partial fulfilment of the requirements for the degree of master of Business. Administration ...... Four pharmacy technicians were trained for data collection and.
WOLLO UNIVERSITY COLLEGE OF BUSINESS AND ECONOMICS DEPARTMENT OF MANAGEMENT
Determinants of Pharmaceuticals Inventory Control System Performance in Public health facilities of North Wollo and Waghimera Zones, Northern Ethiopia 2015
Submitted By: Samuel Getachew Workneh
Principal Advisor: Kassegne Damtie (PHD) Co-advisor: Abiwot Alemu (MA) Thesis submitted to Department of Management, College of Business and Economics, for partial fulfillment of the requirements for the Award of master of Business administration (MBA)
Dessie, Ethiopia June, 2015 1
Declaration I the under signed senior MBA student declared that this thesis is my original work in partial fulfilment of the requirements for the degree of master of Business Administration (MBA). Name :Samuel Getachew Workneh Signature………………….. Place
of
submission:
Wollo
University, college of
Business
and
Economics,
Department of management. Date of submission: June 4, 2015 This research thesis has been submitted for examination with my/our approval for Wollo University. Name
Signature
Kassegne Damtie (PHD)
………………….
Abiwot Alemu (MA)
………………….
I
Acknowledgement First of all I would like to honestly express my heartfelt gratefulness towards my advisors Kassegn Damtie (PHD) and Mr. Abiwot Alemu for their guidance and unreserved support during the need of support arose starting from proposal development to finalization process. Secondly I feel deeply grateful towards Ato Tatek Mulugeta and Wro Selamawit Mesfin North Wollo and Waghimera health department’s logistics officers respectively for their support of provided relevant information on facilities, area of study and facilitating the data collection, Ato Eshetie Shumye PFSA Dessie branch Manager, Ato Haile PFSA Dessie branch capacity building coordinator and Ato Mesfin Geto PFSA Dessie branch acting distribution coordinator for the information they have provided on training and capacity building related, distribution related, reference materials and arrangement of transportation for data collectors.
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Acronyms AIDS
Acquired Immune Deficiency Syndrome
APTS
Auditable pharmaceuticals transaction system
ART
Anti-Retroviral Treatment
ARV
Anti retro viral
DSM
Drug Supply Management
DTC
Drugs and Therapeutic committee
DU
Dispensing Unit
EDL
Essential Drug List
FEFO
First Expiry first out
FMOH
Federal Ministry of Health
HCMIS
Health Commodity Management Information System
HIV
Human Immune Deficiency Virus
ICS
Inventory Control System
IPLS
Integrated Pharmaceuticals Supply System
LMIS
Logistics Management Information System
NPPL
National Pharmaceuticals Procurement List
PFSA
Pharmaceutical Fund and Supply Agency
PHC
Primary Health Care
PLMP
Pharmaceutical Logistics Master Plan
SOP
Standard Operating Procedure
STI
Sexually Transmitted Diseases
TB
Tuberculosis
WHO
World Health Organization
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Table of contents Declaration……………………………………………………………………..........I Acknowledgement…………………………………………………………………..II Acronyms…………………………………………………………………………….III Table of contents…………………………………………………… …...…....IV, V List of tables…………………………………………………………………………VI List of Figures……………….……………………………………………………..VII List of Annex…………………………………………………………………. …..VIII Abstract………………………………………………………………………………IX Chapter One………………………………………………………………………….1 1. Introduction……………………………………………………………..………..1 1.1 Back Ground of the study……………………………………………….1 1.2 Statement of the Problem………………………………………………..3 1.3 Objectives……………………………………………………………………5 1.3.1 General Objective……………………………………………………..5 1.3.2 Specific Objectives…………………………………………………....5 1.4 Hypothesis of the study…………………………………………………..5 1.5 Significance of the study…………………………………………………6 1.6 Scope of the study…………………………………………………………6 1.7 Limitation of the study…………………………………………………...7 Chapter Two, Literature Review………………………………………………….8 3. Conceptual framework………….…………………………………………….14 IV | P a g e
Chapter Three, Research Methodology ……………………………………..15 3.1 Study Design……………………………………………………………...15 3.2 Population of Study……………………………………………………...15 3.3 Sampling size and sampling technique……………………………..16 3.4 Instruments……………………………………………………………….16 3.5 Data collection procedure……………………………….……………..16 3.6 Pretesting of questionnaire…………………………………………....17 3.7 Data processing and analysis………………………………………...17 3.8 Operational definitions…………………………………………………17 3.9 Ethical consideration………………………………………………......20 3.10 Dissemination and utilization of results …………………………20 Chapter Four, Data presentation and interpretation …………………...21 4.1 Socio-demographic profile……………………………………………..21 4.2 Relationship between Management support and ICSP………….24 4.3 Relationship between health service volume and ICSP………….28 4.4 Relationship between professional skills and ICSP………………30 Chapter Five, Conclusions and Recommendations………………………35 5.1 Summary………………………………………………………………….35 5.1 Conclusions………………………………………………………………35 5.2 Recommendations………………………………………………………36 References………………………………………………………………………….37 Annex ………………………………………………………………………………40 Assurance of principal investigator………………………………………….47
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List of Tables Table 3.1 Sampling Size Table 4.1 Model fitness Table 4.2 Sex of respondents and performance of inventory control system Table 4.3 Age and profession of respondents and performance of inventory control system Table 4.4 Management ownership and performance of inventory control system Table 4.5 Variables in the Equation Table 4.6 Store manager skill level and the performance of inventory control system Table 4.7 Health facility service volume and performance of inventory control system Table 4.8 Relation of predictors with the performance of ICS
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List of figure
Figure1. Conceptual framework
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List of Annex`s Annex 1: Individual consent form Annex 2: Questionnaires for determinants of pharmaceuticals inventory control system Annex 3: Assurance of principal investigator
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Abstract Inventory control system is the basic component of supply chain management which prevents the products form over stock, under stocking and wastage from expiry if proper implementation is ensured. The concept of inventory control system applied in different kind of products including pharmaceuticals with the aim of fulfilling the six rights of supply chain system. The system has long years of organizational application history in the world, in Ethiopia forced order max-min pharmaceuticals inventory control system employed before 8 years to improve long lasting weak pharmaceuticals supply chain management. In the area of pharmaceuticals supply chain management in general and inventory control system in particular, sufficient studies were not conducted in Ethiopia even though challenges existed till now. This study therefore conducted to determine the association and magnitude between determinant factors with performance of pharmaceuticals inventory control system among Public health facilities of North Wollo and Waghimera zone, where most supply problems were repeatedly reported. This was a census study of all hospitals and health centers in the selected area on determinants of pharmaceuticals inventory control system practice. Data was collected using a semi structured questionnaire for quantitative study set in Yes or No questions; descriptive statistics were used to describe the data and binary Logistics regression was used for analysis. Findings from this study indicate that management ownership level with B value 3.78, sign level of 0.001, odd ratio 43.8 in 95% CI (4.6,415) ,Professionals skill level B value 2.64, sign level of 0.005, odd ratio 14 in CI(2.2,88.6) have positive associations with pharmaceuticals inventory control system performance and the health facility service volume with -0.77,sign level 0.49, odd ratio 0.47 which is less than 1 in 95% CI (0.06,3.4) included 1 in the range has no association with the performance, it also revealed that the two variables which have associations with the independent variable are the significant determinant factors of the pharmaceuticals inventory control system performance in the two study zones.
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Chapter One: Introduction This chapter contains the back ground of the study, statement of the problem, objective to the study, research hypothesis, research justification, scope and definition of terms.
