Medicines and Medical Supplies Availability Report - October 2011
Health service delivery at the district and facility levels has been greatly aff ected by the
persistently poor availability of essenti al medicines and medical supplies, an example here
is the lack of absorbent gauze for a period of a about three to six month prior to and
during a survey conducted by Sikika between May 10 to May 20, 2011.
This study was designed to fi nd out (1) the extent of the problem; (2) how long the
availability problem had persisted prior to the survey; (3) acti ons being taken by service
providers to miti gate the problem; (4) potenti al complicati ons/challenges that the faciliti es
and pati ents faced as a result of the problem; and (5), what other essenti al medicines and
medical supplies were currently out of stock or in low supply. The system used to procure
and distribute absorbent gauze applies to the enti re essenti al medicines and supplies list;
hence problems discussed and recommendati ons given apply to the whole system and are
thus discussed in this report.
Sikika conducted the survey using two structured questi onnaires, in response to
complaints received from service users and providers about the lack of gauze. A total of
71 District Medical Offi cers (DMOs) or their representati ves and 30 facility in-chargers
were interviewed via mobile phones. DMOs are responsible for all faciliti es in a district
hence their responses give a wide picture of the situati on, whereas facility in-charges give
specifi c pictures of individual faciliti es. One DMO, one clinical offi cer, and one nurse incharge
of a dispensary were interviewed face to face as key informants. For purposes of
regional comparison, telephone interviews with offi cials of central medical stores of Kenya
and Uganda were also conducted, aft er fi nding out that there was a stock-out of gauze at
the Tanzanian central medical store.
The results showed that absorbent gauze was unavailable at 48% of the districts
interviewed, and this had persisted for a period ranging from three to six months. Only 8%
of the districts had suffi cient quanti ti es. Similarly, 37% of the faciliti es did not have gauze,
and only 10% had suffi cient quanti ti es2. Faciliti es had to wait for two months on average to
receive orders once they had placed them with the Medical Stores Department (MSD) via
DMOs. Most of the DMOs and facility in-charges did not order exactly what they needed in
terms of quanti ti es. They more oft en ordered less than what was required. The mismatch
could be att ributed to several reasons, the most important being lack of funds in their
MSD accounts. Theoreti cally, DMOs and health facility in-charges had access to, apart from the funds held at the MSD, other sources of funds with which they could purchase supplies from the private market. In practi ce, however, not all of them could access such
funds due to diffi culti es associated with the collecti on and administrati ve bureaucracies.
49% of the DMOs had to cancel or reduce the number of electi ve surgeries, reserving
whatever supplies of gauze they had for emergency purposes.
Service providers also were faced with increased levels of complaints from service users, which aff ected their work
morale. At the same ti me, other essenti al medicines and medical supplies such as surgical
gloves, syringes and ALU were in short supply or running out.
Sikika recommends that:
1. The ordering cycle be shortened from the current three months to one month;
2. the order, order revision process, and order forms used simplifi ed so that even staff
who are not qualifi ed pharmacy technicians or pharmacists are able to understand
and use the ordering process and forms eff ecti vely;
3. the allocati on and disbursement of centrally available funds as well as access to locally
available funds be reviewed;
4. the Central Medical Store and supporti ng insti tuti ons should be bett er organized and