In many developing countries like Uganda, access and availability of essential medicines remains low despite commitments by government as evidenced by stock-out of essential medicines and health Supplies at health facilities (Annual Health Sector Performance Report, 2016/2017) and piling of expired stock in central medical stores and health facilities (Threats posed by stockpiles of expired pharmaceuticals in low- and middle-income counties: a Ugandan Perspective; Pakoyo Fadhiru Kamba, et al, 2017). This highlights poor performance of the pharmaceutical supply.

Poor performing pharmaceutical supply chains lead to failure of treatment programs, loss of patient trust in the health care system, massive wastage of already limited financial resources, and debilitated capacity of the health delivery system to meet the health care needs of the population. The daily monitor in their article titled, “maternal health faces setback over drug stock-outs,” published on 13/3/2018 raised a concern that Uganda’s success in reducing maternal mortality might be reversed by consistent stock-out of Sexual and Reproductive Health Commodities in health facilities, with reference to findings by a 2017 survey report.

During review of literature to find  potential solutions and recommendations for improvement in performance of the pharmaceutical supply chains, I discovered that pharmaceutical supply chains are systems which comprise of organizations, people, technologies, activities, information and resources that come together to ensure the delivery of medicines and health supplies from the point of manufacture to the end use point in to a cost effective way; and also returns critical information regarding need, demand, and consumption to health workers – as described by Prashant Yadav in a research article titled, ‘’Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and  an Agenda for Reform.”

Prashant Yadav argues that the main challenges in the public sector medicines supply chains that contribute to poor performance include; diffuse accountability (i.e. each actor in the supply chain system can attribute under-performance to another because of over fragmentation of responsibilities with the different players in the chain); uncertainties in financing; very many levels of decision making (complex structure) which worsens accountability; long resupply intervals which makes it difficult to precisely forecast needs; and lack of reliable supply chain planning data which leads to planning based on estimates drawn from outdated assumptions among others. One of his recommendations is that “Bold and concerted action is required to create a supply chain that is responsive to the needs of patients in a cost effective manner… Supply chain reform cannot be achieved or sustained without strong leadership in the health sector and a strong and skilled supply chain workforce.”

To create a more effective pharmaceutical supply chain, it is recommended that; collaborative linkages are formed among the supply chain actors, and institutional complexity is reduced to improve information flow and coordination through the pharmaceutical supply chain. In addition, improved accountability among the supply chain players, improved financing for the pharmaceutical supplies, and availability of reliable consumption data can greatly improve performance of the pharmaceutical supply chain. All this serves to make planning easier and more effective subsequently contributing to establishment of an effective pharmaceutical supply chain system characterized by; timely deliveries of the right drugs (quality and quantity), reduced tendencies of expiry and minimal stock outs.

About the Author: Grace Nyamaizi is a Pharmacist and Research Analyst at Access Global Ltd

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