1.1 Back ground of the study In Ethiopia 90% of the population is dependent on the government to provide for their health care needs, mainly through primary health care facilities. The
provision of complete health care necessitates the availability
of safe, effective and affordable drugs and related supplies of the required quality. In the health objectives of the National Drug Policy, the government of Ethiopia outlines its commitment to ensuring availability and accessibility of medicines which are effective, affordable, safe and of good quality in all sectors of the health care system to improve the gaps we had in these areas. The federal ministry of health of Ethiopia initiated a comprehensive supply chain strategic planning process, emphasizing integration of all products into one supply chain. The Pharmaceutical Logistics Master Plan (PLMP) was approved by the Ministry in late 2006, and the Pharmaceuticals Fund and Supply Agency (PFSA) was established by proclamation in 2007. The Agency is mandated to “avail affordable and quality pharmaceuticals sustainably to all public health facilities and improve the management and use of drugs”. Active implementation of PFSA on the new mandates began in early 2009 and to endure the supply it started a single reporting and distribution system which is the integrated pharmaceuticals logistics system (IPLS) nationally. IPLS is the term applied to the single pharmaceuticals reporting and distribution system based on the overall mandate and scope of the PFSA. It aims to ensure that patients always get pharmaceuticals they need and integrates the management of essential pharmaceuticals those were used to be managed vertically before like, HIV/AIDS, Malaria, TB and Leprosy, EPI, MCH and purchased essential drugs. It is the primary mechanism through 1
which all public health facilities obtain essential and vital pharmaceuticals. Generally products included on the National pharmaceuticals procurement List (NPPL) are supplied and managed through the IPLS. IPLS of Ethiopia mainly focused on Logistics management information system
(LMIS),
Inventory
control
system
(ICS)
and
the
storage
of
pharmaceuticals in the health facilities and one of the first concrete steps to move the integrated system from concept to detailed implementation step was the development of the Standard Operating Procedures (SOP) Manual for health facilities of Ethiopia which clarifies the above three components. To sustainably supply pharmaceutical and support the IPLS Implementation for governmental health facilities, MOH of Ethiopia has established 15 PFSA branches in different regions which PFSA Dessie branch in Dessie town for Eastern Amhara region. The branch served for 21 high volume health centers, 250 low volume health centers and 9 hospitals in 54 Districts and provided direct supply to 86 health facilities including the high volume health centers and hospitals which have transportation access and through their district health offices to the others. Since the new system had been structured, the branch trained more than 500 professionals on IPLS and 100 WoHO and ZHD management bodies on orientation and supportive supervision of IPLS. It also providing intensive and continues support to health facilities and management bodies to Better implementation and institutionalize of the system. Even though unreserved support and reasonable budget allocation were provided by the government to improve the pharmaceuticals supply chain management there still complaints on poor implementation of the inventory control system and this study will cover the assessment of association between the determinant factors with the performance of ICS and identifying the associated factors affecting the performance in North and Waghimera zone public health facilities which the problem magnified there.
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1.2 Statement of the problem In health facilities be it small health posts or big teaching hospital drugs form an essential and indispensable resource elements, therefore the supply of medicines needs to be managed efficiently in order to prevent all types of wastage including overstocking, pilferage and expiry. These wastages reduce the quantity of medicines available to patients and finally negatively affect quality of health care they receive. Both under stocking or overstocking and expiry of medicines highlight problems within the entire supply chain activities which include selection, quantification, procurement, Inventory management, storage, distribution and use (Godeliver A.B and Kagashe ,2012). In health facilities about 40%-45% of the health budges allocated for procurement of pharmaceuticals to ensure the availability of essential drugs but due to inventory control is a difficult task and challenging in many countries public health facilities facing financial wastage, essential drugs shortage and decrease quality of patient care (J.F. Manso and J. Annan ,2012).Inventory management is the branch of business management concerned with planning and controlling of inventories. Inventory control is the process of managing inventory in order to meet customer demand at the lowest possible cost at a minimum investment with the objectives of minimize inventory investment, determine the appropriate of customer service level, balance supply and demand, minimize ordering cost and holding cost also preservation of inventory control system failure (SOP IPLS,2007). A well designed and operated inventory control system due to contribution on generating quality data, helps to prevent shortage, over supply and expiry of pharmaceutical (SOP of IPLS, 2007). Taking these benefits in mind in contrast to developed contents most of Asia and African countries due to poor skills of professionals and inefficient pharmaceutical inventory management practice in their health facilities, frequent stock out of life saving products, unnecessary tide up of budgets as a consequence of overstocking of products than the designed inventory maximum quantity 3|Page
and wastage of pharmaceuticals due to expiry were experienced repeatedly (Godeliver A.B et.al,2012) and (Ilma Nurul Rachmania et.al,2013). Inefficient Inventory control system of pharmaceuticals resulted poor health outcomes, wastage of scare resources in most of low and middle income countries (Jones Snow Incorporation, 2011). Studies in Indonesia showed the inventory management of pharmaceuticals found non efficient and due to this higher inventory costs, stock out of essential medicines resulted (Ilma Nurul Rachmania et.al,2013). In Africa frequent shortage of drugs which must be available 24 hours in a day and in all 365 days in a year identified, Cases reported in South Africa in May 2012 shortage of Anti-Retroviral drugs in six of the nations and in July 2012 Western Capes` Groote Schuur hospital experienced major drug shortages for essential medication such as insulin for the treatment of diabetes, steroids to treat inflammatory conditions and certain chemotherapy drugs related to Inventory control system inefficiencies and professionals work load (M.Kachwee,2013) . Due to the immense effort provided in the infancy implementation age of the new supply chain management system in Ethiopia, availability of drugs in government health facilities were reached 77% from below 50% (PFSA Dessie branch report, 2014). But different supportive supervisions reports indicated that indicators for existence of poor inventory control system like holding drugs for more than four months in their stock, failing to use stock recording formats and generating poor quality supply report data observed in government health facilities with worsen case in far sites from supplying agency. Skill problem, work load and loss management ownership were the major factors reasoned for the problem, (PFSA Dessie branch report, 2014). This study therefore conducted to analyze the association and magnitude between
determinants
factors
with
performance
of
pharmaceuticals
inventory control system among Public health facilities of North Wollo and Waghimera zone, North West Ethiopia in 2015.
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1.3.
Objectives of the study
1.3.1 General objective: To analyze the relationship between factors influencing effectiveness of inventory control with performance of pharmaceuticals inventory control system among Public health facilities of North Wollo and Waghimera zone, North West Ethiopia in 2015.
1.3.2 Specific objectives: 1. To analyze the relationship between facility and higher management system ownership/support/ to successful performance of pharmaceuticals inventory control system. 2. To investigate the relationship between health facilities service volume to the successful performance of pharmaceuticals inventory control system. 3. To analyze the association of staff skills to the performance of pharmaceuticals inventory control system.
1.4 Hypothesis of the study For the study on determining the effect of determinant factors on performance of ICS, 3 hypotheses were generated for test, management support(system owner ship), health facility service volume and skill of staffs and stated as follows:HO1: There is positive relationship between management support and the performance of pharmaceuticals inventory control system in public health facilities of North Wollo and Waghimera zone. HO2: There is positive relationship between health facilities service volume and the performance of pharmaceuticals inventory control system in public health facilities of North Wollo and Waghimera zone. HO3: There is positive relationship between skill of staffs and the performance of pharmaceuticals inventory control system in public health facilities of North Wollo and Waghimera zone.
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1.5 Significance of the study Proper implementation of pharmaceuticals inventory control system helps to prevent oversupply, understock and expiry of products and believed taking the lion share to improve the countries pharmaceuticals supply chain management system. In Ethiopia very few studies have been carried out on pharmaceuticals supply chain system in general and no sufficient studies were focused particularly on inventory control system especially in the northern part. The investigator therefore interested to assess determinant factors and analyze the association of factors with the performance of pharmaceuticals inventory control system aiming it has contribution to propose appropriate intervention
for
zonal
health
department
management
and
other
stakeholders working in the pharmaceuticals supply chain system in the area, to use study recommendations for improvement availability of essential drugs, wastage of resource and finally patient satisfaction on the service. It will also become an initial document for other researchers interested in the area to further discuss and suggest recommendations in improving performance of pharmaceuticals inventory control system.
