E-DRUG: "Stop the Stock-Outs" Campaign Launched in Africa (3)
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Dear Beverley,
Thanks for the mail. We believe that the causes of stock outs are many and hence the need for a multifaceted approach by different stakeholders in the health system. In our analysis based on our experience in the different countries we work in, the main causes are many but in terms of the campain we have restricted ourselves to;
- lack of an intergrated procurement approach at national level- In most countries on the continent, medicines procurement is mainly supported by development partners who mainly come in with their parallel programmes. These parallel programmes end up overstreching the central medical stores supply chain capacity which leads to underprioritization for some the diseases/essential medicines that are not supported. This leads to stock outs of some key medicines such as those for non communicable diseases which is on the rise in the continent. For some medicines which are funded externally in some cases, there is overstocking, expiries etc. In some instances the donor funded programmes have even procured medicines like Amodiaquine which is already off the essentila medicines list because of earlier agreed tenders. Lobbying ministries of health and donors to have a coherent procurement system is our approach. In manay countries there has been progress on this but CSOs need to continue the pressure.
- Inadequate participation of users, health facilities in the forecasting and quantification- Most of the times in our countries, the essential medicines estimates are supposed to be determined at central level based on the information from the health facilities at district and local levels. In practice however, the forecasting arrangements are poor because of poor record keeping, untrained human resource managing facilities and supplies and inadequate support from the national level. In some countries, at the moment they are introducing, health management information systems (HMIS), which link up with the national level to record the usage of medicines. Again this data has to be entered by trained staff and sometimes this trained staff are taken away by well resourced donor funded programmes because of poor salaries etc. We believe that continous training of all cadres on these tools will go a long way in alleviating this problem.
- Poor funding and innefficient utilization of the available resources- In smost of our countries the per capita expenditure on essential medicines is less that USD 2.5. Even these resources that are provided are sometimes poorly absorbed and taken back to the ministries of finance. This is mainly due to the bureaucracy in the tendering systems and the procurement laws. This is not withstanding the fact that suppliers in some countries are always complaining of non payment. As civil society we believe this is a matter of serious concern. There has been recurrence of emergency procurements at all levels of the supply chain (national, district and local). The medicines procured using emergency funds are usually highly prices and therefore few quantities are purchased. In some cases, the procurements are done when ministers are to visit given facilities in a region. We believe that having a dedicated budget line for the procurement of medicines at the national level where donors can also provide input will alleviate the problem. We also believe that in terms of strategy governments should increase their funding for essential medicines so as to forestall any imbalances which could be due to the bureacracies in the donor funding.
- Lack of independence of the Central Medical Stores- In some countries, in our experience the Central medical stores are not equiped legally to provide services within their mandate. To the extent that some of the procurements are being done by officials in the ministries of health. This we believe undermnes the perfomance of the CMSs in terms of cordinating the overall procurement, distribution and supply. This is an area that Civil Society Organizations should continue lobbying the members of parliament to ensure that appropriate legal instruments are put in place for the proper functioning of the CMSs.
- We also believe that users and consumers should be adequately represented and informed at all levels of management ranging from the district and local health management teams to the national level. We also think that forecasting and quantification should be participatory to include many other stakeholders so that the problems are easily communicated to and understood by the users.
regards
Patrick Mubangizi
HAI Africa
pato_tibbs@yahoo.co.uk
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I would like to inform you that we have launced a website which will be used by CSOs and communities to share information about the stock outs of medicines.
We are planning to start an sms campaign, blogs and other social networking tools to engage the wider public and also regularly inform policy makers and implementers about the experiences of the communities on stock outs. You can get more information on www.stopstockouts.org. Some of the materials that have been developed include a fact sheet, http://stopstockouts.org/what-are-stock-outs/ and we shall continually improve the information as we get inputs from everyone.
We welcome the debate on this area to seek solutions that we can present to our policy makers to sort out this recurrent problem.