Challenges in the management of drug supply in public health centres in the Sedibeng District, Gauteng Province

Abstract

ABSTRACT

South Africa, 80% of the population is dependent on the

vernment to

provide for their health

care

needs,

mainly

ugh primary health care facilities. In the health objectives

of the National Drug Policy, the government of South Africa

outlines

its

commitment

to

ensuring

availability

and

accessibility of medicines which are effective, affordable, safe

and of good quality in all sectors of the health care system

( N a t ion a IDe par t men t of He a It h, 1 996) .

In

o rd e r

to

assess

the

availability

of

d ru g s

and

identify

ch a II en g e s w hi c h . ex is tin the Emf u Ie n i sub - d is t r i c t wi t hi nth e

Sedibeng

district,

a

questionnaire

was

administered

to

21

primary

health

care

facility

managers/store

managers,

fo u r

Community Health Centre managers and five transport officers

in the district.

In addition, a document review process was conducted to verify

aspects

of

th e

facility

managers'

and

store

managers'

responses. Bin cards and primary health care order files were

also

examined

in

conjunction

with

a

checklist to

establish

whether stock control systems were in place.

There was a 100% response with all primary health care centres

and

community

health

care

centres

completing

th e

questionnaires. It was established that drugs at primary and

community health care clinics were procured from the Sedibeng

district pharmacy.

In

each

of

these

clin ics

there

were

specific

individuals

responsible for medicine supply management. Only four primary

health

care

clinics

had

full-time

pharmacist

assistants

employed, and 14 clinics were visited by the assistants

on a

weekly/bi-weekly basis. There were no employees that have

received training in drug supply management in the last 12

months in 88% of the clinics interviewed.

Nineteen clinics claimed that the storage area was not large

e n 0 ugh to s tor e a II the s toe k f or a m 0 nth's sup ply and 0 n I yon e

clinic had a secure delivery area for their medication.

It was established that 24 facilities received stock by two

specific procedures namely; that the number of boxes

were

checked

and the driver's note was then

signed, and

stock

received was checked against the invoice. Of the interviewed

cl i nics,

20% admitted that the re-order level had

not been

calculated for all tracer items in the store.

Standard Operating Procedures, Standard Treatment Guidelines

and the Essential Drugs List were also not available at all

facilities. The results indicate inadequacies and weaknesses in

procurement, quantification, stock control, storage and record

keeping.

It clearly demonstrates that inadequately-trained staff was a

ma j 0 reo n t rib uti n g fa c tor to d rug s h 0 r tag e s. The r e was a I a c k 0 f

monitoring

and

evaluation

by

th e

district

pharmacy

as

pharmacists did not manage to visit all the clinics each month.

Most of the inadequacies and weaknesses can be addressed at

facility

level

with

pro per

supervision,

in-service

training,

mentoring and support of staff and the reinforcement of drug

supply management training.

Regular supervisory visits together with updating the monitoring

too I

in

terms

of

th e

problems

identified

will

improve

th e

management of drugs and ultimately decrease the number of out

of stocks where problems have been identified at primary health

care level.