1.6 Scope of the study Inventory control system varies from one organization to another and the nature of the firm the nature of items determines types of the system to adopt. The government of Ethiopia has introduced the forced order Max-min inventory control system for pharmaceuticals logistics supply for improving the management. The investigator focuses on analyzing the associations of the factors influencing the effectiveness of inventory control system with the effective performance of pharmaceuticals inventory control in public health institutions of North Wollo and Waghimera zone. The research included respondents who have been assigned to carry out pharmaceuticals stock control function in the health facilities and due to different demographic nature of the area the result of this research may not be generalized to apply 6|Page
to all public health facilities in the rest of Ethiopia, except for those in the same categories of district hospitals and downwards. The hospitals in the study area were not sophisticated like in other areas and the geographical effect may not be same as the study area. 1.7 Limitation of the study The study was limited with lack of adequate finance though we had to ensure maximum utilization of available limited fund with in the budget. We have also faced with a problem of getting all the information from the respondents because of potential suspicion that they might consider us as an investigator but we have tried to overcome by guaranteeing the respondents that secret of the organization will be preserved. Poor keeping of recording and reporting formats was also anther challenges we faced during the study and the last but not the least there was constraint of time to conduct the research study.
7|Page
Chapter Two: Literature Review It has proven in research that essential drugs have a major impact on common causes of frequent visit to health facility and deaths. The huge burden of illness due to acute respiratory infections, diarrheal diseases, malaria, sexually transmitted infection’s (STI), tuberculosis (TB), chronic diseases and other illnesses can be substantially reduced if essential drugs are available and properly utilized(IOMS,2008). According to the World Health Organization (WHO) standards, essential drugs are those drugs which the nation must have in sufficient quantities at all times for the management of the most common health problems that affects the greater number of its population (WHO,2003). Drugs have a special importance and need to be available the needy for the following reasons: •
Save lives and improve health outcomes,
•
Promote trust and participation of the people in health services,
•
Essential drugs provide a direct low cost response for many diseases
Considering these brief reasons for the importance of the availability of drugs, it is imperative that the management of drug supply follows a stringent process and implementing efficient pharmaceuticals supply chain management is indispensable, because it improves the pharmaceuticals logistics activities which in turn have quantifiable benefits. Well-functioning supply chain benefits public health programs by increasing program impact, enhancing quality of care and improving cost effectiveness and efficiency (Jones snow Inc., 2010) The ultimate purpose of effective pharmaceuticals logistics activities is aims to ensure that patients always get pharmaceuticals they need, to be successful, the system must fulfil the six rights of supply chain management by ensuring the right products, in the right quantity, of the right quality, at the right place, at the right time and for the right cost (SOP IPLS, 2007).
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In pharmaceuticals logistics supply management holds interrelated and cyclic logistics activities which are, serving the customer, product selection, quantification and procurement, inventory management and storage with in all activities recording and reporting under taking (Ilma Nurul Rachmania et.al,2013). Inventory management is the heart of pharmaceutical supply system, the specialist says it is pharmaceutical management activities and without it Pharmaceutical supply system as a whole will not be viable. Inventory management for pharmaceutical supply sounds easy all that must be done is to order, receive, store, issue and reorder limited list of items. In reality the task is difficult (Jones Snow,2011) and in many countries poor inventory management in public drug supply system lead to financial wastage, shortage of essential drugs,
decreased in quality of patient Care and
increased the inventory cost (FMOH,2009) and (WHO,2003). Lack of accurate stock cards, and systematic performance procedures and rules to guide staff, lack of understanding of basic issue of proper inventory management system are directly related to ineffective management (J.F. Manso and J. Annan,2012). Study conducted in Indonesia on Pharmaceuticals Inventory management issues
found
that
there
is
inefficient
inventory
management
of
pharmaceuticals in hospital due to less management awareness and this leads to increased inventory cost (Ilma Nurul Rachmania et.al,2013).A study done to assess pharmacy and inventory control in ministry of health hospitals in Jordan showed that medication quantification requirements are not estimated according to actual hospital needs and standard procedures related to poor inventory system. In addition there were improper stock recording practices in some hospitals due to poor skills (Godeliver A.B and Kagashe,2012). Study in Tanzania on Medicine stock out and inventory management in hospitals showed logistics skills levels of professionals who involved in supply chain was poor and pharmaceuticals inventories management was not effective and in turn it affects the availability of essential medicine 9|Page
(Godeliver A.B et.al,2012). Studies in South Africa and Kenya showed due to the inventory management system is by inappropriate professionals and lack of management ownership
difficulties in getting accurate records of
information and product flow, low availability of essential drugs were resulted and challenges to implement FEFO with expiration of huge stocks resulted, poor inventory practice greatly interrelated with to poor skill level of professionals, lack of management follow up, allocation of inappropriate type of professionals (Management sciences for health,2006). Literatures also evidenced that due to lack of appropriate skill, training gaps on the system and failed to deploying the required quantity of pharmacy professionals, appropriate data on drug consumption and stock position had not been collected regularly from the service center, which resulted serious consequence on the rational use of medicine, quantification and availability of medicine at health facilities of developing countries (J.F. Manso and J. Annan,2012). For these reasons it is very important to control the building up of inventory, Pharmaceuticals should be controlled by inventory management systems, items on shelves should be tagged with bin cards, the necessary information’s on the bin cards should be filled and update, the stock record cards should also show an up to date stock balance for received and issue items, there by resulting good inventory control which makes ordering and pharmaceutical management easier (M.Kachwee et.al,2013) Essential medicine programs place a high priority on improving inventory control to ensure the reliable supply of essential medicines and other item at health facility. To achieve this aim staffs need to be trained in inventory control, storage and ordering procedure, system monitoring should be in place, management ownership on the system should be improved; appropriate staff should be recruited (Management sciences for health, 2006). . The purpose of inventory control system at health facility level is to inform when to order or issue, how much to order or issue, and how to maintain appropriate stock level of all product to avoid shortage and over supply, (WHO,2003).In other way the purpose help to prepare orders, maintain 10 | P a g e
sufficient safety stock, maintain records accurately, adjust inventory level to new health problems and changes, provide appropriate, safe and secure storage, prevent expiry of medicine which demands management follow up, trained
and
committed
pharmacy
professional
for
the
system
implementation (Management sciences for health,2006). The management of inventory depends on information systems that provide feedback for tracking the storage and movement of goods at every level within the supply system and storage of medication ready for use in health facilities, ensuring proper stock rotation and medicine with dates so that items of earliest expiry dates are used first, as well as enabling managers to know the total amounts of drugs that are within the supply and where they are located thus allowing the possibility of redistribution and inventory records should be regularly updated to confirm that items are being used correctly and not diverted and misused (FMOH,2003). An inventory control model used to manage purchasing must address the pertinent issues A. Safety stock, How much stock will kept in reserve to prevent stock out B. Reorder frequency, period of time between each order C. Reorder quantity, the number of units ordered (Rob Whewell, 2012). Infrastructure
condition
including
storage
size
and
transportation
accessibility needs to be considered when determining, ordering and replenishment frequency. In pharmaceuticals supply system most common Inventory control models are. 1. Annual purchasing, a periodic review model with the interval set at once a year. 2. Scheduled purchasing, periodic review model in which ordered placed at prescribed intervals, such as weekly, monthly, quarterly biannually 3. Perpetual purchasing, a model in which a stock level are reviewed each time stock is issued (or at least weekly) and order are placed whenever stock falls below a minimum value. 4. Drawing dawn from framework contact, establish essential terms and contracts for procurement agreement such as timeframe, product specification, price, quantities and supplier performance (Management
11 | P a g e
sciences for health, 2006), where their application in different countries varies according to their available resources they have. The introduced integrated pharmaceuticals logistics systems in Ethiopia, drawn
