A study on medicine expiry within the supply chain in Limpopo Province

Abstract

The Limpopo Province Pharmaceutical Services has been experiencing many challenges with regard to expiry of medicines. In the 2007/8 financial year, the budget for medicine and related items was exhausted by October 2007. The Pharmaceutical Services Directorate had to then motivate for more funds and at the same time had to seek approval for the disposing of lists of expired stock. This prompted the Directorate to investigate the management of expired stock within the province:

Discussions held at the various Pharmacy and Therapeutic Committees indicated that the following challenges are currently experienced within institutions in the province

. Overspending on allocated budgets by facilities, . Increased amount of expired stock at facility levels, . Information systems not being reliable, . Lack of facility formularies, . Lack of implementation of standard treatment guidelines by facilities and . Lack of accountability by managers with regard to procurement of medicines.

The aim of this study was to identify reasons for medicines expiry in order to prevent loss of expenditure through efficient and effective management of medicines within healthcare facilities.

The objectives of the study were to: . Record the value of medicines expired over the study period in the health care facilities, . Determine the reasons for medicines to expire, . Determine the financial loss due to the medicine expired, . Determine if there is a need to train health care workers on the efficient and effective management of medicines, . Identify other ways of preventing medicine expiry. A retrospective, quantitative descriptive study was conducted during the period July 2007 till June 2008. Previous records of evaluations and statistics on expired medicines of the Limpopo Province were analysed. The stock management principles were analysed to investigate the main reasons for stock expiry within the supply chain.

The budget over the study period was calculated and compared to the total value of issues to various facilities. The loss of expenditure through expired stock was therefore recorded to determine the percentage loss of expenditure.

The average percentage of expired stock per month was used and compared with the allowed average percentage of expired stock in the province which is 0.05% (Annexure C)

. The total value of expired stock within the study period was R1 009 998.79, i.e. an average of 0.07 % per month. . The reasons for expired medicine within the province were: o Poor drug selection within facilities, o Poor procurement practices, o Lack of internal control measures, o Frequent stock shortages from manufactures hence bulk stocking by managers, o Lack of training in drug supply management, o Lack or inadequate supervision and monitoring of drug management systems, o Centralised budget and lack of accountability for overspending by

managers. . The total value of overspending by facilities is at R149 962 821.53 on an annual basis. . The possible ways of preventing medicine expiry include: o Improving inventory management, o Entrenching good procurement practices within facilities, o Instilling accountability for funds on officials responsible for procurement of medicines,

o Supervision and monitoring of drug supply management. o Strengthening the enforcement and monitoring roles of the Pharmaceutical Depot Manager - Regulatory Affairs and Quality.

To conclude, expiry of medicines is a challenge within the Limpopo Province and the overall stock management principles need to be improved. The following aspect should be taken into consideration.

. Effective management will make a vital difference in all aspects of drug supply. It is especially true with respect to procurement and distribution of essential drugs. . Wise drug selection underlines all other improvements in the supply chain management. The establishment institutional formulary is perhaps the most cost effective action that any health care system or health care provider can take to promote regular supply and rational use of medicines . The strengthening of the therapeutic drug committees. Such committees must monitor progress within the province with regard to drug supply management. . The responsibility of procuring should be given to those who are trained. The responsible person should adhere to the policies and procedures from the Department of Health for procurement. . There should be a system in place that is aimed at ensuring that there is accountability of pharmacy managers at various facilities. This will bring about responsibility and better medicine supply management skills within the pharmaceutical directorate. . The province should be able to cope up with a system which can be able to capture reliable information and maintains quality information. The system should be linked to a provincial office which will be able to monitor on a continuous basis the information from different facilities. The systems would be able to provide early warning signs such as possible expiry of medicines, overstocking, and unnecessary overspending of the budget, irrational drug usage, at any facility and be able to correct discrepancies on time.