Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania

Abstract

BackgroundProvision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).MethodsIn-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.ResultsParticipants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.ConclusionThe unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.

Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria

“…Some needed drugs were either expiring or not available due to delayed reimbursement, untimely replenishment of stocks and providers’ lack of funding for transport to collect drugs from the central medical store. These findings, which are consistent with evidence from several studies, partly explains health workers’ poor adherence to the free care policy and increased involvement in parallel drug supply systems [12,17,26–31]. …”

“…Use of service charters to curb informal payments to service providers [9], active health facility committees (HFCs) including financial management [10–12], timely payment of providers [13], regular and uninterrupted drug supply [13], availability of clear guidelines on use of user fee replacement grants [14], an effective staff sanction framework, which reduces health worker absenteeism [15], have enabled health facilities to effectively implement free healthcare policies. In contrast, barriers to health facilities implementing free healthcare policies include weak decentralization [10,16–18]; poor supervision and monitoring [19,20]; weak referral systems [17]; absence of written implementation guidelines [14,21]; shortage of staff and inconsistent recording and reporting [10,20]; low social accountability and community involvement [9,22–24]; delayed payment of providers [12,21,25]; lack of adequate drug stock [17,18,24,26–31]; mistrust between providers and patients [19,32–34]; absenteeism [10,15,20]; poorly motivated health workers [18,24]; lack of financial incentives [35]; preference for urban postings [19,36]; funding inadequacy in health facilities [16]; inadequate physical infrastructure [18,24,36]; unavailability of guidelines for use of user fee replacement fund [37] and unclear procedures for targeting beneficiaries [3]. …”

Supply-side barriers to maternal health care utilization at health sub-centers in India

“…In line with previous studies, this investigation finds that the availability of essential obstetric drugs is strongly associated with a higher volume of delivery and postnatal care services at the HSCs (Mkoka et al, 2014). However, regrettably, about 42% of sub-centers are still devoid of all the essential obstetric drugs recommended by the Indian Public Health Standards.…”

“…A recent study has concluded that increased facility deliveries in India do not contribute to a reduction in maternal deaths because these facilities often have a weak drug and medical supply system, which leads to poor obstetric care quality (Randive, 2016). The lack of drugs has also been found to cause distrust between users and health care providers; it creates a difficult working environment and decreases health workers’ morale as well (Mkoka et al, 2014). All of these factors, when combined, could result in the low utilization of health care services.…”

Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda

“…inadequate supplies of commodities and drugs such as iron and folic acid [45], syphilis test kits, and HIV test kits, despite some of the drugs being cheap and the significant attention that has been given to HIV-related care in recent years in Uganda [45–48]. These findings are similar to findings in Tanzania [49], where restricted availability of medicines and medical supplies led to poor-quality obstetric care. Here solutions lie on the ‘supply side’, requiring further investigation in the local context as to whether the issue is at facility level (e.g.…”