from
supply
chain
management
system
concept
and
the
pharmaceuticals inventory control system designed to use forced order inventory control system which health centers and hospitals forced to submit supply report every 2 months to PFSA and health posts to report every month for their affiliated health center to get their pharmaceutical resupply, the maximum stock level of hospital and health center fixed to 4 months and 2 months for Health posts, the minimum stock level fixed to 2 months for hospitals and health centers and 1 month to health posts and emergency order level fixed to 15 days for hospitals, health centers and 7 days for health posts considering storage infrastructure of health facilities, transport access to health facilities and availability of health professionals, (SOP of IPLS,2007). To show improvement in operations, many supply chain management specialists consider implementing supply chain performance indicators or metrics as one of the simplest, least expensive, and least time-consuming activities. It is a well-known fact that, “people behave based on the way they are measured”. Global public health supply chains are no different; unless clear measurable indicators are in place (Rob Whewell, 2012). Positive health outcomes are highly dependent on how well the health delivery system health information, financing, personnel and supply chain (including supplies) are performing. The importance of having medicines and other supplies available at the health facility cannot be overstated, and their availability often depends on how well or how poorly the supply chain is performing, but to improve supply chain performance, you must understand how it is currently performing and it needs to be measured, (Jones Snow Inc.,2010). Several types of indicators have been developed to measure many supply chain and logistics activities but the recommend and holistic model is developed by Edward Frazelle in 2001, consists of four types of indicators: 12 | P a g e
quality, time, financial, and productivity which they need to work together (Kassie GM,2014). Quality indicators are often the simplest to measure and typically tell you how well you are performing a specific activity. As a quality indicator inventory
accuracy
rate
measure
of
inventory
control
system
in
pharmaceutical supply management (WHO report, 2007).Time indicator focus on the time it takes to complete specific activities, financial indicators help managers identify the supply chain cost drivers and help move toward a more efficiently managed supply chain and productivity one examines how well resources are used (Mohammad N, ARS,2004). Summarizing the literatures inventory serve as an insurance policy against the unexpected break through, delay and other disturbances that could disrupt ongoing activities. According to the review less management ownerships on system ownership, workload in the health facilities and gap on professional’s skills are some of the factors that limit effective inventory control system and generally it is important to have a good stock record system as it helps in preventing stock out, overstocking, deterioration, obsolescence and high currying cost. A sound stores record system is there for vital for procurement decision making. Effective stock records are important to an organization which expects to operate profitably or offer quality service. Late posting and poor data quality supply reports have undesirable effects.
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Conceptual frame work Management Ownership on the system
-System Follow up
Socio-demographic factors
-sex, age, educational level,
marital status and year of service
-No of management (DTC) meeting on supplies issues
Performance Health Facility service volume -Patient load of the HF`s -Number of DU`s issues drugs from the store
Of Inventory Control
Dependent Variable
Skills of staffs -Professional qualification, -Work experiences in the store -Training Independent Variables Figure one; factors affecting inventory control system performance adapted from Masakhalia O.C and Josephat k, 2012
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Chapter Three: Research Methodology This chapter describes the procedures that were used in carrying out this research. It deals with research design, population of the study, sampling frame, sample and sampling techniques, research instruments, data collection procedure, data processing and analysis, finally operational definition for measuring variables.
3.1 Study Design The study used descriptive survey design because the selected design is appropriate as it involves collecting data in order to answer questions concerning the current status of the subject of the study. Both quantitative and qualitative approach were used as there was need to describe, record, observe, analyze and interpret how the factors influenced the performance of inventory control system.
3.2 Population of the study The study was conducted in East Amhara region of North Wollo and Waghimera zones. North Wollo zone located in Northern part of Ethiopia with estimated population of 1,615,358 about 13% considered urban dweller and 87% rural inhabitant. Woldia town is the capital of the zone where 520 km far from the capital of Ethiopia (Addis Ababa),348 km far from Bahir Dar, the capital of Amhara region and 300 km far from Dessie where the supplying agency located. North Wollo zone has total of 65 health institutions from which 2 were Hospitals and 63 health centers. Waghimera zone located in North West Ethiopia with estimated population of 521,127, about 6% considered urban dweller and 94% rural inhabitant. Sekota town is the capital for the zone where 700 km far from Addis Ababa, Capital of Ethiopia ,408 km far from the Amhara region capital Bahir Dar and 300 km far from Dessie where the supplying agency located. Waghimera Zone has a total of 27 health facilities which 1 hospital and 26 health centers. The target population from which the information was solicited by researcher was ninety three staff involved in managing of pharmaceuticals
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and controlling inventory activities. The source of the study was also the same institutions in the two zones.
3.3 Sample Size and sampling technique The study sample were included all hospitals and health centers serving the people of the two zones which are 3 hospitals and 89 health centers with total of 92 health facilities. Censuses sampling technique which all items enumeration were employed to have information from each representative unit. Table 3.1 Sample Size Zone
Hospital
Health centers
Total
health
facilities North Wollo
2
63
65
Waghimera
1
26
27
Total
3
89
92
3.4 Instruments Semi structure questionnaire set in Yes or No type of questions were used to collect primary data from the facilities. Pharmaceuticals inventory control system questionnaires contain five-part was applied, with Part I was used to gather descriptive information about participants. Part II contains 22 items divided in to Yes or No’s to measure store manager skills, Part III measures level of health facilities, part IV to rate management ownership and part V about the performance of inventory control system of the health facilities based on the selected tracer drugs which except part I all the rest were used to conclude on the research.
3.5 Data collection procedures Four
pharmacy
technicians
were
trained
for
data
collection
and
instruments. The data collectors administered face to face interview semi structured questionnaire for professionals managing pharmaceuticals. Besides the information had collected through interview, physical counts were employed by comparing the actual counts with the available records. 16 | P a g e
Twenty tracer drugs were selected form the Ethiopian essential drugs list and the performance of the facilities in terms of inventory control system assessed. During the data collection process completed questionnaires were reviewed and checked regularly for completeness, inconsistencies, errors and accuracy, adjustments for missing information done by communicating the facilities. Health facilities currently served by Dessie PFSA, have patient serving at least one year and currently implementing the Integrated Pharmaceuticals Logistics System were included for data collection and Health facilities with problem of transportation access and facility where their store manager was not available around the town due to various reason excluded from the data collection.
3.6 Pre-testing of questionnaire Once the questionnaire was developed by the investigator, it was tested in one hospital and two health centers other than the study zone. Testing of questionnaire was carried out to confirm the suitability for the intended purpose. It also helped us in redesigning better and estimates the amount of time required to collect and process the data effectively.
3.7 Data processing and analysis Data from the questionnaire was summarized, edited, coded, tabulated and analyzed. Editing was done to see if respondents responded to questions, to trace if there are black responses and to improve the quality of data for coding. The study adopted qualitative data analysis, descriptive statistics was used to describe the data using frequencies and percentage, data was analyzed using statistical package for social science (SPSS) version 20 by binary logistics regression analysis method. The goodness for fit of model for analyses was tested using omnibus test of model and Hosmer and Lemeshow test, the usefulness of the model was assessed using Cox and Snell Rsquare and Naglkreke Rsquare values and found be fitted for analysis.
3.8 Operational Definitions The following operational definitions were used in the study to define important words and measure variables of the study. Pharmaceuticals 17 | P a g e
inventory control system is the dependent variable and Socio demographic factors, management system ownership (support), health facility service volume level and skill of professionals who are involved in managing of pharmaceuticals are the independent variables. Tracer drugs: these are drugs selected by the federal ministry health of Ethiopia to be available in all government health institutions in all the time, 24 hours a day and 365 days in a year.
