Availability of Essential Medicines and Supplies during the Dual Pull-Push System of Drugs Acquisition in Kaliro District, Uganda

Abstract

The Ugandan government has experimented with various supply chain models for delivery of essential drugs and supplies. In 2010, the dual pull-push system was adopted; however drug stock outs are still a common occurrence in health facilities. This study on availability of essential medicines during the dual Pull-Push system in Kaliro District was undertaken, to be used as an indirect or direct indicator of effectiveness of the dual pull-push system of drugs acquisition in the district. The study combined quantitative and qualitative methods; the study mainly based on; document review (stock cards, delivery notes,) and key informant interviews. Results showed that average stock-out duration of essential medicines and supplies was 23.89% (20.47 % for essential medicines and 27.32% for medical supplies). ACT Artemether/lumefantrine 20/120 mg tablets had the highest percentage stock-out followed by Cotrimoxazole 480mg tablets (51.6 and 32.4 %, respectively). Among the short falls of the system were; drug requisitions based on neither morbidity nor consumption methods of quantification, delays during distribution, supplying medicines with short shelf life, rare condition drugs or low usage drugs. In conclusion, the trend of essential medicines and supplies availability during the dual pull-push system seemed to be declining since its initiation in 2010. It is thus recommended that national medical stores involve stakeholders at all stages of medicines and supplies planning, especially the district health officers, who are the final consumers in the supply chain. The government can also adopt a revolving drug fund system, in the form of ‘Special Pharmacies and drug stores’ to enhance availability of essential drugs in public facilities and thus improve the quality of health care.