Malaria diagnostic capacity in health facilities in Ethiopia.

BACKGROUND: Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. METHODS: A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities' laboratory practices were assessed by direct observation. RESULTS: Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff's participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53/104) of assessed health facilities. CONCLUSIONS: The current study indicated that most of the health facilities had basic infrastructure and equipment to perform malaria laboratory diagnosis but with significant gaps in continuous laboratory supplies and reagents, and lack of training and supportive supervision. Overcoming these gaps will be critical to ensure that malaria laboratory diagnosis is of high-quality for better patient management.

Inventory Management of Health Commodities in a Tertiary Teaching Hospital in Ethiopia.

Background: Analyzing purchased health commodities based on their budgetary consumption and importance is crucial for efficient utilization of a hospital's budget. However, it is rarely seen when hospitals, mostly in developing countries, conduct such kinds of analyses and make an informed decision, including to utilize their limited budget efficiently. Therefore, the purpose of this study was to analyze a 3-year inventory of health commodities (medicines, medical supplies, and laboratory reagents and chemicals) in Saint Paul Hospital Millennium Medical College (SPHMMC). Methodology: The study was conducted in SPHMMC located in Addis Ababa, Ethiopia. It is one of the largest specialized public hospitals in the country. It is a huge teaching hospital in the country where a large amount of budget is utilized. Three years of data were collected and ABC, VEN, and ABC-VEN matrix techniques were applied for the analysis. The data collection period was from March to April 2017. Results: An average of 296 medicines, 194 laboratory commodities, and 105 medical supplies were purchased over 3 years. Class A medicines, which consume 80% of the total annual pharmaceutical expenditures (APE) account, are 17.8%-20% of the total medicines by quantity. Antibiotics (ceftriaxone 1 gm injection and metronidazole), IV fluids (sodium chloride 0.9% injection and dextrose 40% injection), and antidiabetic medication (insulin zin suspension and metformin) are among the top 10 medications by value that consume significant amounts of the budget of the hospital. On VEN analysis, an average of 24% of the items were vital, 67% were essential, and 4-8-8.9% were nonessential. Nonessential items consumed 0.49%, 9.9%, and 1.1% of Annual Expenditures (AEs) in 2013/14, 2014/15 and 2015/16, respectively. On ABC-VEN matrix analysis, a single expensive and nonessential medicine (valganciclovir HCL 450 mg tablet) consumed 9.4% of expenditure in 2014/15. Class A laboratory commodities, which consume 70%-80% of the total laboratory expenditures represented 8.5%-20% of the total laboratory commodities analyzed for the 3 years. From class A items, antimonoclonal antibodies in 2013/14, hemocue glucose 201 4 × 25 tests in 2014/15, and glucose tests in 2015/16 consumed the highest percentages: 9.2%, 8.2%, and 23.7% of the AEs, respectively. There were laboratory commodities procured out of the VEN list, and these accounted for 6.8%-31.2% of the total laboratory expenditures over the 3 years. Class A medical supplies, which consumed 80% of the total medical supply expenditures, represented only 8.2%-15.8% of the total items over the 3 years studied. Surgical gauze 90 cm × 100 m, surgical gloves sterile latex number 7.5, and examination gloves were the top three based on expenditures in all the studied years. In 2015/16, examination gloves alone consumed 71.9% of the total expenditure. Conclusion: SPHMMC manages large numbers of health commodities (more than 500 excluding program commodities) which necessitate efficient inventory management practice in place. However, the purchase of the commodities particularly those products used for laboratory diagnosis is not strictly based on the hospital's VEN list, indicating the need for better communication of the laboratory unit with the Drug and Therapeutic Committee (DTC) of the hospital. The DTC of the hospital should update the VEN list of the health commodities and strictly enforce the hospital procurement to adhere to the agreed upon list of medicines. In addition, the hospital should prioritize and decide the quantity and frequency of ordering health commodities based on regular ABC-VEN results.

The mediating effect of information sharing on pharmaceutical supply chain integration and operational performance in Ethiopia: an analytical cross-sectional study.

BACKGROUND: Information is crucial in enhancing partnership, reducing uncertainties and inventory costs, improving order fulfillment, and increasing customer satisfaction. However, there is a scantiness of studies on how information sharing affects pharmaceutical supply chain practices and performance. Hence, this study aimed to examine the mediating effect of information sharing between supply chain integration and operational performance. METHOD: We conducted an analytical cross-sectional study complemented with a qualitative assessment between May and July 2021. The study populations (n = 343) were selected employees working at the Ethiopian pharmaceutical supply agency's head office and selected hubs. The quantitative data were collected by self-administered five-point Likert-scale questions and analyzed using SPSS®-version 23. The mediation effect was determined using sequential linear regression based on the Baron and Kenny stepwise approach. A 95% confidence interval and a p-value less than 5% were used to determine statistical significance. We gathered the qualitative data through in-depth face-to-face interviews with nine key informants and analyzed them using a thematic analysis technique. RESULTS: Among 320 completed questionnaires returned (with a response rate of 93%), we used 288 in the analysis. Of the respondents, 97 (33.7%) disagreed that information sharing with the agency is simplified. One hundred seventeen (40.6%) disagreed that customers share information via an online system. Most respondents (76.4%) agreed that internal integration in the agency reduced total order time. Information sharing (ß = 0.270, p < 0.001), customer integration (ß = 0.265, p < 0.001), and internal integration (ß = 0.151, p < 0.001) were predictor variables that had a direct positive effect on operational performance. Information sharing posited a partially mediating role between customer integration and operational performance with ß = 0.136 at p < 0.001. Data quality problems, human-resource-related issues, and natural and human-made calamities were the major challenges affecting information sharing and the overall supply chain practices. CONCLUSION: Customer integration, internal integration, and information sharing influenced operational performance positively. Although coordination among the units in the agency is reasonable, there was a lack of communication and quick response from partners, as well as data quality problems and the absence of an automation system in most health facilities. The key informants suggested end-to-end supply systems connections with partners through Enterprise Resource Planning and other means.