Availability of antimalarial medicines and inventory management at the community level: a case study of Bugesera district in Rwanda.

BACKGROUND: Malaria is a public health hazard globally, with Sub-Saharan Africa accounting for more than 90% of malaria deaths, primarily affecting children under the age of five. In Rwanda, malaria interventions include the availability of antimalarial medications, notably Artemisinin-based combination treatments (ACTs) and quick diagnostic test kits (RDTs). However, the availability of antimalarial medicines and its related inventory management at community level in Rwanda has yet to be identified. METHODS: The study was conducted using a descriptive cross-sectional research design. The study involved the Community Health Workers (CHWs) in Bugesera District, working as a team of one male-female pair called Binômes. CHWs provide Integrated Community Case Management (iCCM) and treatment of Malaria in the villages. The sample size was 295 and respondents were selected using convenient random sampling from 15 sectors of Bugesera District, each cell being represented. A structured research questionnaire was used to collect data. The questionnaires were filled by CHWs who were available for this study at the time of data collection. Collected data were exported to SPSS version 26 for coding and analysis. RESULTS: The CHWs reported to be actively involved in managing the antimalarial medicines inventory. Overall, 64.1% of CHWs indicated that the population could easily obtain antimalarial medicines from community health workers and 31.2% attested that people could also obtain antimalarial medicines from the health centers. Majority of respondents 78% confirmed that the CHWs had the appropriate storage conditions for antimalarial medicines, while the overall stock out recorded was 3.20%. Furthermore, CHWs described some challenges, including but not limited to, lack of appropriate or dependable transportation and inappropriate medicines storage. Transportation was reported as a critical barrier for accessing antimalarial medicines. The majority, 70,85% travel on foot while 25.4% reported that CHWs walk for a distance between 1 and 2 h for resupply of antimalarial medicines. CONCLUSION: This study investigated the availability of antimalarial medicines and inventory management challenges at community level in Rwanda. Addressing these challenges will reduce the rate of stockout and increase the availability of antimalarial medicine at community level. Appropriate storage, and reduction of stock out rate, will serve to strengthen the current CHWs system, and provide critical guidance for the evolution of CHWs' systems in Rwanda.

Factors that influence the availability of childhood vaccine in healthcare facilities at Tana River County, Kenya.

BACKGROUND: Routine vaccine is a cost-effective health intervention against vaccine preventable diseases (VPD). Tremendous gains have been realized since the introduction of vaccines. Despite the gains, access to the lifesaving commodity has remained a major obstacle globally. Various factors have been associated with vaccine stock-out. This research assessed the factors that influence the availability of vaccines in healthcare facilities at Tana River County in Kenya. METHODS: Cross-sectional design was adopted. Census sampling technique was used where all 61 immunizing healthcare facilities were included. The study was carried out in Tana River County which is located in the coastal part of Kenya. A structured questionnaire was used to collect the data. The researchers requested for authorization from relevant bodies and consent from participants. Data were collected, cleaned and recorded in Microsoft excel. STATA version 14 was used to analyze data. Both descriptive and inferential statistics were used in the analysis at 0.05 level of significance. RESULTS: The study revealed that 62.71% of the facilities experienced routine vaccine stock-out. There was statistically significant association between availability of vaccines and work experience (p = 0.001), training on immunization services (p = 0.027), catchment area map with target population displayed in the facility (p = 0.049), and use of target population method in vaccine forecasting (p = 0.004). The independent predictor of vaccine availability was work experience (p = 0.025). CONCLUSION: There was inadequate vaccine forecasting, vaccine stock management practices and accountability. Work experience was the main factor that affected their availability in the health facilities.

Factors affecting the availability of tracer health commodities in public facilities at Tana River County, Kenya.