Inventory control performance: It is a measure of how well the inventory control system is operated and measured by Inventory accuracy rate. Inventory accuracy rate: Measures whether the stock balances recorded on the stock ledger, bin card or automated system (if run only the computerized system) of tracer drugs are similar to the actual inventory on hand. Number of items stock record count equals physical stock count X100 Total number of items counted (available) Considered Good if the result is >= 80%, Fair from 65-79% and poor when it is < 65 Both good and fair considered as acceptable performance level and the poor considered as unacceptable level (Jones snow Inc. M&E, 2010). Management ownership on the system (support): is the level of the management on system follow up and considered acceptable if management of health facilities fulfilled at least seven from the following ten criteria (System implementation supportive supervision check list of Ethiopia) 1. Health facility management or DTC meets and discuss on the system implementations at least every other month. 2. District health office or higher health structure support on the system at least every quarter 3. Inclusion of system implementations in BSC and amount of points on measures given,
18 | P a g e
4. Conducting logistics review meeting at least once a year per district health office and/or zonal health department 5. Availability of require pharmacy professionals as per the BPR 6. Holding budget for deployment of pharmacy professionals 7. Receiving of stock status report 8. Allocating budget for printing of recording and reporting formats 9. Provision of feed backs, signing on resupply report 10. Continues skill transfer from trained to untrained profession during release/transfer of trained professionals Health facilities service volume level: considers Low if daily patient load is less than or equal to 50 patients, Medium provide service in between 5079 per day and high if serves greater than or equal to 80 patients per day according to the FMOH of Ethiopia and additional other four questions which are ART implementing sites, more than 5 dispensing units implementing IPLS, HCMIS implementing sites, at least 3 years since implementing the system and considered high volume when serving more than 80 patients and any three from the rest four or serving more than 50 patients and the all other four criteria(FMOE). Skills of the staff: the ability to do the inventory control system well and requires placement of required professionals (pharmacy) and training on the system. For the study facilities fulfilling at least 7 from the ten following considered acceptable. 1. Pharmaceuticals storage being run with IPLS trained professionals 2. Pharmaceuticals storage being run by pharmacy professionals 3. Regularly preparing and sending the supply report timely 4. Orienting and Establishing Max-min ICS for the DUs of the health facility 5. Conducting pharmaceuticals inventory at least annually 6. Proper storage of pharmaceuticals 19 | P a g e
7. Able of updating recording formats, 8. Properly transposing data from recording formats for preparing supply report 9. Regular supporting the dispensing units and health posts on recording, reporting and drugs supply management. 10. Generating valid and accurate supply report.
3.10 Ethical Consideration Permission to carry out the study was granted from ethical clearness string committee from College of Business and Economics, in Wollo University. Informed consents were also obtained from the store managers after the purpose of the study was explained to them. They were also informed that the information obtained from them was not disclosed to the third person. Name and other identifying information was not used in the study.
3.11 Dissemination and utilization of Results The findings of this study were disseminated to PFSA Dessie branch, Amhara region health bureau, North Wollo and Waghimera zone health departments by providing hard copies. The findings were also disseminated to different organizations that have a contribution to improve the pharmaceuticals supply chain management in the area and presentations also conducted during review meeting.
20 | P a g e
Chapter Four: Data presentations and Interpretations The surveyed item on determinants of performance of pharmaceuticals inventory control system covered socio-demographic characteristics and three other three independent factors which were management system ownership (support), health facilities operational volume level, skills of staffs working in the pharmaceuticals storage. Descriptive statistics was used to present the data to show the relation of factors with the performance of inventory control system. Direct binary Logistics regression was performed to assess the association and the impact on the likelihood that facilities pharmaceuticals inventory control system had a problem on their performance. The analysis model fitness test was performed to confirm the suitability and found analysis model containing all predictors was statistically significant, C2 (3, N=82) =64.5, P0.05 found be 0.446. The model usefulness also supported by Cox and Snell R square value the amount of variation should be from 0 to 1, which was in the limit (0.545,0.73), the chi-square value reported by 64.5, in 3 degree of freedom.
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Table 4.1, model fitness table
Omnibus Tests of Model Coefficients Chi-square
Step 1
df
Sig.
Step
64.503
3
.000
Block
64.503
3
.000
Model
64.503
3
.000
Hosmer and Lemeshow Test Step
Chi-square
df
Sig.
3.718
4
.446
1 Model Summary Step
-2 Log likelihood
1 a.
47.951
a
Cox & Snell R
Nagelkerke R
Square
Square
.545
.730
Estimation terminated at iteration number 6 because parameter estimates changed by less than .001.
4.1. Socio demographic profile In the study total of 82 pharmaceuticals store managers were interviewed with responses rate of (89%): 10(11 %) were not participating due to nonavailability at the data collection time and access problem in 3 of the health facilities. The response rate 89% was representative enough to reflect reliable result for the study. Steven (2004) agrees respondent rate above 80% means less sampling bias and effective. The socio- demographic characteristics of respondent’s data presented with the performance of the pharmaceuticals inventory control system of the health facilities to describe the effects on the performance. As indicated on table 4.2 from the total 58(70.7%) were males and 24(29.3%) were females, the performance was 64 % acceptable for health facilities store managed by males and 34 % acceptable for health facilities store managed by females.
22 | P a g e
Table 4.2 Sex of respondents and pharmaceuticals inventory control performance
Sex
Acceptable performance
Unacceptable
of ICSP
performance of
Respondent
ICSP No.
%
No.
%
No.
%
Male
58
70.7
23
64
35
76
Female
24
29.3
13
36
11
24
Total
82
100
36
100
46
100
The age of the respondents in relation of the performance presented below by table 4.3 with the age breakdown of 18-25 recorded frequency of 61(74.4%), 26-30 frequency of 18(22%) and 31-35 (3.6%) and when the age of professionals increases the performance also increases. Regarding on marital status majority of the respondents were single 74(90.2%) and small number of them were married 8(9.8%) and effects on their performances were not observed, the profession type of respondents who managed the pharmaceuticals were 53(64.6%) Nurses, 29(35.4%) pharmacy technicians and their respective performances increased if the store managed by pharmacy technicians look table 4.3 for details.
23 | P a g e
Table 4.3 Age and profession of respondents and pharmaceuticals inventory control performance. Character Respondent
Acceptable
Unacceptable
performance of ICS
performance of ICS
Age group 18-25
No. 61
% 74.4
No. 18
% 30
No. 64
% 70
26-30
18
22
15
83
3
17
31-35
3
3.6
3
100
0
0
Nurse
53
64.6
13
25
40
75
Pharmacy technician
29
35.4
23
79
6
21
Educational Level
Total of 36 (43.9%) health facilities in the study area found in acceptable range of inventory control system performance with their mean performance was 52% which is similar to in developing countries like Kenya 55% and in Nigeria 60 % (IOMS,2008). As a result of socio demography analysis in the study those storage managed by the required professionals and male participants contributed for better performance for about 64 % both, which is similar to study conducted in Indonesia( Simon,2013). Improvements on the performance in the study were also observed when the age group increases up; the marital status was not found significant contribution in the study. 4.2 Relationship between management support and performance of pharmaceuticals inventory control system 4.2.1 Descriptive statistics Respondents were asked on management system ownership/support/ importance on performance of inventory control system and 75% were replied as it is a key for performance improvement. The management ownership level of the facilities measured on various aspects found 24 | P a g e
29(35.4%) facilities with good and 53(64.6%) with poor management ownership. All the 29 health facilities with good management support performed acceptable level of pharmaceuticals inventory control system and from the poor management ownership health facilities only 6(11%) performed acceptable level of performance. The various aspects of management owner ship on the system showed that, 55(67.1%) the health facilities in the study areas regularly meet to discussed on supply issues and 32(58%) form these they performed acceptable
and
23(42%)
performed
unacceptable
performance
of
pharmaceuticals inventory control system. 40(48.8%) facilities in the study area have got continues higher management support and from those got support 31(78%) achieved acceptable level of management support for the system, the other 41(51.2%) health facilities did not get higher management support and among them only 5(12%) achieved acceptable management support level. In 33(40.2%) health facilities the system implementation measured using BSC and from those 32(97%) achieved acceptable performance of management support. 49(59.8%) health facilities in the study area did not measured the system implementation using BSC and only 4(8%) health facilities achieved the acceptable management support level. From the study health facilities only 10(12.2%) fulfilled the recruitment pharmacy professionals as per the BPR and 9(90%) of them achieved acceptable level of management support. 36(43.9%) health facilities hold necessary budget for professional recruitments and 33(93%) of them performed acceptable level of management support for the system implementation.
