I am studying why stock-out and expiration of medicines occur in developing countries, as part of my Doctoral research work under the Maastricht School of Management (MSM), the Netherlands. The research utilizes Uganda as a case study.
I was privileged to present preliminary findings at the Uganda Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) symposium of 2019 on August 06, 2019. The presentation argued that stock-out and expiration of medicines in Developing Countries is caused mainly by three factors 1) mechanisms for collaboration have not been enacted (performed) such that funding, supply and management of the essential medicines is done within silos demarcated by program and funding source resulting into uncoordinated and sporadic stock levels; 2) demand forecasts are inaccurate because they are not informed by health facility data (stock on hand and number of patients served) but they rely on national level issues data which is not a true reflection of need; and 3) expiration of medicines is not reported in the routine Health Management Information System (RHMIS) unlike stock-out which is now included in the RHMIS.
Participants in the symposium appreciated the argument and made further comments as follows;
- How can people report on expiration (of essential medicines) when there is a blame game (over who is responsible for expiration)?
- Medicines are delivered late (with short shelf life) at the Health Facilities
- At the lower level Health Facility (HCIII), there is need for staff dedicated to inventory management because Health workers at that level prioritize serving the sick to updating stock cards and making accurate demand forecasts
- Lower level Health Centers (HCIII and HCII) receive pre-determined kits. The study should compare occurrence of stock-out and expiration in health centers that receive pre-determined kits against those that order
- The test and treat policy (a recent policy recommendation in HIV management to put HIV positive patients on treatment immediately upon diagnosis) could be contributing to stock-out
- Orders made to the central medical stores are not fully served. The study could benefit from analyzing the order fill rate for selected health facilities
- The study should not disregard pilferage of medicines as a potential cause of stock-out.
The other potential causes proposed by the participants namely; changes in treatment policy, low order fill rate by the central warehouses and pilferage have been and will continue to be considered under the study to generate sufficient evidence to support or annul the suggestions.
Meanwhile, the subsequent discussion and reflection suggest that stock-out and expiration of essential medicines in developing countries could be greatly reduced by investing in information sharing including 1) breaking down silos delineated by program and funding source; 2) improving health facility visibility such that national stakeholders and supply chain managers could see the stock on hand and number of patients served per health facility; 3) expiration of essential medicines could be detected and avoided once there is health facility visibility and 4) visibility of stock on hand and number of patients served per health facility will enable detection and action against pilferage of medicines. A more advanced capability – visibility across the supply chain levels such that all stakeholders and supply chain managers including those at the health facility could see the stock on hand and order processing at the central level, would allow for monitoring and acting on the order fill rate.
It is also noteworthy that the technology-based interventions proposed here have been successfully deployed in the private sector by various Global business and could be adapted to address the challenge of stock-out and expiration of essential medicines in developing countries like Uganda.
I therefore welcome comments and your view of the causes of stock-out and expiration of essential medicines in developing countries like Uganda.