Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region’s primary healthcare clinics, Ghana

Abstract

Introduction Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana’s primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region’s (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. Material and methods We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic’s compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. Results Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%–82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%–95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%–57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. Discussion There is poor supply chain management of POC diagnostic tests in UER’s PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.

Geographical access to point-of-care testing for hypertensive disorders of pregnancy as an integral part of maternal healthcare in Ghana

“…This revelation supports the findings of a previous study in Ghana which aimed to assess the accessibility of pregnancy-related POC diagnostic tests [18]. Similarly, a study aimed to audit the supply chain management of POC diagnostics in PHC clinics in Ghana also reported the stock-out of POC diagnostics [17]. The spatial pattern of the distribution of the health facilities providing HDP POC testing was revealed to be random.…”

“…Despite this, previous studies in the Upper East Region (UER) of Ghana demonstrated low availability, weak supply chain management, and stock-outs of pregnancyrelated point-of-care (POC) tests including urine dipsticks for proteinuria and BP monitoring devices [16][17][18]. Previous research that evaluated geographical access to POC testing services focused on Tuberculosis [19], Glucose-6-Phosphate Dioxygenase Deficiency [20], and Blood Group and Rhesus Type [21].…”

National primary care responses to COVID-19: a rapid review of the literature

“…Further, many primary care settings lack the necessary procurement linkages to ensure an ongoing supply of PPE and resources. [48][49][50] Without significant investment and support of mass production of PPE, and complementary supply chain support to ensure distribution, these shortages pose a serious threat to our ability to protect healthcare workers while safely providing comprehensive services to persons seeking care for COVID-19. There is a pressing need to provide guidance on supply chain management and operational continuity recommendations to ensure what UK NHS guidelines refer to as 'practice resilience' in primary care.…”

Geographical Accessibility to Glucose-6-Phosphate Dioxygenase Deficiency Point-of-Care Testing for Antenatal Care in Ghana

“…This current study, therefore, mapped the geographical access to POC testing for G6PD deficiency as part of ANC services. The study setting has been adequately described in the earlier published cross-sectional survey and audit [29,30]. The 2019 project population of the region is approximately 1,273,677 (51.6% females) and is considered largely (79%) rural and scattered in dispersed settlements [33].…”

“…However, G6PD deficiency testing in Ghana is still a laboratory-based test (microscopy) and may not be accessible to all pregnant women particularly, those accessing ANC in rural primary healthcare (PHC) clinics. Although previous studies assessed the availability and supply chain management of point-of-care (POC) test including G6PD deficiency tests [29][30][31], geographical accessibility to comprehensive ANC POC testing [32], and evaluated a POC testing device for G6PD deficiency [5], to date, no study in Ghana has assessed the geographical accessibility to POC testing for G6PD deficiency. To inform national policy on G6PD deficiency screening test, support treatment decisions with anti-malarial medicines and SP administration to pregnant women in rural PHC clinics, the national malaria control or elimination program, and to improve equity to healthcare, we mapped the geographical access (distance and travel time) to POC testing for G6PD deficiency using geographical information systems.…”