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Table4.4.Management system owner ships level and performance of inventory control system, North wollo and Waghimera zone, May 2015 No.
Characters
%
Acceptable
Inacceptable
No.
%
No.
%
Management/DTC meeting on supply Regularly meet
55
67.1
32
58
23
42
Non Regular
27
32.9
4
15
23
85
At least quarterly
40
48.8
31
78
9
22
More than three months
41
51.2
5
12
37
88
Measured BSC
33
40.2
32
97
1
3
Not measured by BSC
49
59.8
4
8
45
92
Organized at least once a year
29
35.4
25
86
4
14
Not organized
53
64.6
11
21
42
79
Full filed
10
12.2
9
90
1
10
Not Full filed
72
87.8
26
36
45
64
Available
36
43.9
33
97
2
3
Not available
46
56.1
2
4
44
96
Good
29
35.4
29
100
0
0
Poor
53
64.6
6
11
46
89
Higher management support
System Implementation in facility
Logistics review meeting by WoHO
Pharmacy fulfilment as per BPR
Budget
for
pharmacy
prof
recruitment
Management ownership(support)
4.2.2 Binary logistics regression As shown in the table 4.5 the effect of the predictor variable was tested by using Wald test of binary logistics regression indicated that management ownership on the system had sig value p=0.001 which is less than 0.05 and found be significant effect on the performance. The association of factors 26 | P a g e
with the performance in this study explained using the generated logistics regression in table 4.5, the B value in the second column provided use in the equation to calculate the probability of a case falling in to a specific category and the sign of the value tell about the direction of the relationship to the performance, Hence B value of 3.78 for acceptable management owner ship have positive association with performance. The association of predictors in this study also determined by the confidence intervals value in the corresponding odd ratio value of 95% CI, if there is number 1 in the 95% CI variable not have relation and in this study the 95% CI for management owner ship level (4.6, 415) indicated there is relationship. The magnitude of the association explained by the corresponding odd ratio of the table and the odd ratio of management ownership level 43.8 indicated acceptable management owner ship(support) were over 43 times more likely to perform inventory control system better than with those with in nonacceptable management owner ship. Table 4.5, Variables in the Equation B
S.E.
Wald
df
Sig.
Exp.(B) AOR
95% C.I.for EXP(B) Lower
Upper
ProS(1)
2.639
.941
7.864
1
.005
14.004
2.214
88.594
HVHF(1)
-.768
1.012
.577
1
.448
.464
.064
3.368
AMOS level(1)
3.780
1.148
10.850
1
.001
43.815
4.622
415.338
-2.452
.569
18.562
1
.000
.086
step
Constant
Variable(s) entered on step 1: ProS, HVHF, AMOS level.
P ln = -2.45 + 3.8x1 + 2.64x 2 - 0.77x3 1- P From the model equation the logit of the independent variables determined using the above formula and -2.45 indicated the constant alpha, X1 is the management system ownership level, X2 skills level of health professionals and X3 is the health facilities service volume level. From the equation when X1 which is the management level increase by one unit the performance of pharmaceuticals inventory control system increases by 3.8 times when other independent variables kept constant and this showed it is the highest factor affecting the dependent variable. 27 | P a g e
4.3
Relationship
between
skills
level
and
performance
of
pharmaceuticals inventory control system 4.3.1 Descriptive statistics When respondents were asked to respond skill affects the performance the response 65% were responded it affects the process of performance and the various skill measures found 40 (48.8 %) facilities store managers were with good and 42(51.2 %) with poor skills on inventory control system, and table 4.6 indicated that good skill performance related to acceptable inventory control performance, from 40 good skill 24(60%) health facilities performed acceptable inventory control system and 16(40%) with unacceptable level of performance. From 42 health facilities with poor skill level of professionals managing the pharmaceuticals only 11(26%) performed acceptable level of pharmaceuticals
inventory
control
system
and
29(74%)
performed
unacceptable level of pharmaceuticals inventory control performance. The various measures of skill level showed that form the studied facilities 53(64.6%) pharmaceutical store were managed by appropriate professionals and from these 25(47%) of them achieved the acceptable inventory control system
performance,
29(35.4%)
facilities
store
managed
by
other
professionals and only 10(34%) performed well on inventory control system. 63(76.8%) established Max-Min inventory control system on their facilities and from these, 32(51%) performed acceptable ICS and from19(23.2%) health facilities only 3(16%) were in acceptable performance level. From the studied health facilities 36(43.9%) of them conducted physical inventory of pharmaceuticals at least once a year and from these 29(81%) health facilities achieved acceptable level of performance and 7(19%) unacceptable performance, 46(56.1%) health facilities did not perform pharmaceuticals physical inventory at all and from these only 6(13%) of them achieved the acceptable level of inventory control performance and 40(87%) failed to achieve the acceptable performance level.
28 | P a g e
Table4.6. Store manager’s skill level and performance of inventory control system, North Wollo and Waghimera zone, May 2015 Characters No.
%
Acceptable
Inacceptable
No.
No.
%
%
Store managed by Appropriate professionals
53
64.6
25
47
28
53
Other professionals
29
35.4
10
34
19
66
Regularly
71
13.4
31
44
40
56
Non regularly
11
86.6
4
36
7
64
Established
63
76.8
32
51
31
49
Not established
19
23.2
3
16
15
84
Conducted
36
43.9
29
81
7
19
Not conducted
46
56.1
6
13
40
87
Good
40
48.8
24
60
16
40
Poor
42
51.2
11
26
31
74
Send supply report
Max-Min ICS
Inventory at least a year
Professional ICS skills
4.3.2 Binary logistics regression As shown in the table 4.5 the effect of the predictor variable was tested by using Wald test of binary logistics regression indicated that professional skills on the system had sig value p=0.005 which is less than 0.05 and found it has significant effect on the performance. The association of factor 29 | P a g e
with the performance in this study explained using the generated logistics regression in table 4.5, the B value in the second column provided use in the equation to calculate the probability of a case falling in to a specific category and the sign of the value tells about the direction of the relationship to the performance, Hence B value of 2.64 for acceptable professional
skill
have
positive
association
with
performance.
The
association of predictor in this study determined by the confidence intervals value in the corresponding odd ratio value of 95% CI, the 95% CI for professional skill level (4.2-88.6) indicated there is relationship since it does not contain number 1 in the range. The magnitude of the association explained by the corresponding odd ratio of the table and the odd ratio of professional level 14 indicated acceptable professionals skills were over 14 times more likely to perform inventory control system better than with those from within non-acceptable, the value of X2 from the equation tells us when the skill level of the professionals increases by one unit the performance of pharmaceuticals level increases by 2.64 which is the second strong determinant factors next to the management ownership on the system. 4.4 Relationship between health service volume and performance of pharmaceuticals inventory control system 4.4.1 Descriptive statistics Regarding on the health service volume factor query, most of the respondents (56%) were responded that service volume would have relation with the performance. The study covered 22(26.8%)high volume and 60(84.2%) low volume health facilities and from the table 4.7 hospitals better performed from health centers but there are high patient load health centers than hospitals, facilities with low patient load have better inventory control performance and there are also high volume health facilities 10(46%) performed unacceptable level of performance. From the various indicators of health service volume all the three hospitals (3.6%) performed acceptable level of inventory control system and from this 30 | P a g e
category only 9(10%) of health centers performed the acceptable level. 61(74.4%) health facilities served less than 50 patients per day and from those,19(31%)
performed
acceptable
level
and
41(81%)
performed
unacceptable level of inventory control performance, 74(90.2%) health facilities store were managed by inventory control system implementation trained personnel and from those 32(43%) performed acceptable level and 41(57%)
performed
unacceptable
level
of
inventory
control
system
performance. In 50(61%) health facilities the integrated pharmaceuticals logistics system implemented in 80% of their dispensing units and from this 19(38%) of them performed acceptable level and 31(62%) performed unacceptable level of pharmaceuticals inventory control performance, 32(39%) of the health facilities did not implement the system in 80% of the dispensing units and form this 17(53%) in acceptable level of inventory control system performance and 15(47%) of them unacceptable level of performance. Table4.7. Health facility service volume with their performance level, North Wollo and Waghimera zone, May 2015 Acceptable
Characters No.
