RESUMO
BACKGROUND: Health supply chain is crucial for proper functioning of a health system and advancing national and international health security goals. The Coronavirus 2019 pandemic caused major challenges for health supply chain systems in Uganda and globally. OBJECTIVES: This study involved literature review to examine how the electronic logistics management information system and related digital systems were harnessed be best support public health emergencies. METHODS: We describe how the health supply chain system leveraged the emergency Electronic Logistic Management Information System developed during the Ebola epidemic in 2019 to support the COVID-19 response in Uganda. The findings are based on the analysis of reports, guidelines, and discussions with stakeholders involved in implementing the electronic Management Information System during the COVID-19 response. Lessons and experiences are shared on how the system supported data visibility, use and health commodity management. RESULTS: A web-based emergency Electronic Management Information System was developed to support the supply chain system during preparedness and response to the Ebola Virus. The system facilitated coordination, information management and provided real-time data for planning, decision making, and distribution of commodities during the COVID-19 response. To address any human resource challenges, 863 staff were trained and mentored in the use of the system. The system enabled the Ministry of Health to track the distribution of Medical Counter Measures through the warehouses, eight regional pre-positioning centers, and over 2000 user units in 136 district vaccine stores. In addition, the system provided quality data for the quantification and monitoring of commodities at all levels of care. Over 1800 bulk orders were processed through the system. Real time stock status reports were transmitted from all national, regional, district and health facility levels. Procurement tracking reports, stock gap analysis and partner contribution were all accessible and visible in the system. This supported the Ministry of Health's resource mobilization and coordination efforts. CONCLUSIONS: Availability of reliable, quality real-time data are essential for effective decision making during public health emergencies. The emergency Electronic Logistic Management Information Systems supported health authorities to mount coordinated and effective responses to ensure timely availability of commodities and supplies to support the COVID-19 pandemic response. Lessons learnt from the Ebola epidemic response were translated into actions that enabled effective preparedness and response to the COVID-19 pandemic.
RESUMO
BACKGROUND: Health supply chain systems are essential for effective and efficient healthcare system by ensuring availability of quality essential medicines and health supplies. While several interventions have been made to ensure the availability of quality essential medicines and health supplies, health facilities continue to report stockouts in Uganda. OBJECTIVES: This study aimed to assess the status and performance of the supply chain system across all levels of care in health facilities in Uganda. METHODS: This was a cross-sectional study conducted in 128 public and private-not-for-profit health facilities across 48 districts in Uganda. These facilities included all levels of care from Health Centres II, III, IV, general and referral hospitals, and national referral hospitals. Data were collected using desk reviews, health facility surveys, and key informant interviews with key personnel. Stock registers were reviewed to assess the availability of a basket of essential medicines based on the essential medicines list of the Ministry of Health. RESULTS: Less than half (42%) of health facilities had computer hardware. Most (84%) of health facilities were using a form of Logistics Management Information System with only (6%) were using the Electronic Logistics Management Information System. Just under a third (33%) of health information officers and (51%) of public health officers' positions were filled in the health facilities. Nearly (66%) of health facilities used supply chain data to support decision-making. Most (84%) of health facilities reported stockouts of Essential Medicines and Health Supplies in the past 6 months. The main reasons for stockouts were (59%) a sudden increase in demand (40%) delivery gaps/delayed deliveries and (35%) discrepancies in orders and deliveries. Health facilities responded to stockouts through various means including (75%) redistribution (43%) purchased from a distributor, and (30%) placing emergency orders. CONCLUSIONS: The findings from this study show that the performance of health facilities in different supply chain processes and functions was defective. To improve the supply chain performance of health facilities, it is important to invest in infrastructure development, provide computer hardware and internet connection and strengthen the capacity key personnel. This is key for ensuring full functionality of the supply chain and availability of quality medicines and health supplies to the end-user.
RESUMO
BACKGROUND: In late 2010, Uganda introduced a supervision, performance assessment, and recognition strategy (SPARS) to improve staff capacity in medicines management in government and private not-for-profit health facilities. This paper assesses the impact of SPARS in health facilities during their first year of supervision. METHODS: SPARS uses health workers trained as Medicines Management Supervisors (MMS) to supervise health facilities and address issues identified through indicatorbased performance assessment in five domains: stock management, storage management, ordering and reporting, prescribing quality, and dispensing quality. We used routine data generated during SPARS visits to 1222 health facilities to evaluate performance changes during the first year of supervision as well as the time until achieving an adequate score in this period. We also explored variables related to facilities, MMS, and intensity of implementation as predictors of performance improvement and time until achieving an adequate score. RESULTS: Health facilities received an average of 3.4 MMS visits during the first year of supervision, with an average of 88 days between visits; each MMS implemented a median of 28 visits per year. Overall SPARS scores (maximum of 25) improved by 2.3 points (22.3%) per visit from a mean baseline score of 10.3. The adjusted improvement in overall SPARS score was significantly higher in primary health care facilities (2.36) versus higher-level health facilities and hospitals (2.15) (p = 0.001). The incremental improvement was highest at visit 2, with decreasing but continuing positive gains in subsequent visits. The adjusted mean incremental improvement per visit was highest in the prescribing quality domain, followed by dispensing quality, ordering and reporting, stock management, and storage management. Adjusted improvement in SPARS scores varied by region, year of implementation, and facility ownership. After one year of SPARS, 22% of facilities achieved an adequate score of 18.75 (75% of maximum score). CONCLUSIONS: SPARS was effective in building health facility capacity in medicines management, with a median overall improvement of almost 70% during the first year. The greatest improvements occurred in prescribing quality and at lower levels of care, although the highest level of performance was achieved in storage management. We recommend broad dissemination of the SPARS approach in all Ugandan health facilities as well as in other countries seeking a practical strategy to improve medicines management performance.
