out (260 days) was recorded for TB commodities. Seventeen items from different programs were purchased through emergency orders with a higher frequency of levonorgestrel purchase. Only 6 (60%) warehouses met acceptable storage conditions. Space deficit, outdated warehouse designs, shortage of warehouse equipment, lack of precise data, and capacity building gaps were the inventory management challenges identified. CONCLUSION: Though the wastage rate was near to the acceptable range, there were lesser order fill rates, storage condition inadequacy, and significant stock-outs of program commodities. The finding implies the need for an improvement in inventory management practice of the agency.