%
3 89 70 12
3.6 93.4 85.3 14.7
Below 50
61
74.4
51-79
14
Above 100
Inacceptable
No.
%
No.
%
3 33 29 6
8 92 82 18
0 46 40 6
0 100 86 14
19
31
41
81
17.0
9
64
5
36
7
8.6
7
100
0
0
Trained professionals
74
90.2
32
43
41
57
Untrained professionals
8
9.8
3
37
5
63
Health facility type Hospitals Health centers Paper based HCMIS Daily Patient Load
Facility store managed by
31 | P a g e
System implemented in 80% of DU`s
50
61
19
38
31
62
Not 80% of DU`s
32
39
17
53
15
47
Implementing facilities
27
33
16
59
11
41
Non implementing Facilities
55
67
19
54
35
76
High
22
26.8
12
55
10
45
Low
60
73.2
23
38
37
62
ART
Facility Level
4.3.2 Binary logistics regression As shown in the table 4.5 above the effect of the predictor variable tested by using Wald test of binary logistics regression, indicated that health service volume had sig value p=0.448 which is greater than 0.05 found be insignificant effect to the performance of pharmaceuticals inventory control system, the 95% confidence interval value (0.064, 3.67), also contained the value 1 which indicated that there is no relationship and the hypothesis is rejected, the B value -0.77 indicated that there is no positive relationship with the performance, the odd ratio of this factor is 0.464 less than one explained that the strength of the relationship with the performance of pharmaceuticals inventory control system is weak and have negative relationship. The value of X3 from the model equation which is -0.77 also indicated that when the variable health service volume increase by one unit, the performance of pharmaceutical inventory control system decreases by 0.77 showed no positive relationship and weak magnitude. 4.4 General system implementation assessment The overall system implementation of inventory control mean performance of health facilities in the study area found to be 52% which is 13% less from 32 | P a g e
the acceptable range and this is also much related with the poor performance of the overall management system ownership (support) which is only 29(35%) of the health facilities in the acceptable support limits and the skill level of professionals which was in acceptable limit in 40(48.8%). Health facilities in acceptable level of management owner ship achieved all in the acceptable level of inventory control performance level should the predictors has much more link on the dependent variable and from health facilities with acceptable level of skills, 24(60%) of the facilities have achieved the acceptable inventory control performance level and showed there is link of the predictor and the dependent variable. Regarding on service volume in the study area, from 22 high volume health facilities 12(55%) were in acceptable performance and from 60 low volume health facilities 23(38%) were in acceptable performance of inventory control system showed very little link of predictor with the independent variable. Table 4.8 relation of predictors with the performance of ICS
Characters
Management support Staff Skills
Health facility volume
Acceptable
Unacceptable
ICS
ICS
performance
Performance
Respondent
No.
%
No.
%
No.
%
Acceptable Level
29
35
29
100
0
0
Unacceptable level
53
65
6
11
47
89
Acceptable level
40
49
24
60
16
40
Unacceptable Level
42
51
11
26
31
74
High
22
27
12
54
10
46
Low
60
73
23
38
37
62
The study finding on effects of management ownership and skill level of professionals on successful implementation of pharmaceuticals inventory 33 | P a g e
control system have similar with other countries studies, in Indonesia on Pharmaceuticals Inventory management issues found that less management awareness leads in inefficient inventory management of pharmaceuticals in hospital (Ilma Nurul Rachmania et.al,2013), a study done to assess pharmacy inventory control in ministry of health hospitals in Jordan showed that poor skill of professionals is major contributor on poor performance of inventory control system. Study in Tanzania on Medicine stock out and inventory management in hospitals showed logistics skills levels of professionals who involved in supply chain was poor and pharmaceuticals inventories management was not effective (Godeliver A.B et.al,2012). Studies in South Africa and Kenya showed management
system
is
management
ownership
by
inappropriate
difficulties
in
due to the inventory
professionals getting
and
accurate
lack
of
records
of
information and product flow, low availability of essential drugs were resulted and challenges to implement FEFO with expiration of huge stocks resulted, poor inventory practice greatly interrelated with to poor skill level of professionals, lack of management follow up, allocation of inappropriate type of professionals (Management sciences for health,2006). The work load relationship of the study does not much with other studies that in Indonesia, poor inventory control system in hospitals resulted due to high work load and service volume of the health facility(Godeliver A.B et.al,2012).
.
34 | P a g e
Chapter Five Summary, Conclusions and Recommendations 5.1 Summary The study sought to analyze the relationship of the management ownership (support) to effectiveness of the pharmaceuticals inventory control system, to investigate the relationship of skills of professionals working in managing the store to the effectiveness of pharmaceuticals inventory control system and to analyze the relationship of health facilities service volume to the effectiveness of pharmaceuticals inventory control system. The first two variables were found to have an effect on effectiveness of pharmaceuticals inventory control system and the last found to have no effect.
5.2 Conclusions The study found out that the management ownership on the system (support) and the skill of the staff on the system implementation were poor which resulted the performance of the effectiveness of pharmaceuticals inventory control system in the study area be poor, but the poor performance of the inventory control system was not the effect of the health service volume level. Lack of orientation on the system, poor commitment of managements to support the system and less attention on supplies issues were the major factors on poor management support and inability to get the required professionals and poor skill transfer mechanism were the factors to poor professional’s skill. Based on the findings the investigator draws that the poor performance of the pharmaceuticals inventory control system is strongly linked to management support and skill, so that there is a strong and positive relationship of management ownership on the system and the performance of pharmaceuticals inventory control system performance, also there is a positive relationship of the skill of professionals working in the pharmaceuticals storage and the pharmaceuticals inventory control system performance, but no positive relationship of the health facility volume (high or Low) with the pharmaceuticals inventory control system performance observed. Management owner ship and the skill of professionals are the two 35 | P a g e
important determinant factors on performance of pharmaceuticals inventory control system performance in the area In the study area the overall health facilities pharmaceuticals inventory control system performance is low with only 36 (43%) health facility performed with acceptable level of performance with the mean performance of 51%,the management ownership of health facilities is low with only 40(49%) meet the acceptable level. And most of the professionals working and managing inventory control activities
do not have the necessary
professional qualification in pharmaceuticals supply chain and postemployment training on the system not based on the need and targeting those involved in the actual activity.
5.3 Recommendations Findings from this study indicates that the practice of the current pharmaceuticals inventory control system much more influenced by the management ownership and the skill of professionals working in the system, there for the Key management bodies in health facility, district health office and zonal health departments should be oriented or trained on the system implementation and follow up, appropriate monitoring and evaluation of the pharmaceuticals
inventory
control
system
and
the
supply
chain
management in general should be in placed in all level, health facility management follow-up on the system and regular evaluation should be strengthening., establishment and strengthening of technical committee (DTC) to support the system implementation in facility level should be commenced, regularly reviewing, supporting, monitoring and providing of feedbacks jointly with all stockholders should be practiced in the zone and district levels, the regional government should work on improving the challenge on availability of pharmacy technicians and managements of the District should employ adequate qualified personnel involved in stock control activity. The district and health facility managements should insure the inventory control activities only handled by competent and well trained professionals and relevant training to improve the inventory control functions and supply 36 | P a g e
chain management activities should be coordinated regularly with need based and delivered to the appropriate professional.
