Anti-TB Medicines Supply Chain Management Practices in Public Health Facilities of Gurage Zone, Southern Ethiopia: A Cross-Sectional Study

Abstract

The fight against tuberculosis (TB), one of the leading causes of death worldwide, depends on a wellfunctioning supply chain system of anti-TB medicines. There is a paucity of information on the anti-TB medicine supply chain management situation in the Gurage Zone,  Southern Ethiopia. Hence, this study explored supply chain practices in public health facilities of the Zone. A concurrent mixed methods  design was followed to collect quantitative and qualitative data from August to September 2020. A total of 20 health facilities were  involved in the study following the logistics indicator assessment tool recommendations to include at least 15% of the facilities in the  geographic region. A structured questionnaire and observational checklist were used to collect quantitative data. In-depth interviews  were done with experts from selected health facilities, Gurage Zone health department, Regional Health Bureau, the Ethiopian Pharmaceutical Supply Services and the Federal Ministry of Health for the qualitative part of the study. Inductive thematic analysis was  employed for qualitative, while descriptive statistics were utilized for the quantitative data. Eighteen out of the 20 facilities in the study  (90%) relied solely on stock recording cards, one (5%) used computerized system and the other one did not have any system for  controlling their anti-TB medicine inventory. The average inventory accuracy for a set of anti-TB medicines was 76.6% with a range from  0% to 100%. For a set of anti-TB medicines, the average availability in the review period was 82.6% and the average stock out duration  was 11.23 ± 1.38 days in a year (Min. = 0, Max. = 115). The average wastage rate for a set of first-line anti-TB medicines was 4.8%. The  thematic analysis identified the themes: forecasting and procurement, storage and inventory management and supervision and updates  on guidelines. Data accuracy issues and long lead time were forecasting and procurement related challenges for anti-TB medicines. Poor  condition of storage facilities and outdated stock records were storage and inventory management related challenges. Weak supervision  and resource limitations for trainings were supervision and updates on guidelines related challenges. Overall, the study documented  poor stock management practices reflected by presence of shortages and wastages of essential anti-TB medicines. Digitalization of  inventory control systems and capacity-building interventions to improve quantification are recommended to improve the supply chain  management practices of the studied facilities.