BACKGROUND: Delivery of quality healthcare is significantly based on the level of commitment among health facilities. This includes building a strong system with the continued availability of tracer commodities. Human resources, financing, health information provision, and technologies integrated into the care environment have been vital in defining improved care. METHODS: This was a cross-sectional study conducted in health facilities in Tana River County. A census method was used where all 62 health facilities across different tiers of healthcare delivery were considered. Out of 62 facilities, 60 participated in the study. A structured questionnaire and a checklist were used to collect data. Data were analysed using both descriptive and inferential statistics at 0.05 level of significance. Statistical Package for Social Sciences version 26 was used for data analysis. RESULTS: Majority of the participants were nurses (71.7%), male (68.3%), and diploma holders (78.3%). The mean availability of the tracer commodities was 68.73%. The human resource-related factors influencing availability were personnel training on commodity management (ß = 4.56, 95%CI 2.29-11.21, p = 0.012) and presence of pharmaceutical technicians dispensing commodities (ß = 2.85, 95%CI 1.29-5.21, p = 0.005) Financial factors investigated revealed that those who were in county hospitals (ß = 19.11, 95%CI 7.39-30.83, p = 0.002) and facilities which has disbursement of budgetary allocation on time (ß = 12.08, 95%CI 3.11-23.57, p = 0.002) had higher availability of tracer commodities. CONCLUSION: There was moderate availability of tracer commodities which was influenced by training, personnel, level of the facility, and budget allocation on time.

Factors affecting provision of female family planning commodities in public health facilities in Kajiado county, Kenya.

BACKGROUND: Family planning involves the use of traditional or modern methods to prevent maternal and infant mortality associated with unintended pregnancies and negative economic outcomes. In sub-Saharan Africa, the unmet need for modern family planning is approximately 66%. However, information on factors affecting utilization of female family planning commodities is limited. Therefore, this research was conducted to bridge this gap. METHODS: Health facility-based descriptive cross-sectional research design was conducted and involved the public health facilities offering family planning, targeting respondents who handle the commodities and service providers themselves. A semi-structured questionnaire was used to collect data about availability of the commodities, knowledge of service providers and barriers affecting provision of the service. Data were coded and analyzed via Microsoft Excel 2019 and SPSS version 20. RESULTS: The study showed that shorter term methods were more readily available, 60-75% than the long-term methods, 20-60%. Approximately 60% of the service providers did not comprehensively utilize the recommended World Health Organization Medicine Eligibility Criteria (WHO MEC) during service provision. Stock outs, myths and misconceptions, male interference and culture were the major barriers identified. CONCLUSION: Provision of family planning commodities in public health facilities in Kajiado county is affected by stock levels at the national program, and provider knowledge on WHO MEC. The key factors affecting provision of family planning were stock outs, myths and misconceptions on the contraceptives, inadequate male involvement and inadequate community engagement on potential benefits of the service. These challenges need to be part of the solutions to bridging the gap identified.

The capacity of young national medicine regulatory authorities to ensure the quality of medicines: case of Rwanda.

BACKGROUND: Access to quality medicines is a global initiative to ensure universal health coverage. However, the limited capacity of National Medicines Regulatory Authorities (NMRAs) to prevent and detect the supply of poor-quality medicines led to the predominance of sub-standard and falsified (SF) medicines in the supply chains of many countries. Therefore, this study was designed to assess the capacity of a young NMRA to ensure the quality of medicines with Rwanda as a case study. OBJECTIVE: This study aimed to assess the capacity of the Rwanda FDA, a young NMRA, to identify gaps and existing opportunities for improving regulatory capacity and ensuring the quality of medicines. METHODS: This study used a descriptive cross-sectional design with both quantitative and qualitative approaches. The quantitative approach used a self-administered questionnaire to collect data from employees of Rwanda FDA who are involved in medicine regulatory practices based on their positions while the qualitative research approach covered a desk review of key regulatory documents. The data collection tool was developed from the World Health Organization (WHO) Global Benchmarking Tool (GBT) for "Evaluation of National Regulatory System of Medical Products Revision VI". RESULTS: Of the 251 WHO sub-indicators assessed, 179 sub-indicators (71%) were fully implemented, 17 sub-indicators (7%) were partially implemented, 9 sub-indicators (4%) were ongoing and 46 sub-indicators (18%) were not implemented by the time of the study. The results of the study showed that the estimated maturity level at which Rwanda FDA operates is maturity level 2. The study reported the challenges hindering the implementation of key regulatory functions that need to be addressed. Challenges reported include but are not limited to understaffing, lack of automation system, poor implementation of the quality management system, lack of screening technologies for SF medicines, low capacity of the quality control laboratory to test all sampled medicines and lack of regulatory inspection tools/equipment. CONCLUSION: Findings indicated that all key regulatory functions were operating and supported by the legal framework. However, the implementation of key regulatory functions faced challenges that need to be addressed for better organizational effectiveness and compliance with the requirements of a higher maturity level.