GAP FILLING COMMODITIES SUPPLY TO THE POINT OF USE AT HEALTH FACILITIES IN DAR ES SALAAM

Situation:

Comprehensive HIV/AIDS program requires a wide range of commodities for supporting prevention, care, and treatment programs. A well-functioning logistics management information system is a basic requirement in a program seeking a secure and uninterrupted supply of health commodities throughout. Such system requires three essential logistics data items i.e. consumption data, stock on hand and losses and adjustments. Health Facilities use these data to reports and requests commodities from central government stores, MSD. In case facilities experience stock outs from MSD, implementing partners within the region fill the gaps.

Previously Municipal Medical Office for Health (MMOH) and hospitals through Laboratories have been supplied with gap filling commodities from MDH program to distribute down to their respective district facilities and various sections within the facilities respectively. With this system most of health facilities were complaining of stock out of commodities. This compromised good quality patient’s care and treatment services required in timely manner including enrolment of new clients into care and treatment services, timely initiation of patients on ARV and monitoring of patients on ART. The supply chain gaps also affected retention of patients as they were not comfortable with increased clinic visits for lab monitoring processes.

In addition with this system, the quantity supplied to MMOH and hospitals didn’t tally with the logistics data collected and reported to stakeholders. Moreover there were a lot of challenges including distribution of gap filling commodities made by districts was also not reported back to program.

Intervention: In order to improve the situation, there was a great need of an effective and efficient system of supplying commodities to the users. MDH program reviewed the system of distributing gap filling commodities to abide the standardized national system introduced since October 2014. Thereafter, the program informed officially MMOH and the hospital in charges of the respective health facilities that gap filling commodities and related supplies will be delivered direct (DD) to health facilities specifically to point of consumption. This means Laboratories, specimen collection points and dispensing areas will be receiving directly Lab reagents; Lab consumables & related supplies and Pharmacy back up supplies respectively. Health facilities were informed to report and request (R & R) commodities from MDH on monthly basis in case experienced inadequate stock from MSD. Authorized orders/requests from heath facilities were then submitted to MDH for approval and supply of gap fillings. This system was effective since Feb 2015.

Moreover, program through supply chain unit designed a simple tool, monthly distribution form which is used for reporting back to program the distribution made of both commodities originating from the program and MSD. MDH in collaboration with CHMT also mentor HCW’s on how to implement the system and complete the tools developed.

In addition, M & E including internal auditing was also conducted to ensure that commodities supplied both from central government stores, MSD and the program tallies with the data captured at facility level.

Furthermore, health facilities are continuously reminded on the system through regular districts Monthly meetings, quarterly supply chain management meeting and sites visits to ensure system is working properly and hence uninterrupted supply of commodities throughout.

Results: The system is implemented and used to all 96 MDH care and treatment supported facilities in Dar es Salaam region. The new designed supply chain system ensured uninterrupted availability of commodities at facilities e.g. Lab consumables i.e. HIV test kits & HB Cuvettes etc. as compared to the period that were delivered via MMOH and hospital Labs. None of health facility reporting stock out situation of commodities since started. Few facilities were noted to have gaps in implementing the system i.e. had experienced site-specific issues such stock shortage due to none/ late reporting.

Generally the system created true demands of HIV care commodities, facilitated scale-up of ART initiations, timely monitoring of lab investigations and strength adherence to clinic.

The stock out of commodities at ART facilities decreased significantly. Quantities of commodities supplied were observed to tally with the reports /data collected from the Logistics tools and the services provided. This is evident through the internal auditing that was conducted on Monthly and quarterly basis.
     
Since health care providers are mentored on how to use the system, majority have observed to increase their knowledge and skills towards Health commodities Logistics system and be able to make their requests on time to alleviate stock outs situations.

Furthermore, facilities were reported back to program the distribution of commodities made on Monthly basis. MDH also shared with districts/DMO’s the distribution made to their respective district health facilities

Program benefits:
The system is effective and efficiency. Facilities are able to report and requests gap filling commodities in timely manner. This has not only ensured availability of commodities at health facilities, but also quality of services and treatment required is provided to patients. Scale up of ART services is also observed and routine monitoring of patients on care is done as per schedule.

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