37 | P a g e
References Godeliver A.B, Kagashe, Massawe T. 2012, Medicine stock out and inventory management problems in public hospital in Tanzania. International Journal of Pharmacy. J.F. Manso, J.Annan, Anane SS. 2012, Assessment of Logistics Management in Ghana Health Service. International Journal of Business and social Research (IJBSR). PFSA. 2007, Standard operating procedure for Integrated Pharmaceuticals Logistics System in health facilities,Addis Ababa. Ilma Nurul Rachmania,BasriMH.2013,Pharmaceutical inventroy managemnt issues in hospital supply chains. John Snow Inc. 2011, Healthcare Supply Chains in Developing Countries: Situational Analysis. Arlington,: USAID. M.Kachwee, MrD.Hartmann. 2013, HOSPITAL SUPPLY CHAIN MANAGEMENT AND OPTIMISATION. South Africa: School of Mechanical, Industrial and Aeronautical Engineering University of the Witwatersrand. Branch PD. 2014, Second quarter performance report. Dessie: Deesie PFSA branch. IOMS. 2008, The Challenges of Making Quality Essential Drugs and Supply Available For primary health care Services in Nigeria: Minstry of Health. World Health Organization. 2003, Managing Drug Supply. Essential Drugs Monitor. Switherland. Jone snow Inc. 2010, The Logistics Handbook A Practical Guide for the Supply Chain Management of Health Commodities. Arligton: Deliver project. Minstery of Health of Ethiopia.2009, ARV logistics assessmnet. Addis Ababa. World Health Organization.2003, Situation of Antiretroviral Drug use in Nigeria Nigeria. Mnagemnt Sciences for Helath. 2006, Drug supply Mnagement. Arlingtone: MSH. 38 | P a g e
Ethiopia MHO.2003, Guide line for procurement, distribution and use of Anti-retroviral drugs Addis ababa: EMOH. ROB WHEWELL. 2012, Supply Chain in Pharmaceuticals Industry, Strategic influences and Supply chain responses.Switherland. Inc JSI.2010, Monitoring and Evaluation Indicators for Assessing Logistics Systems Performance. Arlingtone: The people deliver. Kassie GM. 2014, Assessment of pharmaceuticals store management in Dstict health office of west Harergie. E International research journal of pharmacy. Organization WH. 2007, operational package for assessing, monitoring and evaluating country Pharmaceutical situations. Mohammad NARS. 2004, Handbook on Supply Chain Management for HIV/AIDS Medical Commodities. HIV and AIDS Programs. Kariuki James N. 2013,an assessmnt of the factors influencing effectiveness of Innventory control Intenational journal of Business and commerce . MasakhaliaO.C, Josephat k, 2012, Determinants of sucessful implemntation of inventory mangemnt informantion systemin public sector, Kenya International jurnal of scince and research. Simon S.U, 2013, Supply chain mangemnt practice and stock levels of essential drugs in Public health facilities in Bugoma, Kenya. Surabi D, Arun K, Preeti K, 2012, Inventory mangement a tool of identifying items,IC Journal.
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Annexes Annex1. Individual Consent form Dear Participants, The information you provide will only be used to study the determinants of pharmaceuticals inventory control system and factors affecting it. The interview will take approximately 45 minutes. I will ask you questions about. •
Some personal details.
•
The Inventory control system related activities.
•
Reviewing of reports and records.
The information you provide is totally confidential and will not be disclosed to anyone. It will only be used for research purposes. Your name will be removed from the questionnaire, and only a code will be used to connect your name and your answers without identifying who you are. Your participation is voluntary and you can withdraw from the survey after having agreed to participate. You are free to refuse to answer any question that is asked in the questionnaire. If you have any questions about this survey, feel free to ask the interviewer. Signing this consent indicates that you understand what will be expected of you and are willing to participate in this survey. The individual consent form read by interviewer The individual consent form agreed to and signed Respondent _______________________________ Interviewer_______________________________
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Date ____/____/_____
Annex 2: Questionnaires for determinants of pharmaceuticals inventory control system Introduction My name is…………………, I am working in research team of Wollo University, the team will conduct studies on Pharmaceuticals inventory management in the currently implementing System. The study will benefit the facility and supplying agency by suggesting important intervention point to better serving to community. Before that we are engaging data collection process and now I am requesting you your kind voluntariness on providing information according to the developed questionnaires for this purpose. Thank you, the questions are not as such difficult to answer and I hereby assure you that your name will not be recorded in the formats and never be requested in connection with any of the information you are going to provide for me. You are not also obliged to respond any question/s you do not want to answer and you may interrupt this interview at any time you think it imposed inconvenience; however providing honesty response for the questions will contribute generating quality and factual outcome for the study which enables us to come up with pertinent intervention point at the end. Thank you again and appreciate your help on participating in our job, interview by the way will not take more time, not more than an hour. Date……………………………………………………………… 001:-Questionnaire number…………. 002:-Are you willing to participate in the study? 1. Yes 2.No 003:-Study area, Zone: -……………………, District:-…………………….. Name of Facility………………………., Facility phone no….. Facility distance from Dessie……………Km, Zone……..Km District…………..Km
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Part One; Socio-demographic Number Questions 101 Title 102
data (store)
Sex
Response 1. Store Manger 2. Other specify 1. Male 2. Female
103
Your age?
1. 18-25 2. 26-30 3. 31-35
104
Current Marital Status?
4. 36- 40 1. Single 2. Married 3. Windowed 4. 1. 2. 3. 4.
Separated Nurse Pharmacy technician Pharmacist Other specify
105
Current educational Level?
106
Number of years and months you have worked at this facility in the current position?
1. 2. 3. 4. 5.
0-1 years 1.1-2years 2.1-3 years 3.1-4years Above 4years
107
Total years of Working experience
108
Do You take the following trainings
1. 2. 3. 4. 5. 1. 2. 3. 4. 5.
0-1 years 1.1-2years 2.1-3 years 3.1-4years Above 4 years IPLS 6. Two of them SCMS 7. Three of them DSM 8. More than 3 FBP ART
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Part Two. Facility related information A. Skills related/Store man/ 201
Is your profession pharmacy related?
1. Yes
202
Do you trained on IPLS?
2. No 1.Yes
203
How many Times You trained on IPLS or DSM area in the last two Years?
204
Did you acquire recording abilities form the training?
205
and
reporting
Is supplies/stock management your primary role at this facility?
2. No
1.Yes 2.No 1. Yes 2. No
206
Are U happy Being working in pharmaceuticals management in the facility?
1. Yes 2. No
207
Did you conduct physical inventory in the store at least once a year?
1. Yes
208 209
Did you report the inventory result to facility head? Do you know your facility Max-Min quantity?
2. No 1.Yes 2.No 1. Yes 2. No 1. Yes
210
Is there an established Max-Min stock level for Dispensing unit?
211
Do you use Bin cards in the store?
2. No 1. Yes
Do the bin cards updated?
2. No 1. Yes
213
Do you send RRF every two months to supplying agencies?
2. No 1. Yes 2. No
214
Do you take the ending balance of RRF from the ending balance of bin cards for reporting?
212
215
Did the last supply report include, Stock on 43 | P a g e
1. Yes 2. No 1. Yes
216
217
hand, Loss and adjustment and quantity used? Do you place emergency order in the last four month? How many times Is the resupplying quantity need determined by the facility?
218
Do you always use established formulas to determine facility resupply need?
219
Does the facility use Expiry tracking chart to follow expiry date of products?
220 221
Do you always Implement FEFO system in your store? Do you use computer software for inventory control?
222
Do you use it continuously and the data updated in the software?
223
Did you trained on the software?
2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1.Yes 2. No 1. Yes 2. No 1. Yes 2. No 1.Yes 2.No
No. 301
302 303
B. Health facility service level
Questions The patient load of the health facility per day?
Response 1.
